全身短期应用糖皮质激素治疗加重期慢性阻塞性肺疾病气道炎性细胞因子的产生

探讨对全身短期应用糖皮质激素对慢性阻塞性肺疾病(COPD)患者加重期气道炎症和肺功能的影响。对59例COPD加重期患者给予地塞米松5mg静脉滴注5d,10d内减量至停用。治疗前后分别进行肺功能检查测定FEV1.0及FEV1.0占预计值百分数(FEV1.0pre),并收集诱导痰液分析炎性细胞变化。按照痰液嗜酸粒细胞占白细胞百分数升高与否分为嗜酸粒细胞增高组20名(A组)和非嗜酸粒细胞增高组39名(B组)。健康对照组13名为C组。检测治疗前后上清液白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、嗜酸粒细胞阳离子蛋白(ECP)、内皮素1(ET-1)的变化。与B组比较,A组治疗后Eos/Leu百分率下降(P<0.05),其他细胞比例无变化。B组治疗后炎性细胞占白细胞比例无变化。治疗后两组患者IL-8、TNF-α均明显下降(P<0.05),A组TNF-α下降明显(P<0.05)。治疗后A组ECP及ET-1显著降低,而B组变化不明显。全身短期应用糖皮质激素可改善加重期COPD患者的肺功能及气道炎症,在诱导痰液嗜酸粒细胞升高者效果更明显,与激素抑制嗜酸粒细胞气道炎症有关。中和实验,中和效价分别为10-1.8/10μl、10-1.6/10μl。由此表明,该抗独特型抗体疫苗具有良好的免疫原性。

Influence of short course of systemic corticosteroid therapy on the airway inflammations and lung function in patients with excerbations of chronic obstructive pulmonary disease

In the present study, the influence of short course of systemic corticosteroid therapy on the airway inflammations and lung function in patients with excerbations of chronic obstructive pulmonary disease (COPD) was investigated in which the induced sputum specimens were collected and the lung functions were tested in 59 patients with acute excerbations of COPD after short course treatment with dexamethasone of 5 mg per day and then rendered a gradual tapering of doses to zero by 10 days. These patients were divided into two groups on the basis of the percentages of eosinophils (Eos)/ leucocytes (Leu) in the induced sputums, in which 20 patients was found to be of high Eos/Leu ratio (group A), and the other 39 patients showing no any increase of the Eos counts in sputum (Group B). The levels cytokines including IL-8, TNF-α, eosinophil cationic protein (ECP) and endothelin-1 (ET-1) in induced sputum were determined by immunoassays. The results showed that compared with group B,, the Eos/Leu ratio in group A decreased significantly after corticosteroid treatment, and no change was found in the proportions with other cell types. Also in group B, there was no any change on the proportions of the inflammatory cells with leucocytes after treatment. The levels of IL-8 and TNF-α in sputum of all patients were significantly decreased, especially in group A, and the levels of ECP and ET-1 dropped markedly in group A, whereas there was no change in group B. It appears that systemic corticosteroid therapy can improve the lung function and airway inflammations in patients with excerbations of COPD, especially more evident in patients with elevation of eosinophils in the induced sputum.