吸入糖皮质激素对慢性阻塞性肺病急性加重期患者诱导痰中炎性标志物及肺功能的影响

目的探讨诱导痰中可溶性细胞间黏附分子-1(SICAM-1)、白细胞介素-8(IL-8)在慢性阻塞性肺病(COPD)发病机制中的作用和吸入糖皮质激素对COPD的影响。方法将70例患者随机分为一般组(35例)、激素组(35例),并以同期健康体检者为对照组(20例),分别于入院后第1天及治疗2周后行肺功能测定FEV1.0占预计值百分数(FEV1.0pre),应用ELISA法分别检测诱导痰上清液中IL-8和SICAM-1的水平。结果一般组和激素组治疗前后诱导痰液IL-8和SICAM-1水平均高于对照组(均P<0.01),FEV1.0pre低于对照组(P<0.01),治疗缓解后诱导痰液IL-8和SICAM-1水平低于治疗前(均P<0.01),FEV1.0pre有明显改善(P<0.01)。一般组和激素组治疗前诱导痰液IL-8和SICAM-1以及FEV1.0pre差异无统计学意义(P>0.05),治疗后激素组FEV1.0pre改善好于一般组(P<0.01),治疗后IL-8水平激素组低于一般组(P<0.05),SICAM-1水平两组治疗后比较差异无统计学意义(P>0.05)。结论IL-8和SICAM-1参与了COPD的炎症过程,COPD急性加重期患者短期吸入糖皮质激素能抑制IL-8的表达,不能抑制SICAM-1的表达,但可明显改善患者的气流受限状况。

Corticosteroid Inhalation on Expression of Inflammatory Molecules Ininduced Sputum and Pulmonary Function in Patients with Chronic Obstructive Pulmonary Diseases at Acute Exacerbation Phase

Objective To investigate the potential roles of soluble inter-cellular adhesion molecule-1（SICAM-1） and interleukin-8（IL-8） in pathogenesis of chronic obstructive pulmonary diseases（COPD）,and to evaluate the effects of corticosteroid inhalation on development of COPD.Methods Seventy patients with COPD at acute exacerbation phase were randomized into routine treatment group（n=35） and routine treatment plus corticosteroid group（n=35）.In parallel,a healthy control group was set up（n=20）.Patients in different groups were tested for their pulmonary function one day and two weeks after admission,respectively.Pulmonary function was evaluated as percent of forced expiratory volume in 1 second（FEV1.0）/ predicted FEV1.0（FEV1.0pre）.SICAM-1 and IL-8 in induced sputum were assayed with ELISA kit.Results The levels of SICAM-1 and IL-8 in induced sputum pre-and post-treatment from patients in two groups were higher than that in healthy control（P〈0.01）,while FEV1.0pre values were lower than that in healthy control（P〈0.01）.Compared to that of pretreatment,post-treatment levels of SICAM-1 and IL-8 in induced sputum from patients in two groups were lowered（P〈0.01） and FEV1.0pre significantly improved（P〈0.01） at remission.There was not any significant difference on pre-treatment FEV1.0pre,SICAM-1 and IL-8 in induced sputum between routine treatment group and routine treatment plus corticosteroid group at acute exacerbation phase（P〉0.05）.However,the post-treatment FEV1.0pre was much higher（P〈0.01）,and IL-8（P〈0.05） was lower in routine treatment plus corticosteroid group than that in routine treatment group.Surprisingly,there was not any significantly difference on post-treatment levels of SICAM-1 between the two treatment groups（P〉0.05）.Conclusion It＇s suggested that both SICAM-1 and IL-8 may be involved in the inflammatory process of COPD.It＇s demonstrated that short-term corticosteroid inhalation could inhibit expression of IL-8 but not SICAM-1,and significantly improve the obstruction status of airflow in patients with COPD at acute exacerbation phase.