慢性阻塞性肺疾病急性期血清白细胞介素-6、白细胞介素-13和白细胞介素-17A水平与GOLD分级的关系

Relationship between serum IL-6, IL-13 and IL-17a levels with GOLD grade in acute stage of chronic obstructive pulmonary disease

目的 通过检测慢性阻塞性肺疾病(COPD)急性加重期和稳定期前后血清白细胞介素6(IL-6)、白细胞介素13(IL-13)和白细胞介素17A(IL-17A)的水平变化,探讨IL-6、IL-13和IL-17A在COPD急性加重期中的作用。方法 选取2017年1月至2018年6月上海市静安区市北医院呼吸内科收治的COPD急性加重期病人42例设为COPD急性加重期组(AECOPD),经过抗感染及对症治疗后病情稳定的COPD病人42例设为COPD稳定期组。收集各组血清并采用双抗体加心法(ELISA)检测IL-6、IL-13和IL-17A,同时采集和检测各组血C-反应蛋白(CRP)、降钙素原(PCT)、血沉、白细胞数、中性粒细胞及嗜酸性粒细胞数,采用肺功能评估COPD稳定期的COPD全球创议(GOLD)分级。结果 COPD稳定期和急性期之间的相关炎症指标CRP、血沉(ESR)、PCT、白细胞计数(WBC)、中性粒细胞计数(Neu)、IL-6、IL-13和IL-17A有差异有统计学意义(P<0.01)。COPD急性期CRP、ESR、PCT、白细胞计数、中性粒细胞计数、IL-6、IL-13和IL-17A均显著高于稳定期(P<0.05)。COPD病人血清IL-6、IL-13和IL-17A水平治疗前后均差异有统计学意义(P<0.01)。急性期病人随着GOLD分级的级别增高,血清IL-13和IL-17A是增高的,GOLD分级与血清IL13呈正相关(r=0.58,P<0.01),与IL-17A水平呈正相关(r=0.53,P<0.01),与IL-6水平不相关(r=0.25,P=0.114)。稳定期病人血清IL-17A与GOLD分级差异有统计学意义(P<0.01),且与GOLD分级呈正相关(r=0.57,P<0.01)。结论COPD急性加重期IL-6、CRP、PCT、血沉、白细胞数、中性粒细胞数等均升高,但缺少特异性和相关性。COPD病人血清IL-13逐渐增高与GOLD分级呈正相关,而血清IL-17A水平与COPD气道炎症反应与重塑相关,更好地控制Th17细胞因子的产生可能是治疗COPD的有效手段之一,联合检测IL-6、IL-13和IL-17A相关细胞因子能更好地指导COPD病人的管理和治疗。

Objective To discuss the role of serum IL-6,IL-13,and IL-17a levels in acute exacerbation of COPD by measuring the levels of serum IL-6,IL-13 and IL-17a during acute exacerbation and stabilization state.Methods Forty-two patients who were admitted to the respiratory department of Shibei Hospital from January 2017 to June 2018 were selected as the AECOPD group.After antiinfection and symptomatic treatment,42 patients were assigned to the stable COPD group.The serum of each group was collected to detect IL-6,IL-13,and IL-17a by double antibody cardioversion (ELISA),and the blood c-reactive protein (CRP),calcitonin (PCT),sedimentation,white blood cells,neutrophil and eosinophil Numbers were also collected and detected.Lung function was used to evaluate the GOLD classification of COPD in stable state.Results C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),PCT,white blood cell count (WBC),neutrophil count (Neu),IL-6,IL-13 and IL-17a were significantly different between stable COPD and acute COPD (P<0.01).CRP,ESR,PCT,white blood cell count,neutrophil count,IL-6,IL-13 and IL-17a in acute phase of COPD were significantly higher than those in stable phase(P<0.05).The serum levels of IL-6,IL-13 and IL-17a in patients with COPD before and after treatment were significantly different (P<0.01).The levels of serum IL-13 and IL-17a increased with the GOLD grading.Gold grade was positively correlated with serum IL-13 (r=0.58,P<0.01) and IL-17a (r=0.53,P<0.01),but not with IL-6 (r=0.25,P=0.114).The serum IL-17a level of patients in stable phase was significantly different from that of gold classification (P<0.01),and was positively correlated with gold classification (r=0.566,P<0.01).Conclusion IL-6,CRP,PCT,erythrocyte sedimentation rate,white blood cell count,neutrophil count and so on are all increased in acute exacerbation of COPD but lack of specificity and correlation.The level of IL-13 is positively correlated with GOLD grade,while the level of IL-17a is correlated with airway inflammation and remodeling in COPD.Combined detection of IL-6,IL-13 and IL-17a related cytokines can better guide the management and treatment of patients with COPD.