慢性阻塞性肺疾病治疗期间呼出气冷凝液中8-异前列腺素、IL-6、IL-10的变化及与气道炎症的相关性研究

目的探讨应用呼出气冷凝液（EBC）炎症因子评价重度稳定期慢性阻塞性肺疾病（简称慢阻肺）患者吸入沙美特罗/氟替卡松（50/500μg,bid）治疗期间气道炎症变化情况,并结合肺功能、生活质量评分分析其临床意义。方法收集治疗前及治疗后14、28、90 d重度稳定期慢阻肺患者24例及健康对照组18例的EBC,采用液相芯片技术测定EBC中白细胞介素6（IL-6）、IL-10水平,ELISA法测定8-异前列腺素（8-iso-PG）浓度,并行肺功能检测及生活质量评分（SGRQ评分）。结果治疗前重度稳定期慢阻肺组EBC中各细胞因子浓度水平均高于健康对照组。慢阻肺组治疗14 d后EBC中8-iso-PG水平较治疗前显著下降（11.59±4.12）pg/mL比（14.17±4.66）pg/mL,P〈0.05],但在治疗后14-90 d保持低水平,各观测点细胞因子水平比较差异无统计学意义（P〉0.05）。IL-6水平在治疗28 d后较治疗前显著降低（1.46±0.19）pg/mL比（1.59±0.19）pg/mL,P〈0.05],与治疗90 d后比较差异无统计学意义（P〉0.05）。IL-10在治疗90 d的水平较治疗28 d显著升高（1.72±0.19）pg/mL比（1.62±0.12）pg/mL,P〈0.05]。治疗后肺功能FEV1、FVC、FEV1/FVC较治疗前显著增加,SGRQ评分显著下降（P〈0.05）。相关分析结果表明FEV1与EBC中8-iso-PG、IL-6、IL-10水平无显著相关性。结论动态观察EBC中8-iso-PG的变化可作为监测重度稳定期慢阻肺患者治疗期间气道炎症变化的指标,IL-10可能与气道抗炎作用有关。

Changes of 8-Isoprostane,IL-6 and IL-10 in Exhaled Breath Condensate in COPD patients and Its Relationship with Airway Inflammation

Objective To monitor the airway inflammatory factors in exhaled breath condensate（ EBC） of severe stable COPD patients during salmeterol/fluticasone（ 50/500 μg,bid） treatment,and explore their clinical significance. Methods Twenty-four sever stable COPD patients and 18 healthy controls were included in the study. EBC was collected from COPD patients before treatment（ day 0） and 14 days,28 days,90 days after treatment. Meanwhile lung function test and SGRQ score were measured.Concentrations of IL-6 and IL-10 were measured by liquid chip and 8-isoprostane by enzyme-linked immunosorbent assay. Results Levels of 8-isoprostane,IL-6 and IL-10 in EBC were significantly higher in the sever stable COPD patients before treatment compared with the healthy controls. 8-isoprostane was decreased significantly at day 14 compared with day 0 （ 11. 59 ± 4. 12） pg /mL vs.（ 14. 17 ± 4. 66） pg /mL,P 〈 0. 05 ],and kept in low level till day 90（ P 〉 0. 05）. IL-6 was significantly decreased at day 28 compared with day 0 （ 1. 46 ± 0. 19） pg /mL vs.（ 1. 59 ± 0. 19） pg /mL,P 〈 0. 05],but did not change significantly till day 90. IL-10 was in low level but showed increase at day 90 compared with day 28（ 1.72 ±0.19） pg/mL vs.（ 1.62 ±0.12） pg/mL,P 〈0.05]. FEV1 and FEV1/FVC were improved and SGRQ score was decreased after 90 days treatment（ P 〈 0. 05）. FEV1 was not correlated with 8-isoprostane,IL-6 or IL-10 level. Conclusions Dynamic observation of EBC 8-isoprostane level in severe COPD patients can help in evaluating drug efficacy. IL-10 may play a role in airway anti-inflammation.