老年COPD患者全身炎症反应综合征与Th17/Treg失衡及TGF-β水平变化的关系  

Relationship of systemic inflammatory response syndrome and Th17/Treg imbalance and transforming growth factor-βlevel in elderly patients with chronic obstructive pulmonary disease

作　　者：曾娟 罗世林[1] 蔡懿[1] 黎必亮 王明枫 陈志勇[1] 向绍山 胡小英 李博 张立 Zeng Juan;Luo Shilin;Cai Yi;Li Biliang;Wang Mingfeng;Chen Zhiyong;Xiang Shaoshan;Hu Xiaoying;Li Bo;Zhang Li(Department of Respiratory and Critical Care Medicine,Bazhong Central Hospital,Bazhong 636000,China)

机构地区：[1]巴中市中心医院呼吸与危重症医学科,巴中636000

出　　处：《国际呼吸杂志》2023年第4期419-424,共6页International Journal of Respiration

基　　金：四川省医学科研课题计划(S20041)。

摘　　要：目的探讨老年慢性阻塞性肺疾病(COPD)患者全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)与外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)失衡及转化生长因子β(TGF-β)水平变化的关系。方法采用单纯随机抽样,回顾性分析2019年3月至2021年3月在巴中市中心医院诊治的100例老年COPD患者的临床资料,按是否发生SIRS分为单纯COPD组(53例)和合并SIRS组(47例),选取同期50名体检者作为对照组。将患者基本资料进行对比,检测并比较各组Th17、Treg、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、TGF-β水平,分析患者Th17、Treg、TGF-β与炎症反应的关系,经多因素logistic回归分析SIRS发生的危险因素。结果合并SIRS组患者PaCO_(2)>40 mmHg(1 mmHg=0.133 kPa)占比[65.96%(31/47)]、PaO_(2)≤70 mmHg占比[74.47%(35/47)]、CAT评分>20分占比[70.21%(33/47)]均高于单纯COPD组[33.96%(18/53)、49.06%(26/53)、39.62%(21/53),均P<0.05]。3组Th17比例、Th17/Treg、CRP、IL-6、TNF-α、TGF-β水平相比,治疗前合并SIRS组>治疗前单纯COPD组>对照组(均P<0.05);3组Treg比例相比,治疗前合并SIRS组<治疗前单纯COPD组<对照组(均P<0.05)。治疗后合并SIRS组Th17比例、Th17/Treg、CRP、IL-6、TNF-α、TGF-β水平均高于单纯COPD组,Treg比例低于单纯COPD组(均P<0.05)。Pearson相关性分析结果显示,外周血Th17比例、Th17/Treg、TGF-β水平与CRP、IL-6、TNF-α呈正相关,外周血Treg比例与CRP、IL-6、TNF-α呈负相关(均P<0.05)。经logistic回归分析,发现PaCO_(2)>40 mmHg、PaO_(2)≤70 mmHg、CAT评分>20分、Th17/Treg、Th17比例、Treg比例、TGF-β均是导致老年COPD患者发生SIRS的危险因素(均P<0.05)。结论老年COPD患者存在Th17/Treg细胞失衡及TGF-β水平升高,且Th17/Treg细胞失衡及TGF-β水平升高与其疾病活动度及炎症程度之间存在密切相关性。Objective To investigate the relationship between systemic inflammatory response syndrome(SIRS)and peripheral blood helper T cell 17(Th17),regulatory T cells(Treg),and transforming growth factor-β(TGF-β)in elderly patients with chronic obstructive pulmonary disease(COPD).Methods Simple random sampling was adopted.Retrospective analysis was made on the clinical data of 100 elderly patients with COPD diagnosed and treated in Bazhong Central Hospital from March 2019 to March 2021.They were divided into simple COPD group(53 cases)and SIRS combined group(47 cases)according to whether SIRS occurred.At the same time,50 individuals for physical examination were selected as the control group to compare the basic data of the subjects,to detect and compare Th17,Treg,C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and TGF-βlevels,and to analyze the relationship between SIRS and Th17,Treg,TGF-β.Logistic regression was adopted to evaluate the risk factors of SIRS.Results The proportion of PaCO_(2)>40 mmHg(1 mmHg=0.133 kPa),PaO_(2)≤70 mmHg,and CAT score>20 in SIRS group were 65.96%(31/47),74.47%(35/47),and and 70.21%(33/47),respectively,which were significantly higher than those in COPD group(33.96%[18/53],49.06%[26/53],39.62%[21/53],all P<0.05).Before treatment,Th17,Th17/Treg,CRP,IL-6,TNF-α,and TGF-βin SIRS group>simple COPD group>control group(all P<0.05).Before treatment,Treg level in SIRS group<simple COPD group<control group(all P<0.05).After treatment,Th17,Th17/Treg,CRP,IL-6,TNF-α,and TGF-βin SIRS group was higher than those in COPD group,while Treg was lower than that of COPD group(both P<0.05).Pearson correlation analysis showed that the peripheral blood Th17,Th17/Treg,and TGF-βwere positively correlated with CRP,IL-6,and TNF-α(P<0.05),and peripheral blood Treg was negatively correlated with CRP,IL-6,and TNF-α(P<0.05).Logistic regression analysis showed that PaCO_(2)>40 mmHg,PaO_(2)≤70 mmHg,CAT score>20,Th17/Treg,Th17,Treg,and TGF-βwere all risk factors for SIRS in elderly pa

关 键 词：肺疾病 慢性阻塞性 辅助性T细胞17 调节性T细胞 转化生长因子Β 老年 全身炎症反应综合征 

分 类 号：R563.9[医药卫生—呼吸系统]