白细胞介素-17的表达与狼疮肾炎关系初探

目的　了解狼疮肾炎 (LN)病人白细胞介素 17(IL 17)在血浆、尿液及肾组织中表达水平与LN发病相关性。方法　建立正常对照、活动期和非活动期LN组 ,用酶联免疫吸附法(ELISA)测定其血浆和尿液IL 17水平 ;制备正常对照、WHOⅣ型和非Ⅳ型肾组织标本 ,采用微波免疫组织化学染色法 ,光镜观察IL 17在肾组织中的表达。结果　血浆IL 17均测不出 (<5 pg/ml) ;尿液IL 17水平 ,活动期LN病人 (2 9± 5 ) pg/ml较正常对照 (3 3± 0 8)pg/ml和非活动期LN病人(9 6± 0 9) pg/ml明显升高 (P <0 0 0 1) ,且非活动期LN病人较正常对照亦明显升高 (P <0 0 0 1) ;免疫组织化学显示 ,WHOⅣ型LN较非Ⅳ型和正常对照组 ,单位肾小球细胞数 [(117± 31) / gcs(肾小球横向联合切面 )较 (4 3± 8) /gcs和 (34± 7) / gcs]明显升高 (P <0 0 1) ,单位肾小球IL 17+ 细胞数(Ng) [(33± 8) /gcs较 (8 2± 1 6 ) / gcs和 0 ]明显增多 (P <0 0 1) ,每平方毫米肾小管、间质IL 17+ 细胞数 (Nt) [(2 9± 9) /mm2 较 (8 8± 1 5 ) /mm2 和 0 ]亦明显增多 (P <0 0 1)。相关分析显示Ng与肾小球细胞增多、肾组织活动指数、尿蛋白、尿N 乙酰 β 氨基葡萄糖苷酶 (NAG)、血肌酐及尿IL 17亦呈正相关 ;Nt与肾组织活动指数、肾小管间质损害程度、尿     

COPD患者血清CRP、IL-1β、IL-17水平变化及临床意义

目的探讨CRP、IL-1β、IL-17在慢性阻塞性肺疾病发病过程中水平变化及临床意义。方法检测COPD急性期组、COPD稳定期组、健康对照组血清CRP、IL-1β、IL-17的浓度水平。结果 (1)AECOPD、COPD稳定期组、健康对照组血清CRP、IL-1β、IL-17浓度水平各组间比较差异具有统计学意义(P0.05);(2)AECOPD、COPD稳定期、健康对照组的FEV1%各组间比较差异具有统计学意义(P0.05);(3)COPD吸烟组的血清CRP、IL-1β、IL-17浓度水平较COPD不吸烟组均显著升高(P0.05);(4)急性期组及稳定期组血清IL-1β、IL-17水平呈直线正相关(r=0.685、0.419,P均0.05);(5)急性期组、稳定期组IL-1β、IL-17均与CRP呈正相关,与FEV1%呈负相关(P均0.05)。结论血清CRP、IL-1β、IL-17可能与COPD的炎症反应及疾病严重程度有关。     

Th17在COPD炎症中的作用

COPD与慢性炎症有关,主要影响肺实质和外周气道,最终导致外周气道存在很大程度上不可逆的和进行性的气流限制.这种炎症的特点是由于血液循环中的肺泡巨噬细胞、中性粒细胞、T细胞(Tc1、Th1和Th17细胞亚群为主)和固有淋巴细胞的增加造成的.而Th17,一种CD4+T细胞的新子集,以能分泌IL-17A和IL-17F而得名.在COPD大鼠肺组织内IL-17 mRNA表达增加并伴随着肺功能的降低.本文就Th17在COPD的发展中的作用作一综述.     

