COPD继发性肺动脉高压患者血清Th17/Treg及其细胞因子变化及意义

目的探讨慢性阻塞性肺疾病(COPD)继发性肺动脉高压患者血清辅助性T细胞17(Th17)和调节性T细胞(Treg)及其细胞因子白细胞介素17(IL-17)、IL-10的变化及临床意义。方法以该院2013年1月至2016年1月收治的62例COPD患者作为研究对象,其中32例伴肺动脉高压,30例不伴肺动脉高压,另选取同期行健康体检的志愿者26例作为健康对照组。所有研究对象均抽取空腹静脉血5mL,离心取上清按ELISA试剂盒说明书检测IL-17、IL-10;流式细胞仪检测Th17、Treg比例。所有研究对象均行肺功能检查。结果健康对照组、COPD不伴肺动脉高压组和COPD伴肺动脉高压组1秒用力呼气容积(FEV1)占预计值百分比、FEV1/用力肺活量(FVC)百分比、残气量(RV)占预计值百分比差异均有统计学意义(P0.05)。COPD不伴肺动脉高压组和COPD伴肺动脉高压组FEV1占预计值百分比、FEV1/FVC百分比、RV占预计值百分比均低于对照组,差异均有统计学意义(P0.05)。各组间Th17细胞比例、Treg细胞比例、IL-17和IL-10水平、Th17/Treg差异均有统计学意义(P0.05)。COPD不伴肺动脉高压组和COPD伴肺动脉高压组Th17细胞比例、IL-17水平和Th17/Treg均高于健康对照组,差异有统计学意义(P0.05),Treg细胞比例和IL-10水平均低于健康对照组,差异有统计学意义(P0.05)。COPD伴肺动脉高压组Th17细胞比例、IL-17水平和Th17/Treg均高于COPD不伴肺动脉高压组,差异有统计学意义(P0.05),Treg细胞比例和IL-10水平均低于COPD不伴肺动脉高压组,差异有统计学意义(P0.05)。Pearson相关分析结果显示,FEV1占预计值百分比、FEV1/FVC与Th17/Treg均呈负相关(r=-0.827、-0.845,P0.05)。结论血清Th17/Treg失衡及其细胞因子IL-17、IL-10的水平变化在COPD继发性肺动脉高压诊断及评估病情方面具有重要临床意义。

Changes and significance of serum Th17/Treg and its cytokines in patients with secondary pulmonary hypertension in COPD

Objective To investigate the changes and clinical significance of T helper 17 (Th17) and regulatory T cells (Treg) and the cytokine interleukin‐17 (IL‐17) ,IL‐10 in patients with chronic obstructive pulmonary disease (COPD) secondary pulmonary hypertension .Methods Totally 62 cases of COPD patients were collected in our hospital from January 2013 to January 2016 ,in which 32 patients with pulmonary hypertension ,30 patients without pulmonary hypertension ,and 26 cases of healthy volunteers in the same period in our hospital as the control group .All the subjects were given 5 mL of fasting venous blood and the supernatant was centrifuged to detect IL‐17 and IL‐10 according to the instructions of ELISA kit .Flow cytometry was used to detect the ratio of Th17 and Treg .All subjects underwent pulmonary function tests .Results There was significant difference of FEV1% ,FEV1/FVC% ,RV% predicted in the control group ,COPD without pulmonary hypertension and COPD with pulmonary hypertension group ,FEV1% ,FEV1/FVC% ,RV% predicted in patients with COPD without pulmonary hypertension and those with COPD and pulmonary hypertension were lower than those in control group (P<0 .05) .The ratio of Th17 cells ,the proportion of Treg cells , the levels of IL‐17 and IL‐10 and the ratio of Th17/Treg were statistically significant(P<0 .05) .The ratio of Th17 cells ,IL‐17 lev‐el and Th17/Treg ratio in patients with COPD without pulmonary hypertension were significantly higher than those in the control group (P<0 .05) ,Treg cells and IL‐10 levels were lower than the control group ,the difference was statistically significant (P<0 . 05) .The ratio of Th17 cells ,IL‐17 and Th17/Treg in COPD with pulmonary hypertension were significantly higher than those in COPD without pulmonary hypertension (P<0 .05) ,Treg cells and IL‐10 levels were significantly lower than those of COPD with‐out pulmonary hypertension (P<0 .05) .The results of Pearson correlation analysis showed that the percentage of FEV 1 ,FEV1/FVC and Th17/Treg were negatively correlated (r= -0 .827 ,-0 .845 ,P<0 .05) .Conclusion The imbalance of serum Th17/Treg and the changes of cytokines IL‐17 and IL‐10 have important clinical significance in the diagnosis and evaluation of COPD secondary pulmonary hypertension .