老年慢性阻塞性肺疾病患者急性加重期T细胞免疫状况与免疫干预

Immunological functions of T-lymphocyte in the elderly with chronic obstructive pulmonary disease during acute exacerbations and medication intervention

目的探讨老年慢性阻塞性肺疾病(COPD)患者急性加重期T细胞免疫功能的改变及其影响因素,并观察免疫干预治疗的作用。方法采用随机的方法将75例老年COPD住院患者分为老年COPD干预组37例、老年COPD对照组38例,另设非老年COPD对照组28例,老年健康对照组20例。患者入院后行常规检查治疗,老年COPD干预组口服非特异免疫促进药匹多莫德,分别于第1天、第15天、第30天,用流式细胞仪检测患者外周血CD3+、CD4+、CD8+、CD4+／CD8+的改变,同时观察临床症状的改善情况对患者进行评估。结果老年COPD干预组、老年COPD对照组、非老年COPD对照组最终纳入分析患者分别为32、34、25例。老年COPD干预组和老年COPD对照组入院当天一般临床情况相似,两组的T细胞亚群与老年健康对照组及非老年COPD对照组比较,CD4+下降、CD8+上升、CD4+／CD8+倒置,差异均有统计学意义(分别为P<0．05、P<0．01)。老年COPD干预组治疗前CD3+、CD4+、CD8+、CD4+／CD8+值分别为(63．77±11．09、26．23±5．73、35．42±7．82、0．78±0．28),第30天分别为(67．83±10．04、36．80±9．82、27．28±10．00、1．36±0．46),差异有统计学意义(均为P<0．01)。老年COPD干预组住院时间(18．0±6．4)d,费用(10 266±6574)元,与老年COPD对照组比较,差异有统计学意义(均为P<0．05)。结论老年COPD患者在急性加重期细胞免疫功能下降。应用非特异性免疫促进剂匹多莫德,可改善其细胞免疫功能,同时减少了住院天数及费用。

Objective To investigate the adaptive immune responses in elderly patients with chronic obstructive pulmonary disease during acute exacerbations （ECOPD） and effects of the immunostimulating agent Pidotimod in ECOPD patients. Methods A randomized, prospective clinical trial was held, and 103 patients with ECOPD were recruited into the study. Seventy-five patients aged 65 years and over were divided into two groups： 38 patients with general treatment as a control group and 37 patients with general treatment plus pidotimod as an experimental group. Another non-elderly groups comprised 28 patients younger than 65,and 20 healthy individuals served as the healthy elderly control. Levels of CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋ in peripheral blood were measured by flow cytometry at baseline （the 1st day） and at the 15th and 30th treatment day, meanwhile,the clinical conditions were evaluated. Results Ninety-one patients completed the trial （32 in experimental group,34 in control group and 25 in non-eldely group）. The experimental group and control group were statistically homogeneous. The aged COPD intervention group and aged COPD control had a more decreased CD4^＋ level, CD4^＋/CD8^＋ ratio and more increased CD8^＋ level, while compared with aged health control and non-elderly COPD control （all P〈0. 05）. Before treatment, the elderly COPD intervention group showed lower levels of CD3^＋ （63.77 ± 11.09 vs 67.83±10. 04）, CD4^＋ （26. 23±5.73 vs 36. 80±9.82） and CD4/CD8^＋ ratio（0. 78±0.28 vs 1.36±0.46）, and higher level of CD8^＋ （35.42±7.82 vs 27.28±10.00） ,as compared with the 30 d of pidotimod treatment（all P〈0. 05）. Conclusions T-cell immune responses are suppressed in elderly patients with ECOPD. Pidotimod treatment can improve the cell immune response.