慢性阻塞性肺疾病患者血清IL-2、IL-6及IL-12表达与生活质量的关系

目的 探讨慢性阻塞性肺疾病（COPD）患者血清IL-2、IL-6、IL-12表达及与生活质量的关系.方法 选择170例COPD患者为观察组,80例正常健康者为对照组;采用酶联免疫吸附法检测两组血清IL-2、IL-6、IL-12,用SF-36量表行生活质量评价,分析血清IL-2、IL-6、IL-12表达与生活质量总分的关系.结果 与对照组比较,观察组血清IL-2降低,IL-6、IL-12升高,生活质量降低（P均＜0.05）;COPD患者的血清IL-6水平与生活质量总分呈负相关（r=-0.45,P＜0.05）.结论 血清IL-2低表达、IL-6、IL-12高表达在COPD发生、发展中起重要作用,IL-6表达可能对患者的生活质量有潜在影响.     

老年COPD患者CD83、IL-17、SP-D、HDAC2 mRNA水平变化及其临床意义

目的探讨老年慢性阻塞性肺疾病(COPD)患者CD83、白细胞介素(IL)-17、肺表面活性蛋白(SP-D)、组蛋白乙酰化酶(HAT)/去乙酰化酶(HDAC) 2 mRNA水平变化及其临床意义。方法选取老年COPD患者,选取同期接受体检的健康老年人为对照。观察两组CD83、IL-17、SP-D、HDAC2 mRNA水平及细胞因子和肺功能的差异,分析老年COPD患者CD83、IL-17、SP-D、HDAC2 mRNA水平与肺功能和细胞因子的相关性。结果 COPD组CD83和HDAC2 mRNA水平明显低于对照组,IL-17和SP-D水平明显高于对照组,IL-18、IL-6和高敏C反应蛋白(hs-CRP)水平均高于对照组(均P<0. 001); COPD组用力肺活量(FVC)、1 s用力呼气容积(FEV1)/FVC、最大呼气中期流量(MMEF)和呼气峰流速值(PEF)水平低于对照组(P<0. 001); COPD组CD83和HDAC2 mRNA水平与IL-18、IL-6、hs-CRP水平负相关,与FVC、FEV1/FVC、MMEF和PEF正相关;COPD患者IL-17和SP-D水平与IL-18、IL-6、hs-CRP水平正相关,与FVC、FEV1/FVC、MMEF和PEF负相关(P<0. 05)。结论老年COPD患者CD83、HDAC2 mRNA水平较低,IL-17、SP-D较高,可作为临床监测的重要指标。     

COPD患者血浆IL-17、sICAM-1的研究

目的探讨慢性阻塞性肺疾病（COPD）患者血浆白细胞介素-17（IL-17）、可溶性细胞间粘附分子-1（sICAM-1）浓度的变化及相关性。方法30例急性加重期和稳定期COPD患者、25例健康体检者,分别查血常规、测定肺功能,用ELISA法检测血浆IL-17、sICAM-1浓度。结果同一患者COPD急性加重期血浆IL-17浓度、sICAM-1浓度均明显高于稳定期（P〈0.01,P〈0.01）;患者COPD急性加重期血浆IL-17浓度、sICAM-1浓度明显高于健康对照组（P〈0.01,P〈0.01）,患者COPD稳定期血浆IL-17浓度、sICAM-1浓度明显高于健康对照组（P〈0.01,P〈0.01）且在急性加重期IL-17、sICAM-1与Neu／Leu％呈正相关（r=0.824,P〈0.01;r=0.827,P〈0.01）。结论COPD急性加重期及稳定期IL-17、sICAM-1水平显著升高,提示IL-17、sICAM-1参与了COPD的发病,可能是引起肺内炎症细胞浸润及肺实质破坏的主要原因之一。     

阿奇霉素对COPD稳定期患者血清IL-4及IL-10的影响

目的观察阿奇霉素治疗COPD稳定期患者外周血IL-4、IL-10指标的变化。方法选择我院门诊COPD稳定期患者108例,随机分为实验组和对照组(每组54例)。对照组给予常规治疗,实验组在常规治疗上加口服阿奇霉素。两组在治疗前及治疗后3月、6月、9月检测血清IL-4、IL-10水平变化。结果两组患者血清IL-4、IL-10水平在治疗前及治疗后3个月差别无统计学差异(P0.05)。实验组血清IL-4及IL-10在治疗后6月、9月水平均明显高于对照组(P0.05)。结论阿奇霉素具有免疫调节功能,可增加抗炎因子,口服方便、安全、有效,在治疗COPD患者中具有一定临床应用价值。     

