噻托溴铵联合奥达特罗治疗慢性阻塞性肺疾病患者的疗效及对免疫功能的影响

目的:探讨噻托溴铵联合奥达特罗治疗慢性阻塞性肺疾病(COPD)患者的疗效及对免疫功能的影响。方法:选取我院于2018年10月到2019年10月期间接收的108例COPD患者,按照随机数字表法将患者分为噻托溴铵组(n=36,噻托溴铵治疗)、奥达特罗组(n=36,奥达特罗治疗)、联合组(n=36,噻托溴铵联合奥达特罗治疗),比较三组患者疗效、肺功能、免疫功能及不良反应。结果:联合组治疗3个月后的临床总有效率、肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC、CD3+、CD4+、免疫球蛋白G(Ig G)、免疫球蛋白M(Ig M)均高于奥达特罗组、噻托溴铵组(P0.05)。奥达特罗组、噻托溴铵组治疗3个月后的的临床总有效率、FVC、FEV1、FEV1/FVC、CD3+、CD4+、Ig G、Ig M比较差异无统计学意义(P0.05)。三组治疗期间不良反应发生率整体比较差异无统计学意义(P0.05)。结论:噻托溴铵联合奥达特罗治疗COPD患者,疗效显著,可有效改善免疫功能及肺功能,且不增加不良反应发生率。     

稳定期慢性阻塞性肺疾病患者营养不良与甲状腺激素、肺功能及血清IL-6、IL-18的关系研究

目的:观察稳定期慢性阻塞性肺疾病(COPD)患者营养不良与甲状腺激素、肺功能及血清白细胞介素(IL)-6、IL-18的关系。方法:选择2019年1月~2020年12月我院收治的稳定期COPD患者76例作为研究对象。根据患者的微型营养评定(MNA)评分将其分为营养不良组(n=31)和非营养不良组(n=45),比较两组患者的人口学资料、疾病相关因素,甲状腺激素[三碘甲状腺原氨酸(T3)、甲状腺激素(T4)、促甲状腺激素(TSH)]水平,肺功能[第1秒用力呼气量占预测值百分比(FEV1%pred)、第1秒用力呼气量与用力肺活量比值(FEV1/FVC)],血清IL-6、IL-18水平。分析MNA评分与甲状腺激素水平、肺功能及血清IL-6、IL-18水平的相关性。分析患者发生营养不良的危险因素。结果:营养不良组年龄高于非营养不良组(P<0.05)。营养不良组T3、T4、TSH、FEV1%pred、FEV1/FVC显著低于非营养不良组,血清IL-6、IL-18水平显著高于非营养不良组(P<0.05)。稳定期COPD患者的MNA评分与T3、T4、TSH、FEV1%pred、FEV1/FVC呈正相关,与IL-6、IL-18呈负相关(P<0.05)。多因素Logistic回归分析显示,年龄>60岁、T3≤1.60 nmol/L、T4≤73.00 nmol/L、TSH≤1.50 nmol/L、FEV1%pred≤60.00%、FEV1/FVC≤0.54、IL-6≥8.00 pg/mL、IL-18≥47.00 pg/mL是稳定期COPD患者营养不良的危险因素(P<0.05)。结论:稳定期COPD患者营养不良受多种因素影响,临床应针对相关因素给予有效干预,降低此类患者营养不良风险。     

