稳定期慢性阻塞性肺疾病气道炎症的研究

目的 研究稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)气道炎症和肺功能、下气道细菌定植(lower airway bacterial colonization,LABC)的关系.方法 随机入选45例稳定期COPD门诊患者和28名健康志愿者,行肺功能、血常规和胸片检查.采用痰诱导方法 留取深部合格痰液,COPD患者的痰液行细菌定量培养,两组研究对象的痰液均行细胞因子检测.结果 稳定期COPD组痰液中白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、IL-10、IL-19明显高于对照组(P＜0.05).第1秒用力呼气容积占预计值百分比(FEV1%pred)＜50%组痰液中IL-8、TNF-α、IL-19明显高于FEV1%pred≥50%组(P＜0.05),而IL-10在两组间比较差异无统计学意义.在本实验中LABC量≥107CFU/ml者占总人数的33.33%,主要的下气道定植菌为卡他莫拉菌、副流感嗜血杆菌、肺炎链球菌、流感嗜血杆菌等.LABC量≥107 CFU/ml组痰液中IL-8、TNF-α、IL-19明显高于LABC＜107 CFU/ml组(P＜0.05),而IL-10在两组间比较差异无统计学意义.相关性分析显示,IL-19与IL-10呈负相关,相关系数r=-0.548(P＜0.05),IL-19与IL-8、TNF-α呈正相关,相关系数分别为r=0.702(P＜0.05)、r=0.708(P＜0.05).FEV1%pred＜50%组细菌定植量明显高于FEV1%pred≥50%组(P＜0.05).FEV1%pred＜50%预计值组的吸烟指数明显高于FEV1%pred≥50%组(P＜0.05).结论 稳定期COPD患者存在气道炎症,既与LABC有关,又与吸烟有关,这种与LABC和吸烟相关的气道炎症可能是导致COPD患者肺功能进行性下降的原因.

Study on airway Inflammation of stable chronic obstructive pulmonary disease

Objective To investigate the relationship between airway inflammation and pulmonary runetion.lower airway bacterial colonization(LABC)of stable chronic obstructive pulmonary disease (COPD).Methods Forty-five outpatients with stable COPD and 28 healthy volunteers were randomly studied,all of which accepted pulmonary function examination,blood routine examination and chest X-ray.The deep qualified sputum samples were obtained from all the subiects through sputum induction,quantitative sputum culture was preformed with the sputum of the patients with COPD and the production of cytokine in sputum of all the subjects analyzed.Results The productions of IL-8,TNF-α,IL-10 and IL-19 in sputum of the patients with stable COPD group were higher than those of control group(P＜0.05).The productions of IL-8.TNF-α and IL-19 in sputum of the patients with FEV1%pred＜50% group were higher than those the patients with FEV1%pred≥50%group(P＜0.05),there was no significant difference of IL-10 between the patients with FEV1%pred＜50%group and the patients with FEV1%pred≥50%group( P＞0.05).The patients with LABC≥107 CFU/ml in the study,accounted for 33.33%of the total patients,the main colonized bacterium were Moraxelle catarrhalis,Haemophilus parainfluenzae,Streptococcus pneunmniae and Hernophilus infiuenza in lower airway.The productions of IL-8,TNF-α and IL-19 in sputum of the patients with LABC≥107 CFU/ml group were higher than those the patients with LABC＜107 CFU/ml group(P＜0.05),there was no significant difference of IL-10 between the patients with LABC≥107 CFU/ml group and the patients with LABC＜107 CFU/ml group(P＞0.05).There was negative correlation between IL-19 and IL-10,correlation coefficient r=-0.548(P＜0.05),there were positive correlation between IL-19 and IL-8,TNF-α,correlation coefficient r=0.702(P＜0.05),r=0.708(P＜0.05).The concentration of LABC of the patients with FEV1% pred＜50%group was higher than that of the patients with FEV1%pred≥50%group(P＜0.05).Smoking index of the patients with FEV1%pred＜50% group was higher than that of the patients with FEV1%pred≥50%group(P＜0.05).Conclusions There is airway inflammation of the patients with stable COPD.the airway inflammation ralates tO LAl3(2 and smoking,perhaps airway inflammation which ralates to LABC and smoking is the reason of the great decline of pulmonary function in the patients with stable COPD.