慢性阻塞性肺疾病患者血清IL-21、IL-17、TLR4的表达及临床意义

目的探讨慢性阻塞性肺疾病(简称慢阻肺)稳定期患者血清白细胞介素-21(Interleukin-21,IL-21)、白细胞介素-17(Interleukin-17,IL-17)、Toll样受体4(Toll-like receptor 4,TLR4)的表达水平及三者与肺功能指标第一秒钟用力呼气容积占预计值百分比(FEV_1%pred)及健康损害程度的相关性。方法 70例吸烟慢阻肺稳定期患者为慢阻肺组,70例健康吸烟者为健康吸烟对照组,70例健康非吸烟者为健康非吸烟对照组,采用酶联免疫吸附(ELISA)法测定各组血清IL-21、IL-17、TLR4的表达水平;应用德国耶格肺功能仪检查各组肺功能指标FEV_1%pred;用慢阻肺评估测试量表(CAT)评分,评定慢阻肺患者的健康损害程度;分析血清IL-21、IL-17、TLR4表达水平与FEV_1%pred、CAT评分的相关性。结果慢阻肺稳定期组血清IL-21、IL-17、TLR4的表达水平均高于健康吸烟对照组及健康非吸烟对照组,(P均0.05);慢阻肺稳定期患者血清中IL-21、IL-17、TLR4表达水平与FEV_1%pred均呈负相关(r=-0.586、-0.703、-0.638,P均0.05);慢阻肺稳定期患者血清IL-21、IL-17、TLR4表达水平与CAT评分均呈正相关(r=0.718、0.677、0.596,P均0.05)。结论慢阻肺稳定期患者血清IL-21、IL-17、TLR4表达水平增高,且三者均与患者肺功能指标FEV_1%pred、健康损害程度具有相关性。     

慢性阻塞性肺疾病患者血清IL-17、IL-23水平变化及意义

目的观察慢性阻塞性肺疾病(COPD)患者血清IL-17、IL-23水平变化,并探讨二者在COPD发病中的作用。方法 COPD急性加重期住院患者80例(急性期组),缓解期患者40例(缓解期组),另选同期健康体检者40例做对照(对照组)。采用ELISA法检测各组血清IL-17、IL-23,并测定三组外周血中性粒细胞百分比(NE%)、C-反应蛋白(CRP)水平及肺功能第一秒用力呼气容积占预计值的百分比(FEV1%)。结果急性期组血清IL-17、IL-23水平分别为(61.68±17.37)、(1 265.74±266.70)ng/L,缓解期组分别为(43.20±11.47)、(646.58±106.03)ng/L,对照组分别为(32.40±4.26)、(492.34±50.08)ng/L,三组相比,P均<0.05。急性期组NE%、CRP高于缓解期组及对照组,FEV1%急性期组<缓解期组<对照组(P均<0.05)。急性期组、缓解期组COPD患者血清IL-17与IL-23水平呈正相关(r=0.688、0.399,P均<0.05),且这两个因子与NE%、CRP均呈正相关,与FEV1%呈负相关(r分别为0.382、0.625、-0.584和0.355、0.313、-0.345,P均<0.05)。结论 COPD患者血清IL-17、IL-23水平升高,二者可能与COPD的发病及疾病严重程度有关。     

