COPD患者血清炎症指标与气道炎症的关系

The relationship between serum inflammatory indexes and airway inflammation in COPD patients

目的探讨慢性阻塞性肺疾病(COPD)患者血清白介素-4(IL-4)、粒-巨细胞集落刺激因子(GM-CSF)、单核细胞趋化蛋白-1(MCP-1)及血嗜酸粒细胞(EOS)水平变化与气道炎症的关系。方法选取2018年3月~2019年3月我院收治的患者106例为COPD组(根据疾病病程分为急性加重期和稳定期两个阶段),选择同期健康体检者45例为对照组。根据指南中肺功能分级将106例患者分为4级,Ⅰ级21例,Ⅱ级35例,Ⅲ级31例,Ⅳ级19例。血常规检测EOS水平,用酶联免疫吸附法(ELISA)检测IL-4水平,双抗体夹心ELISA法检测MCP-1水平,放射免疫分析法测定GM-CSF浓度,入院第2d检测患者用力肺活量(FVC)、1s用力呼吸容积(FEV1),计算FEV1/FVC,分析上述血液指标与肺功能指标的相关性。结果 COPD组患者急性加重期和稳定期血清IL-4、GM-CSF、MCP-1及血EOS水平均高于对照组(P<0.05),治疗后稳定期上述血液指标均低于急性加重期(P<0.05);不同程度分级COPD患者血清IL-4、GM-CSF、MCP-1及血EOS水平比较,Ⅰ级<Ⅱ级<Ⅲ级<Ⅳ级(P<0.05),FVC、FEV1、FEV1/FVC水平比较,Ⅰ级>Ⅱ级>Ⅲ级>Ⅳ级(P<0.05);COPD患者血清IL-4、GM-CSF、MCP-1及血EOS水平与FVC、FEV1、FEV1/FVC水平均呈显著负相关(P<0.05)。结论 COPD患者急性加重期和稳定期血清IL-4、GM-CSF、MCP-1及血EOS水平均较健康人群高,且与肺功能有显著相关性,可作为气道炎症损伤的指标。

Objective To investigate the relationship between the changes of serum IL-4(IL-4), granulocyte-macrophage colony-stimulating factor(GM-CSF), monocyte chemoattractant protein-1(MCP-1) and blood eosinophil(EOS) in patients with COPD. Methods 106 patients admitted to our hospital from March 2018 to March 2019 were selected as COPD group. According to the course of the disease, COPD group was divided into acute aggravation stage and stable stage. 45 healthy people in the same period were selected as the control group. According to the classification of lung function in the guidelines, 106 patients were divided into four grades: Grade I(21 cases), grade Ⅱ(35 cases), grade Ⅲ(31 cases) and grade Ⅳ(19 cases). EOS, IL-4, MCP-1 and GM CSF were detected by blood routine, enzyme linked immunosorbent assay, double antibody sandwich ELISA and radioimmunoassay, respectively. FVC1 and FEV1/FVC were measured on the second day after admission, and the correlation between the above blood indexes and pulmonary function indexes was analyzed. Results The levels of serum IL-4, GM-CSF, MCP-1 and EOS at acute aggravation and stabilizationin in COPD group were higher than those in control group(P<0.05). After treatment, the above blood indexes in stable period were lower than those in acute aggravation period(P<0.05). The levels of serum IL-4, GM-CSF, MCP-1 and EOS in patients with COPD of different degrees were different: grade Ⅰgrade Ⅱ>grade Ⅲ>grade Ⅳ. The levels of IL-4, GM-CSF, MCP-1 and EOS in COPD patients were negatively correlated with FVC, fev-1 and fev-1/FVC(P<0.05). Conclusion The levels of serum IL-4, GM-CSF, MCP-1 and EOS in patients with COPD in acute exacerbation and stable stage are higher than those in healthy people, and are significantly correlated with lung function, which could be used as an index of airway inflammation injury.