血清细胞因子水平检测在COPD急性加重期和稳定期的临床价值研究

Clinical values of evaluating serum levels of cytokines in COPD from acute exacerbation to stable phase

目的探讨血清炎性指标水平和T细胞亚群水平变化在判断慢性阻塞性肺疾病(COPD)病情严重程度中的临床价值。方法选择2018年3月~2019年3月我院呼吸内科收治的COPD患者86例做为研究对象。依照COPD不同病程分为稳定期组(n=32)和急性期组(n=54)。检测86例急性期和稳定期COPD患者血清中的TNF-α、IL-6、IL-1β、CD4+和CD8+水平。检测其肺功能,并对血清TNF-α、IL-6、IL-1β、CD4+、CD8+与肺功能指标(FEV1%、FEV1/FVC%)进行相关性分析。结果稳定期患者血清中TNF-α、IL-6和IL-1β的水平均较急性期患者明显下降,差异有统计学意义(P<0.05);稳定期患者血清中CD8+较急性期患者降低,差异有统计学意义(P<0.05);稳定期患者血清中CD4+、CD4+/CD8+均较急性期患者明显升高,差异有统计学意义(P<0.05)。急性期组COPD患者血清CD4+数量、CD4+/CD8+与FEV1%、FEV1/FVC%均呈正相关(P<0.05);IL-1β、IL-6、TNF-α水平及CD8+数量与FEV1%、FEV1/FVC%均呈负相关(P<0.05)。结论血清IL-1β、IL-6、TNF-α、CD4+和CD8+在COPD发病进程中起着重要作用,上述指标与肺功能均存在一定的相关性,血清炎性指标水平和T细胞亚群可以为病情严重程度的判断提供参考价值。

Objective To investigate clinical values of serum indices of inflammation and T-lymphocyte subset in evaluating the degree of severity of chronic obstructive pulmonary disease(COPD).Methods Eighty-six COPD patients admitted in the Department of Respiratory Medicine at our hospital from March 2018 to March 2019 were selected as subjects.They were divided into the stable-phrase group(n=32)and the acute-phase group(n=54)according to the course of COPD.Serum levels of tumor necrosis factor-α(TNF-α),interlukin-6(IL-6),IL-1β,CD4+and CD8+in the 86 COPD patients at the two phases were detected.A general pulmonary function test was performed in all patients.A correlation analysis between serum levels of TNF-α,IL-6,IL-1β,CD4+and CD8+and indices of pulmonary function incorporating forced expiratory volume in 1 second(FEV1%)and FEV1/forced vital capacity(FVC%)ratio was conducted.Results Serum levels of TNF-α,IL-6 and IL-1βin the stable-phrase group decreased compared with the acute-phase group,with statistically significant differences(P<0.05).So did the level of CD8+in the stable-phrase group compared with the acute-phase group,with statistically significant differences(P<0.05).However,the level of CD4+and CD4+/CD8+ratio in the stable-phrase group increased compared with the acute-phase group,with statistically significant differences(P<0.05).Serum amount of CD4+and CD4+/CD8+ratio were positively correlated with both FEV1%and FEV1/FVC%ratio in the acute-phase group(P<0.05).Besides,serum levels of IL-1β,IL-6 and TNF-αand serum amount of CD8+were negatively correlated with FEV1%and FEV1/FVC%ratio in the acute-phase group(P<0.05).Conclusion Serum IL-1β,IL-6,TNF-α,CD4+and CD8+are critical in the onset and pathogenesis of COPD,which are correlated with pulmonary function at the acute phase.Therefore,serum indices of inflammation and T-lymphocyte subset can provide a significant reference for determining the degree of severity of COPD.