百令胶囊联合信必可对中重度稳定期慢性阻塞性肺疾病患者肺功能及免疫功能的影响

目的:探讨百令胶囊联合信必可对中重度稳定期慢性阻塞性肺疾病(COPD)患者肺功能及免疫功能的影响,为临床用药提供依据。方法:选取我院于2015年8月至2017年1月收治的104例COPD患者作为研究对象。采用随机数字表法将其分为单药组与联合组各52例。单药组患者单独给予信必可治疗及常规健康教育,联合组患者在单药组的基础上联用百令胶囊治疗。治疗前及治疗12周后对所有患者的用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及两者之比(FEV1/FVC)进行测定,同时测定患者CD3~+,CD4~+T细胞,并计算CD4~+/CD8~+比值。观察并比较两组患者的临床疗效。结果:治疗12周后,两组患者FVC、FEV1、FEV1/FVC均明显升高(均P0.05),且与单药组比较,联合组患者FVC、FEV1、FEV1/FVC均明显更高(均P0.05)。治疗12周后,两组患者CD3~+、CD4~+及CD4~+/CD8~+均明显升高(均P0.05),且与单药组比较,联合组患者CD3~+CD4~+及CD4~+/CD8~+均明显更高(均P0.05)。联合组总有效率为86.54%,明显高于单药组的67.31%(P0.05)。结论:百令胶囊联合信必可治疗中重度稳定期COPD患者疗效确切,能有效改善患者肺功能并提高免疫功能,值得在临床上推广。     

Coenzyme Q10, Copper,Zinc, and Lipid Peroxidation Levels in Serum of Patients with Chronic Obstructive Pulmonary Disease

Severity of chronic obstructive pulmonary disease (COPD) exacerbation is associated with increased level of copper (Cu), zinc (Zn), and lipid peroxidation (malodialdehyde, MDA). The aim of this study was to investigate the levels of lipid peroxidation, Coenzyme Q10 (CoQ10), Zn, and Cu in the COPD exacerbations. Forty-five patients with COPD acute exacerbation and 45 healthy smokers as control group were used in the study. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were lower in exacerbation group than in control. C- reactive protein levels, white blood cell count, and sedimentation rate were significantly (p < 0.001) higher in patients than in control. CoQ10 level and Cu/Zn ratio was significantly (p < 0.05) lower in patients than in control, although MDA, Cu, and Zn levels were significantly (p < 0.05) higher in patients than in control. Negative correlations were found among MDA, Cu, Zn, FEV1, and FVC values in exacerbation and control subjects (p < 0.05). In conclusion, we observed that oxidative stress in the exacerbation period of COPD patients was increased. The decrease in CoQ10 level and Cu/Zn ratio and elevation in Cu and Zn levels observed in the patients probably result from the defense response of organism and are mediated by inflammatory-like substances.     

慢性阻塞性肺疾病急性加重期患者血清PCT、hs-CRP、D-D和FIB与肺功能和预后的关系研究

目的:探究慢性阻塞性肺疾病急性加重期(AECOPD)患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)和纤维蛋白原(FIB)与肺功能和预后的关系。方法:选择2017年8月至2019年8月期间我院诊治的88例AECOPD患者作为观察组,根据患者生存情况将患者进一步分为85例存活组和3例死亡组。同时选择同期在我院进行健康体检的50名志愿者作为对照组。检测各组患者的血清PCT、hs-CRP、D-D和FIB水平,采用肺功能检测仪检测第一秒用力呼气容积(FEV1)%、第一秒用力呼气容积占用力肺活量比值(FEV1/FVC)和最大通气量(MVV)肺功能指标,采用Pearson相关性分析进行各指标的相关性分析。结果:与对照组相比,观察组的血清PCT、hs-CRP、D-D和FIB水平均明显升高(P0.05)。与存活组相比,死亡组的血清PCT、hs-CRP、D-D和FIB水平均明显升高(P0.05),FEV1%、FEV1/FVC和MVV指标均明显下降(P0.05)。Pearson相关性分析显示,血清PCT、hs-CRP、D-D和FIB水平均与FEV1%、FEV1/FVC和MVV肺功能指标呈负相关(P0.05)。结论:AECOPD患者肺功能下降和不良预后与血清PCT、hs-CRP、D-D和FIB水平升高密切相关,在AECOPD患者的预后预测中具有一定临床价值。     

