慢性阻塞性肺疾病患者肺泡巨噬细胞分泌的细胞因子的临床意义

The study of the roles of cytokines in patients with chronic obstructive pulmonary disease

目的观察慢性阻塞性肺疾病(COPD)患者肺泡巨噬细胞分泌的细胞因子的临床意义。方法稳定期COPD患者15例,另有11名健康者作为对照,进行肺功能检查,并经支气管肺泡灌洗获取肺泡巨噬细胞进行培养,测定大肠杆菌内毒素(LPS)刺激前、后上清液中白细胞介素-18(IL-18)I、L-23的浓度;采用直线相关分析IL-18I、L-23与肺功能关系。结果①COPD组患者肺泡巨噬细胞基础值IL-18均较对照组降低(P<0.05);LPS刺激后,COPD组和对照组IL-18均较刺激前升高(P<0.05),但两组之间差异无统计学意义(P>0.05);②COPD组患者肺泡巨噬细胞IL-23基础值均较对照组升高(P<0.05);LPS刺激以后,COPD组和对照组患者IL-23均较刺激前升高(P<0.05),而且两组之间比较差异有统计学意义(P<0.05);③COPD组1 s用力呼气容积/用力肺活量百分比(FEV1/FVC)、FEV1与肺泡巨噬细胞释放IL-23呈负相关(P<0.05)。结论IL-18、IL-23参与了COPD气道炎症反应,而且肺泡巨噬细胞释放的IL-23与FEV1/FVC、FEV1呈负相关,可能是导致气道阻塞的原因之一。

Objective To study the correlation between the inflammatory mediators released by alveolar macrophages and the pulmonary ventilatory capacity in patients with chronic obstructive pulmonary disease （COPD）. Methods Alveolar macrophages were collected by fiberoptic bronchoscopy from 15 patients with COPD with a forced expiratory volume in one second（FEV1）≤70%, and 11 healthy people as control group. All patients were in the stable stage. The macrophages were cultured and stimulated with lipopolysaccharide（LPS, 10μg/ml）. IL-18 and IL-23 in the supernatants were measured by ELISA. Pulmonary functions were tested in both two groups. The correlation between lung functions and cytokines was tested with linear relevant analysis. Results （1） The concentrations of IL-18 released from macrophages in the COPD group were lower than those from control group（P〈0. 05） ; The concentrations of IL-18 in the COPD group and in the control group after LPS stimulation were higher than those before LPS stimulation（ P〈0. 05）;but not different from those in patients of two groups after LPS stimulation（P〉0. 05）.（2）The concentrations of IL-23 released from macrophages in the COPD group were higher than those in the control group. After LPS stimulation, the concentrations of IL-23 in the COPD group and in the control group were higher than those before LPS stimulation（P〈0. 05）. IL-23 released from macro- phages in the COPD group were higher than those in the control group. （3）FEV1 / FVC and FEV1 % were nega- tively correlated with the concentrations of IL-23（P%0. 05）. Conclusion IL-18 and IL-23 released by alveolar macrophages are also involved in the airway inflammation in COPD. IL-23 released by alveolar maerophages may play an important role in the process of chronic airflow obstruction.