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目的观察各期慢性阻塞性肺疾病(COPD)患者气道内促炎/抗炎介质的水平变化,阐明COPD气道局部炎症与气流受限的关系。方法检测48例COPD急性加重期患者入院第1d(加重期组)和治疗1周缓解后(缓解期组)、43例COPD稳定期患者(稳定期组),以及28例健康对照者(分为吸烟组和不吸烟组,各14例)诱导痰中肿瘤坏死因子α(TNF-α)和可溶性肿瘤坏死因子受体55、75(sTNF-R55、sTNF-R75)水平,以及肺功能(FEV1、FEV1%pred、FEV1/FVC等)指标的变化。结果COPD缓解期较加重期TNF-α浓度显著下降(P<0.05),sTNF-R55浓度显著上升(P<0.05),sTNF-R75浓度亦上升但差异无统计学意义(P>0.05)。加重期和缓解期诱导痰中TNF-α和sTNF-R55水平均显著高于稳定期患者和对照组(P<0.05)。吸烟组TNF-α水平高于不吸烟组,sTNF-R55水平低于不吸烟组。加重期组痰TNF-α水平与FEV1、FEV1%pred呈显著负相关,而sTNF-R55和sTNF-R75水平与FEV1、FEV1%pred呈显著正相关。稳定期组FEV1与sTNF-R55水平呈显著正相关,与TNF-α无明显相关性。对照组sTNF-R55、sTNF-R75水平与肺功能无明显相关性。结论各期COPD患者气道内存在促炎介质和抗炎介质的失衡,抗炎介质水平增加有利于临床肺功能的改善。
Objective To observe the levels of proinflammatory / anti-inflammatory mediators in the airway of patients with chronic obstructive pulmonary disease (COPD) at various stages and to elucidate the relationship between local airway inflammation and airflow limitation in COPD patients. Methods Forty-eight patients with exacerbation of COPD were enrolled on the first day (exacerbation group) and one week after remission (remission group), 43 patients with stable COPD (stable group) and 28 healthy controls Smoking group and non-smoking group (14 cases in each group) induced the levels of tumor necrosis factor α (TNF-α) and soluble tumor necrosis factor receptor (sTNF-R55, sTNF-R75) in sputum and pulmonary function (FEV1, FEV1% pred, FEV1 / FVC, etc.) changes in indicators. Results The concentration of sTNF-R55 significantly increased (P <0.05) and the concentration of sTNF-R75 increased in COPD remission group (P <0.05), but the difference was not statistically significant (P> 0.05). The levels of TNF-α and sTNF-R55 in induced sputum in both exacerbations and remissions were significantly higher than those in stable patients and controls (P <0.05). The level of TNF-α in smoking group was higher than that in non-smoking group, while the level of sTNF-R55 was lower in non-smoking group. The levels of TNF-α in exacerbation group were significantly negatively correlated with FEV1 and FEV1% pred, while the levels of sTNF-R55 and sTNF-R75 were positively correlated with FEV1 and FEV1% pred. There was a significant positive correlation between the level of FEV1 and sTNF-R55 in stable group and no significant correlation with TNF-α. There was no significant correlation between sTNF-R55 and sTNF-R75 levels and lung function in control group. Conclusions The imbalance between proinflammatory and anti-inflammatory mediators exists in the airway of patients with COPD at each stage. The increase of anti-inflammatory mediators is beneficial to the improvement of clinical pulmonary function.