老年慢性阻塞性肺疾病急性期患者自然免疫缺陷与免疫干预研究

Innate Immune Deficiency in the Elderly with Chronic Obstructive Pulmonary Disease at Acute Exacerbations and Medication Intervention to It

目的探讨老年慢性阻塞性肺疾病(COPD)患者急性期自然免疫功能的缺陷,并研究免疫干预治疗的作用。方法采用随机的方法将70例老年COPD住院患者分成干预组35例、对照组35例,另设老年健康对照组20例。患者入院后行常规检查治疗,老年干预组加用口服的非特异免疫调节药匹多的莫德(pidotimod),观察30d,前15d,口服匹多的莫德,2次/d,2片/次(400mg/片),后15d维持量,1次/d,2片/次,分别于第1天、第30天用流式细胞仪检测患者外周血CD14、CD158b、HLA-DR的改变,同时观察第10天时临床症状的改善情况。结果干预组、对照组、健康对照组最终纳入分析患者分别为30、28、20例。干预组、对照组外周血CD14、CD158b、HLA-DR参数均较健康对照组低,差异均有统计学意义(P<0.05)。在常规治疗一致的前提下,加用匹多的莫德的干预组上述免疫参数在治疗30d时均明显升高,差异有统计学意义(P<0.05)。第10天老年干预组的临床症状如咳嗽、咳痰、肺部湿啰音的改善均较对照组明显,差异有统计学意义(P<0.05)。结论老年COPD在急性期发作期间自然免疫功能低下。加用非特异性免疫调节剂匹多的莫德(Pidotimod)片后,可改善自身的免疫功能,同时加快了临床症状的恢复。

Objective To investigate innate immune deficiency in elderly patients with chronic obstructive pulmonary disease during acute exacerbations（AECOPD）and effects of the immunostimuulating agent Pidotimod in AECOPD patients.Methods A total of 70 elderly patients with AECOPD were randomized recruited as trial group（n=35）and control group（n=35）,with a additional health control group of 20 elderly people.After admission the patients were given routine treatment,but the patients in the trial group were orally given nonspecific immunoregulatory agent Pidotimod for 30 days,for the first 15 days,800 mg（two tables）,twice a day;and for the second 15 days 800 mg as maintenance dose,once a day.The levels of CD14,CD158b and HLA-DR in peripheral blood were measured by flow cytometry at the 1st,15th and 30th day.Meanwhile,the clinical conditions at the 10th day were evaluated.Results The final subjects in the study were 30 in the trial group,28 in the control group and 20 in the health group.The levels of CD14,CD158b and HLA-DR of the patients in the trial and control groups were lower than those in the health group（P0.05）.Before treatment,The eldely COPD intervention group showed lower levels of CD14,CD158b,HLA-DR,as compared with the 30 d of pidotimod treatment（P0.05）.At the 10th day the clinical symptoms such as cough,amount of expectoration,pulmonary wet rales were obviously improved,with a significant difference as compared with in the control group（P0.05）.Conclusion Innate immune responses are suppressed in elderly patients with AECOPD.The medication of nonspecific immune regulatory agent Pidotimod can improve the self immunity,and promote the appearance of clinical symptoms.