慢性阻塞性肺疾病患者合并感染时辅助性和调节性T细胞的变化

Changes of helper and regulatory T lymphocytes .in chronic obstructive pulmonary disease patients com- bined with pulmonary infections

目的探索慢性阻塞性肺疾病（COPD）患者合并肺部感染时辅助性T细胞17（Th17）／调节性T细胞（Treg）的变化规律。方法选择40例COPD合并肺部感染患者作为观察组，按年龄、性别和病程匹配选取35例COPD稳定期患者为稳定期组，同期40名健康体检者为对照组。流式细胞仪检测并对比3组外周血Th17及Keg水平，同时对比COPD合并感染者治疗前后外周血及支气管肺泡灌洗液中Th17/Treg水平的变化。结果COPD合并肺部感染患者外周血Thl7细胞占（2．660±1．336）％，明显高于对照组和稳定期COPD患者（t=3．292、3．008，P均〈0．01）；Treg细胞占（3．509±1．727）％，明显低于对照组（t=4．895，P〈0．01）和稳定期COPD患者（t=2．044，P〈0．05）。COPD合并肺部感染患者支气管肺泡灌洗液中Th17细胞水平为（7．138±2．133）％，高于外周血（t=9．950，P〈0．01），但Keg细胞水平两者差异无统计学意义（t=0．344，P〉0．05）。与急性期相比，患者进入稳定期后，外周血Th17细胞水平为（1．404±0．831）％，低于急性期（t=4．788，P〈0．01），Treg细胞水平为（5．347±1．726）％，高于急性期（t=9．365，P〈0．01）。结论COPD合并肺部感染患者出现明显的Th17/Treg失衡，表现为Th17细胞上调，Treg细胞下调，是COPD合并肺部感染的重要免疫学特征。

Objective To investigate the changing ofT helper cells（Thl7）/regulatory T lymphocytes（Treg） in chronic obstructive pulmonary disease （COPD） patients combined with pulmonary infections. Methods A total of 40 COPD patients with pulmonary infections were selected as observers （observation group）, 35 stable COPD patients matched by age, gender and course of disease （stationary phase group）and 40 healthy people （control group） were enrolled in this study. Thl7 ceils and Treg in the peripheral blood were detected by flow cytometry to compare the changes of Th17/Treg in the peripheral blood and bronchoalveolar lavage fluid （BALF）among 3 groups before and after therapy. Results The average percentage of Thl7 cells in CD4＋ T cells of observation group was （2.660±1.336）%, much higher than that of control group （t=3.292, P〈0.01 ） and stationary phase group （t=3.008, P〈0.01）; Treg cells took up a percentage of （3.509± 1.727）% in observation group, much lower than that of healthy controls （t= 4.895, P〈0.01） and stationary phase group （t=2.044, P〈0.05）. The percentage of Thl7 ceils in BALF （7.138± 2.133）% were much higher than peripheral blood in COPD patients with pulmonary infections （t=9.950, P〈0.01 ）, but the difference in Treg ceils between patients and healthy controls didn＇t show any statistical significance （t=0.344, P〉0.05）. Compared with acute period, the peripheral Th17 cells of the COPD patients in stable phase after therapy were （1.404±0.831）%, which was lower （t=4.788, P〈0.01 ）; and the Treg cells were （5.347±1.726） %, which was higher （t=9.365, P〈0.01 ）. Conclusions The Thl7/Treg imbalance with a manifestation of up-regulated Th17 cells and down-regulated Treg cells. It is a vital immunologic characteristic of COPD combined pulmonary infections.