气温下降后慢性阻塞性肺疾病患者机体免疫情况的变化

Immune change in patients with chronic obstructive pulmonary disease when atmospheric temperature is decreased

目的探讨低气温时慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者机体免疫变化的情况,以及气温下降前给予免疫增强剂后对患者免疫情况的影响。方法将入选的100例COPD患者,按随机数字表法分成2组:基础组70例,免疫增强组30例。2组患者分别在基础点和低气温点检测血IgG、IgA、IgM,血及诱导痰CD3+、CD4+、CD8+、CD4+/CD8+。并记录随访期间呼吸道感染情况。结果①低气温点,基础组IgG、IgA下降,血及诱导痰CD3+、CD8+升高,CD4+、CD4+/CD8+下降(P<0.05);免疫增强组诱导痰CD3+、CD8+升高,CD4+、CD4+/CD8+下降(P<0.05),而血免疫值无明显变化(P>0.05)。②2组患者诱导痰CD4+/CD8+与呼吸道感染情况均存在相关性(呈负相关),且低气温时两者相关性更好(基础组月均发病次数、月均发病天数分别为-0.661、-0.612,免疫增强组分别为-0.901、-0.936)。③气温变化前后,免疫增强组诱导痰免疫变化值与基础组相比差异无统计学意义(P>0.05),而呼吸道感染减少情况与基础组比较有明显差异(P<0.05)。结论气温下降后患者免疫力下降,而诱导痰对气道局部免疫的评估较好。免疫增强剂可提高机体的免疫力,但对气道局部免疫影响不大。

Objective To study the immune change at low atmospheric temperature in patients with chronic obstructive pulmonary disease （COPD） and the effect of immunopotentiators given before the temperature is decreased on the immune of COPD patients. Methods One hundred COPD patients recruited in this study were randomly divided into baseline group （n=70） and immunopotentiator-treatment group （n=30）. IgG,IgA,IgM in blood and CD3＋,CD4＋,CD8＋,CD4＋,/D8＋ in sputum from the two groups were detected respectively at baseline and low temperature. Respiratory infection was recorded during follow-up. Results The level of IgG and IgA was decreased,the number of CD3＋ and CD8＋ was increased while the number of CD4＋ and CD4＋/CD8＋ was decreased in baseline group at low temperature. （P0.05）. The number of CD4＋/CD8＋ in sputum was negatively related with respiratory infection at normal temperature,but better related with respiratory infection at low temperature,（-0.661 and-0.612 in baseline group,and-0.901 and-0.936 in immunopotentiator-treatment group）. No difference was found in immune between baseline group and immunopotentiator-treatment group before and after the atmospheric temperature was changed. However,the respiratory infection rate was significantly lower in immunopotentiator-treatment group than in baseline group（P0.05）. Conclusion The immunity of COPD patients decreases with the decreasing atmospheric temperature. Local immune of the airway should be assessed by inducing CD3＋,CD4＋,CD8＋,CD4＋/D8＋ in sputum. Immunopotentiators can increase the body＇s immunity but have little effect on local immune of airway.