不同慢性阻塞性肺疾病全球倡议分级慢性阻塞性肺疾病稳定期患者外周血辅助性T细胞17、调节性T细胞含量的对比分析

Contrastive Analysis on Peripheral Blood Th17 and Treg Contents in Stable COPD Patients with Different GOLD Grades

目的 对比不同慢性阻塞性肺疾病全球倡议(GOLD)分级慢性阻塞性肺疾病(COPD)稳定期患者外周血辅助性T细胞17(Th17)、调节性T细胞(Treg)含量,以期为临床有效治疗COPD稳定期患者提供新的靶点。方法 选取2017年6—12月于新疆医科大学附属中医医院接受门诊随访的COPD稳定期患者96例,参照2013版GOLD分级标准分为B级组40例、C级组23例、D级组33例;另选取同期体检且年龄匹配的健康者30例作为对照组。比较4组受试者一般资料(包括性别、年龄、身高、体质量),外周血白介素17a(IL-17a)、白介素10(IL-10)水平,外周血Th17、Treg含量及Th17/Treg比值。结果 (1)4组受试者性别、年龄、身高比较,差异无统计学意义(P>0.05);B级组、C级组、D级组患者体质量小于对照组,C级组、D级组患者体质量小于B级组,D级组患者体质量小于C级组(P<0.05)。(2)B级组、C级组、D级组患者外周血IL-17a水平高于对照组,C级组、D级组患者外周血IL-17a水平高于B级组,D级组患者外周血IL-17a水平高于C级组(P<0.05);B级组、C级组、D级组患者外周血IL-10水平低于对照组,C级组、D级组患者外周血IL-10水平低于B级组,D级组患者外周血IL-10水平低于C级组(P<0.05)。(3)B级组、C级组、D级组患者外周血Th17含量及Th17/Treg比值高于对照组,C级组、D级组患者外周血Th17含量及Th17/Treg比值高于B级组,D级组患者外周血Th17含量及Th17/Treg比值高于C级组(P<0.05);B级组、C级组、D级组患者外周血Treg含量低于对照组,C级组、D级组患者外周血Treg含量低于B级组,D级组患者外周血Treg含量低于C级组(P<0.05)。结论 随着GOLD分级增加,COPD稳定期患者外周血Th17含量逐渐升高、Treg含量逐渐降低,炎性反应、免疫功能紊乱程度逐渐加重;有效控制Th17/Treg失衡有可能成为中医宏观、西医微观防治稳定期COPD的新靶点。

Objective To compare the peripheral blood Th17 and Treg contents in stable COPD patients with different GOLD grades,to provide a new target for clinical effective treatment of patients with stable COPD.Methods From June to December 2017,a total of 96 stable COPD patients received outpatient follow-up were selected in the Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,and they were divided into B-grade group(n=40),C-grade group(n=23)and D-grade group(n=33)according to 2013 GOLD grading standard;meanwhile a total of 30 age-matched healthy volunteers admitted to this hospital for physical examination were selected as control group.General information(including gender,age,height and weight),peripheral blood IL-17a and IL-10 levels,peripheral blood Th17 and Treg contents,and Th17/Treg ratio were compared in the four groups.Results(1)No statistically significant difference of gender,age or height was found in the four groups(P>0.05);weight in B-grade group,C-grade group and D-grade group was statistically significantly lower than that in control group,respectively,weight in C-grade group and D-grade group was statistically significantly lower than that in B-grade group,respectively,and weight in D-grade group was statistically significantly lower than that in C-grade group(P<0.05).(2)Peripheral blood IL-17a level in B-grade group,C-grade group and D-grade group was statistically significantly higher than that in control group,respectively,peripheral blood IL-17a level in C-grade group and D-grade group was statistically significantly higher than that in B-grade group,respectively,and peripheral blood IL-17a level in D-grade group was statistically significantly higher than that in C-grade group(P<0.05);peripheral blood IL-10 level in B-grade group,C-grade group and D-grade group was statistically significantly lower than that in control group,respectively,peripheral blood IL-10 level in C-grade group and D-grade group was statistically significantly lower than that in B-grade group,respectively,and peripheral blood IL-10 level in D-grade group was statistically significantly lower than that in C-grade group(P<0.05).(3)Peripheral blood Th17 content and Th17/Treg ratio in B-grade group,C-grade group and D-grade group were statistically significantly higher than those in control group,peripheral blood Th17 content and Th17/Treg ratio in C-grade group and D-grade group were statistically significantly higher than those in B-grade group,and peripheral blood Th17 content and Th17/Treg ratio in D-grade group were statistically significantly higher than those in C-grade group(P<0.05);peripheral blood Treg content in B-grade group,C-grade group and D-grade group was statistically significantly lower than that in control group,respectively,peripheral blood Treg content in C-grade group and D-grade group was statistically significantly lower than that in B-grade group,respectively,and peripheral blood Treg content in D-grade group was statistically significantly lower than that in C-grade group(P<0.05).Conclusion In patients with stable COPD,as GOLD grade increases,peripheral blood Th17 content increases,peripheral blood Treg content reduces,inflammatory reaction and degree of immune dysfunction aggravates,respectively;effective control of imbalance of Th17/Treg may be a new target for preventing and treating stable CODP at macro level of TCM and micro level of Western medicine.