肺炎支原体感染对老年慢性阻塞性肺疾病急性发作及肺炎患者免疫功能的影响

Role of mycoplasma pneumoniae infection in exacerbated stage of COPD and on celluler immune system of community acquired pneumonia patients

目的 探讨肺炎支原体感染 (MP)对老年慢性阻塞性肺疾病 (COPD)急性发作及社区获得性肺炎 (肺炎 )患者细胞免疫功能的影响。 方法 39例老年COPD急性发作、4 0例老年肺炎患者及 30例老年健康对照者用ELISA法测定其血清MP特异性IgM、IgG抗体及干扰素 γ(IFN γ)、白细胞介素 6 (IL 6 )、肿瘤坏死因子 α(TNF α)含量 ;通过聚合酶链式反应 (PCR)法检测痰液中的MP。 结果 (1)COPD组MPPCR法及MP IgM阳性率明显高于肺炎组及对照组 (P <0 0 5 ) ;(2 )COPD组IFN γ含量明显低于肺炎组 (P <0 0 1) ,而TNF α含量则反之 ;(3)COPD、肺炎组MP IgM阳性者IFN γ含量明显低于组内MP IgM阴性者 (P <0 0 5 )。 结论 (1)老年人中COPD急性发作MP感染阳性率显著高于肺炎患者 ;(2 )老年COPD急性发作患者IFN γ水平明显低于老年肺炎患者 ,而TNF α、IL 6水平则显著升高 ;(3)MP感染可能抑制了老年人COPD急性发作及肺炎患者IFN γ的产生。

Objective To explore the relationship of pulmonary mycoplasma pneumoniae(MP) infection with acute exacerbated stages of chronic obstructive pulmonary disease(COPD) and community acquired pneumonia(CAP)in the elderly,comparing different serum concentrations of IFN -γ ,IL-6,TNF-α in these patients. Methods Serologic analysis through ELISA method was used to detect MP-IgM and MP-IgG to determine the presence of MP and the serum concentrations of IFN-γ、IL-6、TNF-α in 30 elderly healthy subjects,39 elderly patients with acute exacerbated stage of COPD and 40 elderly patients with CAP. PCR method was also used to determine the presence of MP from the patients ,sputum. Results (1)The positive rates of MP were much higher in the COPD patients than in the CAP and healthy ones according to PCR or MP-IgM method( P <0.05).(2)The IFN-γ concentrations of CAP patients increased much higher than those of COPD ones( P <0.01) while the TNF-α concentrations were on the contrary.(3)The serum IFN-γ levels of the COPD and CAP patients with MP infection were much lower than those without MP infection ( P <0.05). Conclusions (1)MP is present in the elderly patients of acute exacerbated stage of COPD with greater frequency than the elderly CAP ones.(2)There exist cellular immune function disorder with the decreasing of cytokine IFN-γ and increasing of inflammatory cytokines TNF-α,IL-6 in the elderly patients of COPD.(3)MP infection may inhibit the production of IFN-γ in the acute exacerbated stage of the elderly COPD and CAP patients.