胸腔镜食管癌切除术后肺部感染患者肺功能和炎症因子水平的关系研究

目的:研究胸腔镜食管癌切除术后肺部感染患者肺功能和炎症因子水平的关系。方法:选取2015年3月～2018年7月我院收治的食管癌患者120例为研究对象,将其以随机数字表法分成对照组和观察组。对照组予以传统开胸手术治疗,观察组则予以胸腔镜食管切除术治疗。分别比较两组术后肺部感染发生情况、手术前后肺功能以及炎症因子水平变化情况,并分析胸腔镜食管癌切除术后肺部感染患者肺功能与炎症因子的关系。结果:观察组患者术后肺部感染发生率为13.33%(8/60),低于对照组的36.67%(22/60),差异有统计学意义(P0.05)。术后观察组用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC均高于对照组,差异均有统计学意义(均P0.05)。术后1 d、术后5 d观察组白细胞介素-6(IL-6)、白细胞介素-10(IL-10)以及C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(均P0.05)。经Pearson相关性分析可得:胸腔镜食管癌切除术后肺部感染患者FVC、FEV1、FEV1/FVC与IL-6、IL-10、CRP均呈负相关性(均P0.05)。结论:胸腔镜食管癌切除术可显著降低患者肺部感染发生风险,且术后肺部感染患者肺功能与炎症反应存在密切相关,降低术后肺部感染发生率的机制可能与减轻机体炎症反应有关。     

二十四式简化太极拳联合呼吸功能训练对中老年COPD患者肺功能、运动耐力及心理状态的影响

摘要 目的：探讨二十四式简化太极拳联合呼吸功能训练对中老年慢性阻塞性肺疾病（COPD）患者肺功能、运动耐力及心理状态的影响。方法：选取2019年4月~2020年8月期间我院收治的中老年COPD患者81例,按照信封抽签法分为对照组（40例,给予呼吸功能训练干预）和观察组（41例,给予二十四式简化太极拳联合呼吸功能训练干预）,均干预6个月。对比两组干预前、干预6个月后的肺功能、运动耐力、心理状态及生活质量。结果：两组干预6个月后用力肺活量（FVC）、1 秒用力呼气容积( FEV1)、FEV1/FVC升高,且观察组高于对照组（P<0.05）。两组干预6个月后呼吸症状、疾病影响、活动受限评分降低,且观察组低于对照组（P<0.05）。两组干预6个月后6 min步行试验（6MWT）距离延长,且观察组长于对照组（P<0.05）。两组干预6个月后人际关系、抑郁、偏执、敌对、焦虑、恐惧评分降低,且观察组低于对照组（P<0.05）。结论：中老年COPD患者经二十四式简化太极拳联合呼吸功能训练干预后,肺功能、运动耐力、生活质量及心理状态均得到显著改善,提示该康复训练方案可用于辅助中老年COPD患者的治疗。     

丹参川芎嗪注射液联合NIPPV治疗COPD合并呼吸衰竭的临床疗效

目的:探讨丹参川芎嗪注射液联合无创正压通气(NIPPV)治疗慢性阻塞性肺病COPD合并呼吸衰竭的临床疗效。方法:选择2015年1月至2016年12月在我院进行治疗的COPD合并呼吸衰竭患者70例,随机分为两组,每组35例。对照组患者采用NIPPV治疗,观察组在此基础上给予丹参川芎嗪注射液静脉滴注。比较两组患者治疗期间的动脉血气分数、肺功能指标,评价两组患者治疗前后的病情状况以及阻塞性肺病及支气管哮喘生理状况。结果:治疗后3 d以及10 d,观察组动脉血氧分压(PaO_2)、一秒用力呼气容积(FEV1)、用力肺活量(FVC)以及FEV1/FVC均显著高于对照组(P0.05),观察组动脉二氧化碳分压(PaCO_2)显著低于对照组(P0.05),而两组间动脉血氧饱和度(SaO_2)、pH比较差异无统计学意义(P0.05)。治疗后,观察组的急性生理性与慢性健康状况(APACHEⅡ)以及慢性阻塞性肺疾病和支气管哮喘生理(CAPS)评分均显著低于对照组(P0.05)。结论:丹参川芎嗪注射液辅助NIPPV有利于COPD合并呼吸衰竭患者肺功能的恢复,改善患者血气指标和预后。     

MMP‐3 (–1171 5A/6A; Lys45Glu) variants affect serum levels of matrix metalloproteinase (MMP)‐3 and correlate with severity of COPD: A study of MMP‐3, MMP‐7 and MMP‐12 in a Tunisian population

Background

The present study aimed to examine the role of matrix metalloproteinase (MMP)‐3 [(–1171) 5A/6A; Lys45Glu (A/G)], MMP‐7 [(–181) A/G] and MMP‐12 [(–82) A/G; Asn357Ser (A/G)] variants in the development and severity of chronic obstructive pulmonary disease (COPD) in Tunisians.

