吸烟对慢性阻塞性肺疾病患者相关免疫炎性反应及肺功能的影响

Impact of smoking on immune inflammatory response and lung ventilation function of patients with chronic obstructive pulmonary disease

目的探讨吸烟对慢性阻塞性肺疾病(慢阻肺)患者血清炎性因子、T淋巴细胞亚群及肺通气功能的影响。方法选择上海市第十人民医院沙溪分院、太仓市人民医院、上海长海医院,2017年7月-2018年6月收治的慢阻肺患者135例为研究对象,根据是否吸烟分为吸烟组62例、非吸烟组73例,两组均给予包括健康指导、抗炎平喘化痰、肺康复训练等常规治疗。治疗6个月,比较两组患者血清炎性因子、T淋巴细胞亚群、肺功能等指标。结果吸烟组慢阻肺血清C反应蛋白(CRP)、白细胞介素-6(IL-16)、肿瘤坏死因子-α(TNF-α)明显高于非吸烟组[(4.65±0.72 vs 3.82±0.65)mg/L、(4.35±0.71 vs 3.64±0.65)ng/L、(26.32±4.36 vs 21.30±4.12)ng/L](t=7.036,5.976,6.869,P<0.05);CD+4、CD+4/CD+8明显低于非吸烟组(0.32±0.06 vs 0.43±0.08,1.19±0.32 vs 1.65±0.40)(t=8.095,7.287,P<0.05,P<0.01);用力肺活量(FVC)、一秒用力呼气容积(EFV1)、1秒率(EFV1/FVC)明显低于非吸烟组[(2.23±0.36 vs 2.41±0.40)L、(1.45±0.26 vs 1.75±0.30)L、(65.02±6.20 vs 72.61±5.36)%](t=2.727,6.152,7.629,P<0.05)。结论吸烟不利于慢性阻塞性肺疾病治疗患者肺功能恢复,可能与加重气道炎症症状、削弱T淋巴细胞免疫功能等因素有关,应加强慢阻肺戒烟教育。

Objective To study the impact of smoking on inflammatory factors and T lymphocytes and lung ventilation function of patients with chronic obstructive pulmonary disease(COPD).Methods 135 patients with COPD from July 2017 to June 2018 were divided into the smoking group(62 cases)and the non-smoking group(73 cases).All patients were given including health guidance,anti-inflammatory,anti-asthma and phlegm elimination,and pulmonary rehabilitation training etc routine treatment.6 months after treatment,serum inflammatory factors,T lymphocyte subsets,and lung function were compared between the two groups.Results The levels of CRP,IL-6,and TNF-αwere significantly higher in the smoking group than in the non-smoking group[(4.65±0.72 vs 3.82±0.65)mg/L,(4.35±0.71 vs 3.64±0.65)ng/L,(26.32±4.36 vs 21.30±4.12)ng/L](t=7.036,5.976,6.869,P<0.05).The value of CD+4 and CD+4/CD+8 were significantly lower in the smoking group than in the non-smoking group(0.32±0.06 vs 0.43±0.08,1.19±0.32 vs 1.65±0.40)(t=8.095,7.287,P<0.05,P<0.01).FVC,EFV1,and EFV1/FVC were significantly lower in the smoking group than in the non-smoking group[(2.23±0.36 vs 2.41±0.40)L,(1.45±0.26 vs 1.75±0.30)L,(65.02±6.20 vs 72.61±5.36)%](t=2.727,6.152,7.629,P<0.05).Conclusion Smoking is not conducive to the recovery of pulmonary function of patients with COPD.It may be related to aggravating the symptoms of airway inflammation and weakening the immune function of T lymphocyte,and smoking cessation education of patients with COPD should be strengthened.