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目的探讨慢性阻塞性肺疾病(COPD)患者急性期免疫功能的改变及免疫干预治疗的作用。方法采用随机的方法将65例来自于首都医科大学附属北京朝阳医院呼吸科2004-02—2004-10住院的COPD患者分成对照组、观察组,另有20名为健康组。在常规检查治疗一致的情况下,观察组加用非特异免疫调节药匹多的莫德片(Pidotimod),分别于第1、15、30天,用流式细胞仪检测患者外周血CD14、CD158b、CD3+、CD4+、CD8+、CD4+/CD8+的改变,同时观察临床症状的改善对患者进行评估。结果最终纳入分析的60例患者位于对照组、观察组各30例。60例痰培养阳性率占42·67%,外周血CD14、CD158与健康组比较差异无显著性,对照组病人住院治疗2周后CD14、CD158呈下降趋势,CD14有统计学意义(P<0·05)。观察组2周后CD14、CD158b均呈上升趋势(P<0·05)。重症患者(肺功能FEV1%<50%预计值)与健康组对照CD4+下降、CD8+上升、CD4+/CD8+倒置,差异有统计学意义(均P<0·01)。而经Pidotimod片治疗后,第15天CD4+、CD4+/CD8+上升(P<0·05),第30天时CD4+、CD4+/CD8+仍呈上升趋势,CD8+下降(P<0·01)。临床症状的改善较对照组快。结论COPD在急性期发作期间和治疗过程中存在免疫功能缺陷。免疫调节剂可改善免疫功能,加速临床症状的改善。
Objective To investigate the changes of immune function in acute phase of chronic obstructive pulmonary disease (COPD) and the role of immune intervention. Methods A total of 65 COPD patients admitted to Department of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University from February 2004 to June 2004 were randomly divided into control group, observation group and another 20 healthy subjects. In the routine examination and treatment of the same circumstances, the observation group with more non-specific immunomodulatory drugs Pidotimod Piduo tablets (Pidotimod), respectively, on the 1st, 15th and 30th days, using flow cytometry in patients with peripheral blood CD14, CD158b , CD3 +, CD4 +, CD8 +, CD4 + / CD8 +, while observing the improvement of clinical symptoms to evaluate the patients. Results The final analysis of 60 patients in the control group, the observation group of 30 cases. 60 cases of sputum culture positive rate accounted for 42.67%, peripheral blood CD14, CD158 and healthy group was no significant difference in the control group patients hospitalized for 2 weeks after the CD14, CD158 showed a downward trend, CD14 was statistically significant (P <0 · 05). After two weeks of observation, CD14 and CD158b showed an upward trend (P <0.05). In critically ill patients (FEV1% <50% of predicted pulmonary function) was significantly lower than that of healthy controls (P <0.01). The levels of CD4 +, CD8 + and CD4 + / CD8 + in control group were significantly decreased. After Pidotimod treatment, CD4 + and CD4 + / CD8 + increased on the 15th day (P <0.05). On the 30th day, CD4 + and CD4 + / CD8 + still showed an upward trend and CD8 + decreased (P <0.01). Clinical symptoms improved faster than the control group. Conclusion COPD has immunodeficiency defects during the acute phase and during the course of treatment. Immunomodulators improve immune function and speed up the improvement of clinical symptoms.