Methods

Plethysmography was performed in all participants to measure forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC parameters. Genotyping of MMP‐3, MMP‐7 and MMP‐12 polymorphisms was carried out in 138 patients with COPD and 216 healthy controls using a polymerase chain reaction–restriction fragment length polymorphism. Serum levels of MMPs and cytokines (interleukin‐6, tumor necrosis factor‐α) were determined by an enzyme‐linked immunosorbent assay.

Results

No significant correlations were observed between genetic variations in MMP‐3, MMP‐7 and MMP‐12 and the risk of development of COPD. Additionally, no impact of MMP‐7 (–181) A/G and MMP‐12 [(–82) A/G; Asn357Ser (A/G)] polymorphisms was observed on the respective protein levels and clinical parameters of the disease. Interestingly, both MMP‐3 (–1171) 5A/6A and Lys45Glu (A/G) variants were associated with respiratory function, as well as with serum levels of MMP‐3 in COPD patients. A relationship was found between the (–1171) 6A and 45Glu (G) alleles of the MMP‐3 gene and enhanced airflow limitation among COPD patients. Additionally, carriers of the 6A6A and 45 GG genotypes present higher MMP‐3 levels than noncarriers.

Conclusions

MMP‐3 (–1171) 5A/6A and Lys45Glu (A/G) polymorphisms were associated with the decline of lung function among COPD patients. These results could be linked to the upregulation of MMP‐3 in serum from COPD patients carrying the (–1171) 6A and 45 G homozygous genotypes.     

自血疗法对慢阻肺稳定期大鼠治疗效果及对MMP-9和TIMP-1水平的影响

摘要 目的：分析自血疗法对慢阻肺稳定期大鼠治疗效果及对MMP-9和TIMP-1水平的影响。方法：将30只大鼠随机分成正常对照组、慢性阻塞性肺疾病（COPD）模型组和自血疗法组,每组10只。除正常对照组,其余大鼠采用熏香烟联合气道内灌注大肠杆菌内毒素建立慢阻肺稳定期大鼠模型。正常对照组和COPD模型组大鼠给予生理盐水治疗,自血疗法组给予穴位注射自体血液治疗。比较各组大鼠一般症状、肺功能、血清炎性因子、血清基质金属蛋白酶-9（MMP-9）和金属蛋白酶抑制剂-1（TIMP-1）水平以及肺组织中MMP-9和TIMP-1水平。结果：与正常对照组相比,COPD模型组大鼠的肺功能受损,体重、低0.3s用力呼气量（FEV0.3s）、用力肺活量（FVC）、FEV0.3s/ FVC（%）和呼气峰流速（PEF）均明显降低（P＜0.05）,血清白介素-2（IL-2）、白介素-6（IL-6）、C反应蛋白（CRP）、降钙素原（PCT）、MMP-9和TIMP-1表达水平,呼吸频率以及肺组织中MMP-9和TIMP-1表达水平均明显升高（P＜0.05）。与COPD组相比,自血疗法组大鼠体重、FEV0.3s、FVC、FEV0.3s/ FVC（%）和PEV均明显升高（P＜0.05）,血清IL-2、IL-6、CRP、PCT、MMP-9和TIMP-1表达水平,呼吸频率以及肺组织中MMP-9和TIMP-1表达水平均明显降低（P＜0.05）。结论：自血疗法可通过改善大鼠炎性反应程度,降低血清及肺组织中MMP-9和TIMP-1表达水平,达到改善或缓解大鼠肺慢阻症状的作用。     

