肺部感染对慢性阻塞性肺疾病患者呼吸功能状态与细胞因子表达的影响
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摘要
目的探讨肺部感染对慢性阻塞性肺疾病(COPD)患者呼吸功能状态与细胞因子水平的影响。方法2016年1月-2018年1月医院收治的COPD合并肺部感染患者54例作为试验组,COPD无肺部感染患者50例作为对照组。采用酶联免疫吸附试验检测细胞因子白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和转化生长因子-β(TGF-β)的水平,使用肺功能检测仪检测患者第一秒末用力呼气量(FEV1)、每分钟最大通气量(MVV)、最大呼气中期流速(MMF)、气道阻力(RAW)、共振频率(Fres)、动态胸肺顺应性(Cdyn)呼吸功能指标。结果试验组血清IL-6、IL-8、TNF-α和TGF-β的水平分别为(11.0±0.8)(pg/ml)、(11.3±1.1)(pg/ml)、(1.8±0.1)(ng/L)、(98.2±6.4)(ng/L),均高于对照组,试验组FEV1、MVV、MMF和Cdyn分别为(61.5±5.0)%、(46.5±3.9)%、(0.8±0.1)L/s、(30.8±5.4)ml/cmH2O,均低于对照组,试验组RAW和Fres分别为(118.3±12.4)%、(22.6±5.4)Hz,均高于对照组(P<0.05);感染程度越高,患者血清IL-6、IL-8、TNF-α和TGF-β的水平越高,FEV1、MVV、MMF和Cdyn越低,而RAW和Fres越高(P<0.05)。结论肺部感染影响了COPD患者的肺功能和炎症细胞因子水平,临床上应注重控制和预防肺部感染。
OBJECTIVE To investigate the effects of pulmonary infection on respiratory function and cytokine expression in patients with chronic obstructive pulmonary disease(CODP).METHODS Fifty-four patients with COPD combined with pulmonary infection in our hospital from Jan.2016 to Jan.2018 were included in this study as the observation group,and another 50 patients with COPD and without pulmonary infection were included as the control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect cytokines levels of interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-αand transforming growth factor(TGF)-β.The pulmonary function detector was used to determine the respiratory function indexes such as forced expiratory volume at the end of the first second(FEV1),per minute ventilation volume(MVV),maximal mid expiratory flow(MMF),airway resistance(RAW),resonance frequency(Fres)and dynamic lung compliance(Cdyn).RESULTS The serum levels of IL-6(11.0±0.8)pg/ml,IL-8(11.3±1.1)pg/ml,TNF-α(1.8±0.1)ng/L and TGF-β(98.2±6.4)ng/L levels in the observation group were significantly higher than those in the control group(P<0.05);FEV1(61.5±5.0)%,MVV(46.5±3.9)%,MMF(0.8±0.1)L/s and Cdyn(30.8±5.4)ml/cmH2 O in the observation group were significantly lower than those in the control group(P<0.05).RAW(118.3±12.4)%and Fres(22.6±5.4)Hz in the observation group were significantly higher than those in the control group(P<0.05).The higher the infection degree,the higher the serum IL-6,IL-8,TNF-αand TGF-βlevels were(P<0.05).The higher the infection degree,the lower the FEV1,MVV,MMF and Cdyn,and the higher the RAW and Fres were(P<0.05).CONCLUSIONPulmonary infection significantly affects the lung function and inflammatory cytokine levels in the patients with chronic obstructive pulmonary disease.In clinic,we should pay attention to control and prevent pulmonary infection.
OBJECTIVE To investigate the effects of pulmonary infection on respiratory function and cytokine expression in patients with chronic obstructive pulmonary disease(CODP).METHODS Fifty-four patients with COPD combined with pulmonary infection in our hospital from Jan.2016 to Jan.2018 were included in this study as the observation group,and another 50 patients with COPD and without pulmonary infection were included as the control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect cytokines levels of interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-αand transforming growth factor(TGF)-β.The pulmonary function detector was used to determine the respiratory function indexes such as forced expiratory volume at the end of the first second(FEV1),per minute ventilation volume(MVV),maximal mid expiratory flow(MMF),airway resistance(RAW),resonance frequency(Fres)and dynamic lung compliance(Cdyn).RESULTS The serum levels of IL-6(11.0±0.8)pg/ml,IL-8(11.3±1.1)pg/ml,TNF-α(1.8±0.1)ng/L and TGF-β(98.2±6.4)ng/L levels in the observation group were significantly higher than those in the control group(P<0.05);FEV1(61.5±5.0)%,MVV(46.5±3.9)%,MMF(0.8±0.1)L/s and Cdyn(30.8±5.4)ml/cmH2 O in the observation group were significantly lower than those in the control group(P<0.05).RAW(118.3±12.4)%and Fres(22.6±5.4)Hz in the observation group were significantly higher than those in the control group(P<0.05).The higher the infection degree,the higher the serum IL-6,IL-8,TNF-αand TGF-βlevels were(P<0.05).The higher the infection degree,the lower the FEV1,MVV,MMF and Cdyn,and the higher the RAW and Fres were(P<0.05).CONCLUSIONPulmonary infection significantly affects the lung function and inflammatory cytokine levels in the patients with chronic obstructive pulmonary disease.In clinic,we should pay attention to control and prevent pulmonary infection.
