肺心病急性加重期神经内分泌免疫调节的研究

Study on the Regulations of Neuroendocrine-Immune in Patients with the Exacerbation of Chronic Pulmonary Heart Diseases

目的 :系统研究慢性肺心病 (CPHD)神经内分泌免疫 (NEI)的功能状态及动态变化 ,并探讨其临床意义。方法 :采用放射免疫分析法检测 31例 CPHD病人及 10例慢性阻塞性肺疾病病人血浆中 β-内啡肽 (β- EP)、促肾上腺皮质激素 (ACTH)及糖皮质激素 (GC)水平 ;采用氮唑蓝染色 (MTT)法测定自然杀伤 (NK)细胞活性 ;单克隆抗体法测定 T淋巴细胞亚群 (CD+ 4细胞、CD+ 8细胞 ) ;双抗体 EL ISA夹心法测定白细胞介素 2 (IL- 2 )。结果 :CPHD急性加重期 β- EP、ACTH、GC均显著升高 (P<0 .0 1) ;CD+ 4细胞减少(P<0 .0 5 ) ,CD8+ 细胞增加 (P<0 .0 5 ) ,IL - 2水平下降 (P<0 .0 1) ,NK细胞活性下降 (P<0 .0 5 )。β- EP拮抗剂纳络酮可逆转细胞免疫抑制现象 (P<0 .0 5 )。结论 :CPHD急性加重期存在 NEI调节异常及细胞免疫功能低下 ,其中 β- EP有重要作用。β- EP拮抗剂纳络酮和免疫因子对 CPHD急性加重期治疗有重要临床价值。

Objective:To estimate systemically the function and t he dynamic changes of neuroendocrine-immune (NEI) in patients with the exacerb ation of Chronic pulmonary heart diseases (CPHD), and evaluate its clinical sign ificance. Methods:The plasma levels of β-EP (β-endorphin), ACTH and GC we re measured with RIA method; NK cell activity, T cell activity (CD + 4 cell a nd CD + 8 cell) and the plasma level of IL-2 with methods of MTT, McAb and E LISA respectively in thirty-one cases of CPHD and ten cases of COPD (as the con trol). Results:The plasma β-EP, ACTH and GC were significantly elevated i n CPHD patients with exacerbation (P<0.01); the ratios of CD + 4 cell de scend (P<0.05), CD + 8 cell augmented (P<0.05); IL-2 level (P <0.01) and NK cell activity (P<0.05) reduced in CPHD patients with eacerba tion. These suppressed immunity conditions could be reversed by β-EP antagonis t Naloxone. Conclusion:There were abnormality in NEI regulation and suppression o f cell-mediated immunity in CPHD patients with exacerbation. β-EP may therein play an important role. We suggest that β-EP antagonist Naloxone and immune- activators are of great values for the treatment of CPHD patients with exacerbat ion.