慢性阻塞性肺疾病继发肺部感染的炎性因子及TLR7/IL-23/IL-17信号通路作用

目的探究慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)继发肺部感染的炎性因子及Toll样受体7/白细胞介素-23/白细胞介素-17(Toll like receptor-7/Interleukin-23/Interleukin-17,TLR7/IL-23/IL-17)信号通路作用。方法选取2015年6月-2019年1月海口市中医医院收治的COPD患者120例,根据是否并发肺部感染及感染严重程度分组,选取同期于医院体检的健康者30名作为对照组,患者均抽取空腹静脉血5 ml,部分置于含有EDTA的抗凝管中,部分离心上清,-80℃保存待测。取部分血液样本,采用荧光定量PCR法(qPCR)检测外周血单个核细胞TLR7表达;采用酶联免疫吸附法(ELISA)检测白细胞介素-2(Interleukin-2,IL-2)、白细胞介素-6(Interleukin-6,IL-6)、IL-17、IL-23、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、γ-干扰素(γ-interferon,IFN-γ)水平;采用流式细胞术检测pDC及T细胞亚群比例;采用免疫比浊法检测免疫球蛋白A(Immunoglobulin A,IgA)、免疫球蛋白G(Immunoglobulin G,IgG)、免疫球蛋白M(Immunoglobulin M,IgM)水平。结果轻度感染组和重度感染组的TLR7表达水平均高于对照组(P<0.05);重度感染组的TLR7表达水平高于未感染组(P<0.05);轻度感染组和重度感染组的IL-6、IL-17、IL-23、TNF-α、IFN-γ水平高于对照组和未感染组,IL-2水平低于对照组和未感染组(P<0.05);轻度感染组和重度感染组的pDC、CD4^+、CD4^+/CD8^+比例高于对照组,CD8^+低于对照组(P<0.05);重度感染组的pDC、CD4^+、CD4^+/CD8^+比例高于未感染组,CD8^+低于未感染组(P<0.05);重度感染组的IgA、IgG、IgM水平低于对照组和未感染组(P<0.05)。结论COPD继发肺部感染患者的TLR7表达上升,抑炎因子水平下降,促炎因子分泌增加,提示炎症反应持续。

Detection of inflammatory factors secondary to pulmonary infection and analysis of the role of TLR7/IL-23/IL-17 signaling pathway in chronic obstructive pulmonary disease

OBJECTIVE To explore the role of inflammatory factors and TLR7/IL-23/IL-17 signaling pathways in pulmonary infection secondary to chronic obstructive pulmonary disease.METHODS From June 2015 to January 2019,120 patients with chronic obstructive pulmonary disease admitted to our hospital.They were divided in to 2 groups according to whether they were complicated by pulmonary infection and severity of infection;30 healthy people who were during physical examination in our hospital in the same period were enrolled as the control group.All the subjects were taken 5 mL of venous blood,which was partially placed in an anticoagulant tube containing EDTA.And the residual blood was centrifuged to keep the supernatant stored at-80℃for testing.Blood samples were used to detect the expression of TLR7 in peripheral blood mononuclear cells by real-time PCR(qPCR).The levels of IL-2,IL-6,TNF-αand IFN-γwere detected by enzyme-linked immunosorbent assay(ELISA).Flow cytometry was used to detect the ratio of pDC and T cell subsets;immunoturbidimetric assay was used to detect immunoglobulin IgA,IgG and IgM levels.RESULTS The expression of TLR7 in the mild infection group and the severe infection group was significantly higher than that in the control group(P<0.05).The expression level of TLR7 in the severe infection group was significantly higher than that in the uninfected group(P<0.05).The IL-6,IL-17,IL-23,TNF-α,IFN-γlevels in the mild infection group and the severe infection group were significantly higher than that in the control group and the uninfected group;IL-2 level was significantly lower than that in the control group and the uninfected group(P<0.05).The proportions of pDC,CD4^+,CD4^+/CD8^+in the mild infection group and the severe infection group were significantly higher than that in the control group,and CD8^+was significantly lower than that in the control group(P<0.05);the proportion of pDC,CD4^+,CD4^+/CD8^+in the severely infected group was significantly higher than that in the uninfected group,CD8^+was significantly lower than that in the uninfected group(P<0.05);the levels of IgA,IgG and IgM in the severely infected group were significantly lower than that in the control group and uninfected group(P<0.05).CONCLUSION In patients with chronic obstructive pulmonary disease secondary to pulmonary infection,the expression of TLR7 increased,the level of anti-inflammatory factors decreased and the secretion of pro-inflammatory factors increased,which suggested that the inflammatory response persisted.