前列环素在慢性阻塞性肺疾病患者肺组织中的表达

目的 研究前列环素在慢性阻塞性肺疾病患者肺组织中的表达变化.方法 分别采集湘雅二医院2008年6-10月因肺癌、肺大疱入院行肺叶切除术的患者22例的肺组织标本,分为COPD组(12例)和对照组(10例).采用缺口末端标记法定量测定肺血管内皮细胞凋亡,免疫组织化学法检测前列环素合酶(PGI_2-S)蛋白表达,酶联免疫吸附试验测定6-酮前列腺素F_(1α)含量变化.两组间比较采用t检验.结果 COPD组肺中型血管和微小型血管内皮细胞凋亡指数[(12.9±2.0)%和(11.4±1.4)%]明显高于对照组[(6.1±1.2)%和(5.9±0.4)%],PGI_2-S蛋白表达率[(55.2±9.8)%和(42.3±5.1)%]明显低于对照组[(95.4±2.1)%和(82.3±7.4)%],气道上皮细胞中PGI_2-S蛋白表达率[(31.8±5.2)%]明显低于对照组[(95.5±2.2)%],6-酮前列腺素F_(1α)含量[(2.6±0.4)μg/L]明显低于对照组[(16.2±2.8)μg/L],差异均有统计学意义(t值为9.6～173.6,均P<0.01).结论 COPD患者肺血管内皮细胞存在异常凋亡现象,PGI_2-S蛋白表达下降,肺组织中前列环素生成明显减少,这些变化可能是COPD患者肺血管内皮细胞功能异常的组织学标志,并参与COPD的发生与发展.     

核因子κB、白介素6在慢性阻塞性肺疾病发病机制中的作用

目的 探讨核因子κB(NF-κB)、白介素6(IL-6)在慢性阻塞性肺疾病(COPD)的表达及意义.方法 选择2012年2月至2012年7月呼吸科COPD急性加重期及稳定期患者各25例,无COPD的对照组25例,抽取静脉血,ELISA测定血浆IL-6的浓度,Western blotting测定外周血单个核细胞的NF-κB的表达水平,采用SPSS 13.0进行统计分析它们是否有统计学差异及其相关性.结果 ①CRP在COPD急性加重期组、稳定期组、对照组浓度分别为(28.125 7±38.561 3) mg/L,(8.205 5±16.309 6)mg/L,(2.861 7±4.854 7)mg/L,急性加重期组较稳定期组及对照组有统计学的升高,稳定期组与对照组比较差异无统计学意义;②IL-6在COPD急性加重期组、稳定期组、对照组浓度分别为(31.883 4±19.462 95) ng/L,(44.461±16.181 4)ng/L,(23.856±9.930 33) ng/L,急性加重组、稳定期组与对照组比较差异有统计学意义;③NF-κB在COPD急性加重期组、稳定期组、对照组表达分别为(0.965 9±0.075 4),(0.918 2±0.051 31),(0.949 6±0.143 93),3组之间差异无统计学意义;④相关性分析显示NF-κB与IL-6之间无明显相关.结论 COPD稳定期患者外周血IL-6表达明显增加,提示IL-6与气道的慢性炎症相关,可能与COPD的发病机制有关.COPD患者外周血单个核细胞NF-κB无明显升高,提示其不直接引起COPD患者的全身炎症.     

白细胞介素-17与慢性阻塞性肺疾病

白细胞介素(IL)-17是新发现的主要由CD4 记忆T淋巴细胞、单核细胞等分泌的一种前炎性细胞因子,具有强大的招募中性粒细胞、促进多种细胞释放炎性因子等多种生物学作用,参与呼吸道的炎症,从而在慢性阻塞性肺疾病(COPD)的发病机制中发挥重要作用.认识IL-17与COPD发病的关系有利于为临床治疗COPD提供新的治疗思路与药物.本文就IL-17在COPD中的作用进行综述.     

The metabolic syndrome in patients with chronic obstructive pulmonary disease

PURPOSE: This study was undertaken to evaluate the presence of the metabolic syndrome in COPD patients who participated in a cardiopulmonary rehabilitation program. The metabolic syndrome is characterized by the presence of abdominal obesity, atherogenic dyslipidemia, raised blood pressure, presence of insulin resistance, and prothrombotic and inflammatory states that predispose to cardiovascular diseases. METHODS: Thirty-eight COPD patients (age: 66 +/- 7 years, [mean +/- SD], FEV1: 43 +/- 16% predicted) and 34 control participants matched for age and gender are included in this study. The criteria for the identification of the metabolic syndrome include 3 or more of the following features: abdominal obesity (waist circumference: > 102 cm in men, > 88 cm in women), triglycerides levels (>or= 1.69 mmol/L), high-density lipoprotein cholesterol levels (< 1.0 mmol/L in men, < 1.3 mmol/L in women), blood pressure (>or= 130/ >or= 85 mm Hg), and fasting glucose levels (>or= 6.1 mmol/L). RESULTS: Forty-seven percent of COPD patients and 21% of control participants presented 3 or more determinants of the metabolic syndrome. CONCLUSIONS: The presence of metabolic syndrome is frequent in patients with COPD who participated in a cardiopulmonary program. Hence, this population should be considered for screening for the metabolic syndrome.     

Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Objective

To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD, using St.George’s Respiratory questionnaire (SGRQ), the 6-minutes walking test (6-MWT) and BODE index as the primary outcome measures.

Methods

A prospective, parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD (67 men and 13 women; mean age 64.8 ± 10.6 years; FEV₁, 42.8% ± 7.6% of the predicted value. The active group (n = 40) took part in a 14-week rehabilitation program [3 h/wk, 1.5 h of education and exercise and 1.5 h of cycling]. The control group (n = 40) was reviewed routinely as medical outpatients. The following evaluations were carried out at study entry and after14 weeks: (1) pulmonary function studies; (2) 6-minutes walking test 6MWT; (3) quality of life; and (4) BODE index.

Results

The following patients completed the study: 35 patients (87.5%) from the active group (mean age, 63.7 ± 11.9 years; mean forced expiratory volume in one second (FEV₁), 41.9 ± 2.6% of the predicted value); and 36 patients (88%) from the control group (mean age, 65.9 ± 10.3 years; mean FEV₁, 43.33 ± 3.6% of the predicted value). We found no changes in pulmonary function parameters in the active group and the control one at 14weeks. On the other hand, there were significant changes within the components of the SGRQ (12.3 for the score total) for the patients of the active group but not for the patients of the control one (only 1.5 for the score total), we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one, and finally a decrease of two points (from 6 to 4) was noted in the score of the active group’s BODE index without any change in the control group’s one.

Conclusion

An outpatient-based of 14-week rehabilitation program significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD, and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index.     

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Background

Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD.

Methods

Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA.

Results

Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed.

Conclusions

IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

     

慢性阻塞性肺疾病患者疾病认知状况206例调查分析

慢性阻塞性肺疾病(COPD)患者对疾病的自我认知和管理对于延缓疾病进展十分重要,是COPD综合防治的重要组成部分。本研究旨在调查COPD患者对COPD基本知识的认知程度,为进一步在辽宁地区普及COPD相关知识和提高人们对COPD的     

The nutritional status of patients with chronic obstructive pulmonary disease

The nutritional status of 38 patients with chronic obstructive pulmonary disease (COPD) was assessed by dietary intake, anthropometric measurements biochemical analysis, and immunologic testing. The mean intakes for 9 nutrients were significantly greater than the 1974 Recommended Dietary Allowances of the National Academy of Sciences. Results of the anthropometric measurements for usual weight for height, fat stores, and muscle mass were significantly less than standard. Of the 32 subjects evaluated for immunocompetence, 9 were anergic (induration, 0) on all 3 skin tests. The results of this study indicated that the marasmic type of protein calorie malnutrition is a common finding among patients with COPD, and that patients with COPD who are immunoincompetent may be more susceptible to mixed protein calorie malnutrition of the kwashiorkor-marasmus type.     

老年慢性阻塞性肺疾病血清白细胞介素-13的变化

目的　探讨白细胞介素 13 (IL 13 )与慢性阻塞性肺疾病 (COPD )的关系。方法　用双抗夹心ABC ELISA法测定 3 5例老年COPD患者 (急性加重期 2 0例 ,稳定期 15例 )血清IL 13水平 ,并与 2 2名健康者 (对照组 )进行比较。结果　老年COPD急性加重期组 ,COPD稳定期组和对照组血清IL 13水平分别为 (4 7.2 6± 3 .47) pg/ml、(3 6.11± 5 .3 4)pg/ml和 (3 0 .99± 2 .19) pg/ml。COPD急性加重期组和COPD稳定期组血清IL 13水平均显著高于对照组 (P <0 .0 5 ) ,且COPD急性加重期组血清IL 13水平显著高于COPD稳定期组 (P <0 .0 5 )。结论　老年COPD患者血清中IL 13水平显著升高 ,IL 13与COPD的发生发展有关