吸烟对稳定期COPD患者外周血Th17/Treg免疫平衡影响研究

Investigation of effect of smoking on Th17/Treg in peripheral blood of stable COPD patients

目的：观察稳定期COPD患者和健康人吸烟和非吸烟者外周血中的T辅助细胞（ Th细胞）17和调节性 T 细胞（ Treg 细胞）比例差异,分析吸烟对稳定期 COPD 患者 Th17/Treg的影响,探讨吸烟引发COPD发生发展的可能免疫机制。方法①选取2012年12~2013年4月我院就诊的稳定期COPD 患者73例,分别设为不吸烟组46例、吸烟组27例,同时选取同期进行社区流行病学调查及医院体检中心的健康人26例设为对照组,不吸烟组16例和吸烟组10例。所有受试者均填写统一的调查问卷,明确个人史,现病史、用药史,完善肺功能检查；②各组受试者空腹6 h后清晨抽取静脉血2 ml,应用细胞内染色的流式细胞术检测各组受试者外周血中 Th17/Treg 细胞比例；③多组间比较采用单因素方差分析,多组内两两比较采用SNK 检验（方差齐）和 Games-Howell 法（方差不齐）, Th17/Treg 细胞的比例与吸烟指数及肺功能关系用Spearman相关分析进行相关性检验。结果① COPD组吸烟者和非吸烟者与对照组吸烟与非吸烟者外周血Th17/Treg细胞比例分别为（3．23±0．86）%、（2．97±0．98）%和（2．07±0．40）%、（1．96±0．30）%,多组间比较差异呈显著性（P〈0．01）；② COPD患者吸烟组和非吸烟组第1秒用力呼气容积实测值与预计值比（FEV1% prep）分别为（55．66±20．61）%、（64．04±13．80）%,第1秒用力呼气容积/用力肺活量比（FEV1/FVC）分别为（55．23±10．52）%、（62．62±5．49）%,两组间差异存在统计学意义（P〈0．05）；③外周血Th17/Treg细胞比例与FEV1% prep和FEV1/ FVC存在显著相关性（r=-0．517、-0．512,P值分别为0．00,0．00）。结论吸烟与COPD患者Th17/Treg细胞比例失衡相关； Th17/Treg细胞比例失衡可能参与了发病和进展过程；吸烟可能通过引起Th17/Treg细胞比例失衡导致COPD的发生发展。

Objective To observe and compare the changes in proportion of T help cells 17 （Th17） to regu-latory T cells （ Treg cells） in peripheral blood among stable COPD patients, smokers and non-smokers. Methods 73 COPD patients at stable stage were divided into the group A （ non-smoker） and the group B （ smoker） by their smoking history. Another 26 healthy volunteers from epidemiology study and medical examination center were taken as the control group, which included 16 smokers and 10 non-smokers. All the participants filled out the unified ques-tionnaire, recording about their general condition, smoking history, past medical history and pulmonary function. Ev-ery group＇s blood sample was collected in the morning 6 hours after empty stomach. The proportion of Th17/Treg in peripheral blood was measured by flow cytometry method. Results The proportions were （3. 23 ± 0. 86）, （2. 97 ± 0. 98）, （2. 07 ± 0. 40）, （1. 96 ± 0. 30） respectively in the groups A and B and the control group （P〈0. 05）. The FEV1% prep and FEV1/FVC% in the group A and the group B were （55. 66 ± 20. 61）%, （64. 04 ± 13. 80）% and （55. 23 ± 10. 52）%, （62. 62 ± 5. 49）%. The proportion of Th17/Treg in peripheral blood and FEV1% prep and FEV1/FVC% was correlated （r= -0. 517, -0. 512 and P=0. 00）. Conclusion Immune disorders may exist in COPD patients and smokers, and the proportion of Th17/Treg may be involved in the onset and process of the patho-genesis of COPD.