引文
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[16]Price D,Ostrem A,Thomas M,et al.Dual bronchodilation in COPD:lung function and patient-reported outcomes-a review[J].Int J Chron Obstruct Pulmon Dis,2017,12:141-168.
[17]王蕾,陈忠仁,沈彬,等.慢性阻塞性肺疾病患者血浆NLRP3、IL-1β、IL-18水平及其临床意义[J].中国现代医学杂志,2018,28(35):48-52.
[18]潘美妮,罗维贵,李林霖,等.IL-6与慢性阻塞性肺疾病关系的研究进展[J].医学综述,2018,24(24):4796-4801,4807.
[19]吕侯强,崔淑芬,谢轩,等.高血糖对慢性阻塞性肺疾病急性加重期患者炎性与血凝状态及肺功能影响的观察[J].中国糖尿病杂志,2018,26(8):657-661.
[20]Du YJ,Yang CJ,Li B,et al.Association of pro-inflammatory cytokines,cortisol and depression in patients with chronic obstructive pulmonary disease[J].Psychoneuroendocrinology,2014,46:141-152.
[21]陈永春,王天轶.不同时期慢性阻塞性肺疾病患者血清炎性因子水平和肺功能情况分析[J].解放军医药杂志,2017,29(4):38-40.
[22]刘道喜,刘慧,王晓明,等.COPD患者肺部感染对呼吸功能与细胞因子表达的影响研究[J].中华医院感染学杂志,2017,27(5):1019-1022.
[2]Lv Y,Lv Q,Lv Q,et al.Pulmonary infection control window as a switching point for sequential ventilation in the treatment of COPD patients:a meta-analysis[J].Int J Chron Obstruct Pulmon Dis,2017,12:1255-1267.
[3]Balavoine C,Andrejak C,Marchand-Adam S,et al.Relationships between COPD and nontuberculous mycobacteria pulmonary infections[J].Rev Mal Respir,2017,34(10):1091-1097.
[4]Sethi S.Chronic obstructive pulmonary disease and infection.Disruption of the microbiome?[J].Ann Am Thorac Soc,2014,11(S1):S43-S47.
[5]Bradford E,Jacobson S,Varasteh J,et al.The value of blood cytokines and chemokines in assessing COPD[J].Respir Res,2017,18(1):180.
[6]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[7]刘思娣,吴安华.美国急性病医院预防医院感染策略纲要(2014更新版)Ⅱ[J].中国感染控制杂志,2014,13(11):702-704.
[8]陆再英,终南山.内科学[M],北京,人民卫生出版社,2008,19-20.
[9]尚红,王毓三,申子瑜.全国临床检验操作规程(第4版)[M].北京:人民卫生出版社,2015:182-185.
[10]Lim TK,Ko FW,Benton MJ,et al.Year in review 2016:chronic obstructive pulmonary disease and asthma[J].Respirology,2017,22(4):820-828.
[11]Wouters EF,Wouters BB,Augustin IM,et al.Personalized medicine and chronic obstructive pulmonary disease[J].Curr Opin Pulm Med,2017,23(3):241-246.
[12]郭晓斌,冯可青,赵丽敏,等.慢性阻塞性肺疾病急性加重期患者肺部真菌感染的相关因素分析.[J]中华医院感染学杂志,2018,28(9):1313-1315,1323.
[13]马微,史艳霞,赵瑞芬.慢性阻塞性肺疾病急性加重患者常见病毒感染流行特征分析[J].中国病原生物学杂志,2018,13(7):747-750.
[14]Farah R,Ibrahim R,Nassar M,et al.Neutrophil lymphocyte ratio better addition to CRP than CD64index as marker for infection in COPD[J].Panminerva Med,2017,59(3):203-209.
[15]张海珊.肺康复护理对COPD稳定期患者肺功能及生活质量的影响[J].现代中西医结合杂志,2018,27(19):2160-2162.
[16]Price D,Ostrem A,Thomas M,et al.Dual bronchodilation in COPD:lung function and patient-reported outcomes-a review[J].Int J Chron Obstruct Pulmon Dis,2017,12:141-168.
[17]王蕾,陈忠仁,沈彬,等.慢性阻塞性肺疾病患者血浆NLRP3、IL-1β、IL-18水平及其临床意义[J].中国现代医学杂志,2018,28(35):48-52.
[18]潘美妮,罗维贵,李林霖,等.IL-6与慢性阻塞性肺疾病关系的研究进展[J].医学综述,2018,24(24):4796-4801,4807.
[19]吕侯强,崔淑芬,谢轩,等.高血糖对慢性阻塞性肺疾病急性加重期患者炎性与血凝状态及肺功能影响的观察[J].中国糖尿病杂志,2018,26(8):657-661.
[20]Du YJ,Yang CJ,Li B,et al.Association of pro-inflammatory cytokines,cortisol and depression in patients with chronic obstructive pulmonary disease[J].Psychoneuroendocrinology,2014,46:141-152.
[21]陈永春,王天轶.不同时期慢性阻塞性肺疾病患者血清炎性因子水平和肺功能情况分析[J].解放军医药杂志,2017,29(4):38-40.
[22]刘道喜,刘慧,王晓明,等.COPD患者肺部感染对呼吸功能与细胞因子表达的影响研究[J].中华医院感染学杂志,2017,27(5):1019-1022.