慢性阻塞性肺病患者鼻腔与下气道炎症状况相关性研究

Correlation study on inflammation status of nasal and lower airway at chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺病(COPD)急性加重期患者治疗前后鼻灌洗液炎症细胞、细胞因子与生活质量评分、肺功能和下气道相应指标的相关性。方法观察29例COPD急性加重期患者治疗前后的肺功能、SNOT-20、SGRQ评分以及鼻灌洗液、痰中性粒细胞、IL-8、IL-6含量差异,比较鼻灌洗液与部分炎症相应指标、FEV1、SNOT-20和SGRQ评分的相关性。结果COPD患者鼻灌洗液、痰细胞总数、中性粒细胞比例(N%)、IL-8、IL-6含量和SGRQ评分随分级的增加而增高(P<0.05),重度患者鼻部症状评分(SNOT-20)最高。治疗2周后中、重度患者FEV1%明显升高,鼻灌洗液和痰细胞总数、N%、IL-8含量显著降低;轻度患者仅痰IL-8明显降低,其它各项指标变化不明显。三组患者鼻灌洗液N%、IL-8含量皆与FEV1%呈显著负相关、与痰N%、IL-8呈正相关;中、重度组鼻灌洗液N%、IL-8与SGRQ呈显著正相关。结论COPD患者鼻腔炎症状况可一定程度反映下呼吸道炎症情况、预测病情严重度并有助于判断预后。

Objective To investigate the correlation of inflammatory cells,cytokines in nasal lavage and,score of quality of life,lung function as well as the corresponding indices in sputum in COPD patients with acute exacerbation af pre-post-treatment.Methods Twenty-nine COPD patients with acute exacerbation were selected and divided into three groups according to their lung function,the variation of lung function,SNOT-20 and SGRQ score,percentage of leukocytes（N%）and levels of interleukin IL-8,IL-6 in nasal lavage and sputum at pre-post-treatment were examined,the relationships between inflammatory indices in nasal lavage and FEV1,SNOT-20 and SGRQ score as well as the corresponding markers in sputum were analyzed.Results The cells count,N%,IL-8 and IL-6 concentrations in nasal lavage and sputum at exacerbation of COPD were higher following higher stages of COPD（P〈0.05）.Though there were no significant deviation between the three groups,nasal score（SNOT-20）was highest at severe patients.There was significant improvement in FEV1% and notable reduce of cells count,N%,IL-8 concentrations in nasal lavage and sputum at moderate/severe patients following treatment over two weeks,while no significant changes were observed in IL-6.At mild patients,only sputum IL-8 levels dropped obviously,while other indices not notably.The increased N% and IL-8 in nasal lavage showed closely correlation with the corresponding markers in sputum,and an inversely correlation with FEV1%,whereas no marked correlation with SNOT-2 and sputum IL-6 between three groups;positively correlations between N% and IL-8 in nasal lavage and SGRQ score were observed at moderate/severe patients.However,nasal lavage IL-6 concentrations showed no significant correlations with almost all above-mentioned markers.Conclusion The inflammatory status in nasal cavity of COPD patients can reflect the inflammatory condition in lower respiratory tract to some degree,assess the severity of illness and be useful to predict prognosis.