激素对慢性阻塞性肺疾病患者IL-8和LTB_4及肺功能的影响

The IL-8,LTB_4 levels and the pulmonary function of patients with chronic obstructive pulmonary disease around hormone treatment

目的:观察在治疗慢性阻塞性肺疾病急性加重期(AECOPD)时全身应用糖皮质激素对痰上清液和血清中白介素8(IL-8)和白三烯B4(LTB4)及肺功能的影响。方法:将33例AECOPD患者随机分为治疗组17例,对照组16例。两组均给予常规治疗,同时治疗组给予静脉和口服甲泼尼龙或泼尼松,观察比较两组治疗前后痰上清液和血清中IL-8和LTB4水平、肺功能及呼吸困难(VAS)改善情况。结果:治疗前,痰上清液和血清中IL-8、LTB4水平均高于治疗后,二者间有直线相关关系;且与第1秒钟用力呼气容积(FEV1)、第1秒钟用力呼气容积占预计值百分比(FEV1%)、第1秒钟用力呼气容积与用力肺活量的比值(FEV1/FVC)间有负相关(P<0.05)。治疗后,痰上清液IL-8、LTB4的变化与痰中性粒细胞百分比(Neu%)、VAS的变化有显著相关性(P<0.05)。与对照组相比,治疗组呼吸困难症状缓解快,痰中性粒细胞减少、痰上清液和血清中IL-8、LTB4的下降水平、FEV1、FEV1%和FEV1/FVC改善幅度均较大。结论:AECOPD患者IL-8和LTB4水平增高,这些变化与临床症状和肺功能相关。使用激素可减轻炎症反应、改善肺功能和缓解患者临床症状。

Aim：To observe the levels of IL-8,LTB4 in the sputum and serum and the pulmonary function in patients with acute exacerbations of chronic obstructive pulmonary disease around systemic glucocorticoid treatmen. Methods： A total of 33 cases of AECOPD were randomly divided into two groups,the treatment group（17 cases）,and the controlled（16 cases）.The two groups took the conventional treatment.At the same time,the treatment group received additionlly the intravenous and oral methylprednisolone or predisone.The changes of the levels of IL-8,LTB4 in the sputum and serum,the pulmonary function and VAS were observed after the treatment,which were compared.Results： Before hormone the treatment,the levels of IL-8,LTB4 in serum and sputum were significantly higher than after treatment,which had a significantly linear correlation and had inverse correlations with the FEV1,FEV1% and FEV1/FVC（P〈0.05）.There was a significant correlation with the changes of IL-8、LTB4 in sputum and the changes of Neu%.Compared with the controlled,the treatment improved dyspnea.Moreover,the levels of IL-8、LTB4 in serum and sputum,Neu% decreased significally,while the FEV1% and FEV1/FVC showe an remakable improvement.Conclusion：In those AECOPD patients,the levels of IL-8,LTB4 showed the significant alterations.All these changes have the correlation with the pulmonary function and the presences of clinical symptoms.It is suggested that the early corticosteroid treatment can relieve the inflammation of airway,improve the pulmonary function and alleviate the discomfort of the patients.