雾化吸入性糖皮质激素对慢性阻塞性肺疾病急性加重住院患者血清TNF-αHDAC2及PTX3水平的影响

Effect of Inhaled Coricosteroids on Serum TNF-α HDAC2 and PTX3 Levels in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:观察雾化吸入性糖皮质激素对慢性阻塞性肺疾病急性加重(AECOPD)住院患者血清肿瘤坏死因子-α(TNF-α)、组蛋白去乙酰化酶2(HDAC2)及正五聚蛋白3(PTX3)水平的影响。方法:选取2020年1月至2021年12月我院收治的130例AECOPD患者为对象,采用掷硬币分组法分为两组。两组均给予常规对症治疗,对照组另给予特布他林雾化吸入治疗,观察组在对照组基础上联合雾化吸入性糖皮质激素治疗。比较两组症状体征评分、肺功能、血常规、TNF-α、HDAC2、PTX3的差异,统计两组不良反应。结果:治疗前,两组症状体征评分、肺功能比较,差异无统计学意义(P>0.05)。与治疗前比较,两组咳嗽、咳痰、气促、肺部听诊等评分治疗后下降,观察组治疗前后下降值较对照组更大(P<0.05)。两组治疗后第一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)治疗后升高,观察组治疗前后升高值较对照组更大(P<0.05)。治疗前,两组TNF-α、HDAC2、PTX3、血常规指标比较,差异无统计学意义(P>0.05)。与治疗前比较,两组中性粒细胞百分数(NE%)、TNF-α、中性粒细胞与淋巴细胞比值(NLR)、HDAC2、白细胞计数(WBC)、PTX3治疗后下降,观察组治疗前后下降值较对照组更大(P<0.05)。两组淋巴细胞百分数(LY%)治疗后升高,观察组治疗前后升高值较对照组更大(P<0.05)。对照组和观察组分别发生声音嘶哑2例和1例,未发生咽部不适、血糖升高等不良反应。结论:雾化吸入性糖皮质激素治疗AECOPD可减轻咳嗽、咳痰等症状,改善肺功能,可能与降低TNF-α、HDAC2、PTX3的表达有关。

Objective:To observe the effects of inhaled coricosteroids on the levels of serum tumor necrosis factor-α(TNF-α),histone deacetylase 2(HDAC2)and pentraxin 3(PTX3)in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:One hundred and thirty patients with AECOPD admitted to our hospital from January 2020 to December 2021 were selected and divided into two groups using the coin toss grouping method.Both groups were given conventional symptomatic treatment,the control group was additionally given terbutaline nebulizer inhalation treatment,and the observation group was treated with combined inhaled corticosteroids on the basis of the control group.The differences of symptom and sign scores,pulmonary function,blood routine,TNF-α,HDAC2 and PTX3 were compared between the two groups,and the adverse effects were counted in both groups.Results:Before treatment,there was no statistically significant difference between the two groups in terms of symptom and sign scores and pulmonary function(P>0.05).Compared with before treatment,the scores of cough,sputum,shortness of breath,and lung auscultation decreased after treatment in both groups,and the decrease values were greater in the observation group before and after treatment than in the control group(P<0.05).The first second force expiratory volume(FEV1)and FEV1/forced vital capacity(FVC)increased after treatment in both groups,and the increased values were greater in the observation group before and after treatment than in the control group(P<0.05).Before treatment,there were no statistically significant differences in TNF-α,HDAC2,PTX3,and routine blood indices between the two groups(P>0.05).Compared with before treatment,neutrophil percentage(NE%),TNF-α,neutrophil-to-lymphocyte ratio(NLR),HDAC2,white blood cell count(WBC),and PTX3 decreased after treatment in both groups,and the decrease value was greater in the observation group before and after treatment than in the control group(P<0.05).Lymphocyte percentage(LY%)increased in both groups after treatment,and the increase was greater in the observation group before and after treatment than in the control group(P<0.05).Two cases of hoarseness and one case of hoarseness occurred in the control group and the observation group,respectively,and no adverse reactions such as pharyngeal discomfort and blood glucose elevation occurred.Conclusion:Inhaled coricosteroids for AECOPD can reduce symptoms such as cough and sputum and improve lung function,which may be related to reducing the expression of TNF-α,HDAC2 and PTX3.