病毒感染对慢性阻塞性肺疾病患者Th1/Th2偏移状态的影响

目的 探讨病毒感染与慢性阻塞性肺疾病(COPD)的关系,及病毒感染对COPD患者Th1/Th2偏移状态的影响.方法 应用间接ELISA法时81例COPD急性加重期患者、25例稳定期患者和22例正常对照者的血清进行呼吸道合胞病毒(RSV)、单纯疱疹病毒-1型(HSV-1)、副流感病毒(PIV)、腺病毒(ADV)、巨细胞病毒(CMV)的特异性抗体IgM进行检测.同时测定外周血单个核细胞上清液中细胞因子INF-γ和IL-4水平.结果 急性加重期组IgM阳性28例(34.57%),稳定期组和对照组lgM阳性率均为0,差异有统计学意义(X2=12.16,P<0.01).急性加重期组INF-γ和IL-4分别为(242±43)ng/L和(42±9)ng/L,稳定期组分别为(198±32)ng/L和(56±11)ng/L,对照组分别为(90±18)ng/L和(141±24)ng/L,差异有统计学意义(F分别为26.03和114.69,P均<0.01).急性加重期IgM阳性组INF-γ和IL4分别为(278±54)ng/L和(39±8)ng/L,阴性组分别为(185±33)ng/L和(61±13)ng/L,差异有统计学意义(t值分别为2.65和2.82,P均<0.01).结论 病毒感染是COPD急性加重期的重要诱因,COPD患者存在向Th1极化的调控,且病毒感染加强了COPD患者的Th1优势.

Study of viral infections on changes of Th1/Th2 in patients with chronic obstructive pulmonary disease

Objective To study the relationship between viral infection and chronic obstructive pulmonary disease (COPD),and the effect of viral infections on the changes of Th1/Th2 in COPD patients. Methods The se-ra from 81 patients with acute exacerbations of COPD,25 patients with stable COPD and 22 healthy subjects were tested for specific IgM of respiratary syncytial virus(RSV) ,herpes simplex virus type 1 (HSV-1), parainfluenza vi-rus (PIV), adenovirus (ADV) and cytomegalovirus (CMV) by indirect enzyme-linked immunosorbent assay (ELISA). Supernatant INF-γ and IL-4 cultured with PHA were determined. Results The positive rates of IgM in patients with acute exacerbations of COPD compared with those in patients with stable COPD and healthy subjects were significantly different(P <0.001 ). The level of INF-γ, and IL-4 in patients with acute exacerbations of COPD and stable COPD compared with normal control group;the level of INF-γ (242±43) and the of IL-4(42±9) in pa-tients with acute exacerbations of COPD was not significantly different as compared with the level of INF-γ( 198±32) and the level of IL-4(56±11 ) in patients with stable COPD (P<0.05), but the level of INF-γ was increased (90±18)and IL-4 was decreased (141±24) in control group (P<0.05). Compared with those in IgM negative group, the levels of INF-γ were significantly higher and the levels of IL-4 were significantly lowerIL-4 in lgM positive group( P<0.01 ). Conclusion Virus infection is a rather important factor in acute exacerbations of COPD, and COPD is characterized by a predominance of Th1-type response,and there is more significant Th1 response predomi-nance in COPD with virus infection.