Associations of ABHD2 Genetic Variations with Risks for Chronic Obstructive Pulmonary Disease in a Chinese Han Population

The human α/β hydrolase domain-containing protein 2 gene (ABHD2) plays a critical role in pulmonary emphysema, a major subset of the clinical entity known as chronic obstructive pulmonary disease (COPD). Here, we evaluated genetic variation in the ABHD2 gene in a Chinese Han population of 286 COPD patients and 326 control subjects. The rs12442260 CT/CC genotype was associated with COPD (P < 0.001) under a dominant model. In the former-smoker group, the rs12442260 TT genotype was associated with a decreased risk of developing COPD after adjusting for age, gender and pack-years (P = 0.012). Rs12442260 was also associated with pre-FEV1 (the predicted bronchodilator forced expiratory volume in the first second) in controls (P = 0.027), but with FEV1/ forced vital capacity (FVC) ratios only in COPD patients (P = 0.012) under a dominant model. Results from the current study suggest that ABHD2 gene polymorphisms contribute to COPD susceptibility in the Chinese Han population.     

清气化痰汤联合穴位贴敷治疗AECOPD痰热壅肺证的疗效及对血清MMP-2、MMP-9、MMP-12的影响

摘要 目的：探讨清气化痰汤联合穴位贴敷治疗慢性阻塞性肺疾病急性加重期（AECOPD）痰热壅肺证的疗效及对血清基质金属蛋白酶（MMP）-2、MMP-9、MMP-12的影响。方法：选取武汉市中医医院2020年8月~2022年8月期间收治的116例AECOPD 痰热壅肺证患者,按照随机数表法分成对照组（n=58,西医常规治疗联合穴位贴敷治疗）和实验组（n=58,对照组基础上联合清气化痰汤治疗）。对比两组中医证候积分、慢性阻塞性肺疾病评估测试问卷（CAT）评分、炎症因子指标[白细胞介素（IL）-6、IL-8、降钙素原（PCT）]、肺功能指标[第一秒用力呼气容积（FEV₁）、用力肺活量（FVC）、FEV₁/FVC]、血清MMP-2、MMP-9、MMP-12水平。结果：两组治疗后发热、咳嗽或喘息气急、大便干结、口渴喜冷饮、痰多色黄或白黏、CAT评分下降,且实验组低于对照组（P<0.05）。两组治疗后FEV₁、FVC、FEV₁/FVC升高,且实验组高于对照组（P<0.05）。两组治疗后IL-6、IL-8、PCT下降,且实验组低于对照组（P<0.05）。两组治疗后血清MMP-2、MMP-9、MMP-12下降,且实验组低于对照组（P<0.05）。结论：清气化痰汤联合穴位贴敷治疗AECOPD痰热壅肺证,可改善患者的肺功能,降低炎症因子和血清MMP-2、MMP-9、MMP-12水平,进一步改善患者的临床症状。     

慢性阻塞性肺疾病患者中血清亲环素A、趋化因子CX3CL1表达水平及临床意义

摘要 目的：探讨慢性阻塞性肺疾病（COPD）患者中血清亲环素A（CyPA）、趋化因子CX3CL1以及其他炎性指标的表达水平及其临床意义。方法：选取2019年1月-2021年6月本院收治的COPD患者120例作为研究对象,其中68例患者为急性加重期组,52例患者为稳定期组;另选取体检健康者45例作为对照组。收集所有受试者的临床资料,检测其血清中CyPA、CX3CL1、C反应蛋白（CRP）、白细胞介素-6（IL-6）以及基质金属蛋白酶-9（MMP-9）水平,比较3组患者各参数的差异,并与肺功能进行相关性分析,比较急性加重期患者治疗前后各指标的差异。结果：急性加重期组患者的血清 CyPA、CX3CL1、CRP、IL-6、MMP-9水平均明显高于稳定期组和对照组患者,稳定期组患者的血清 CyPA、CX3CL1、CRP、IL-6、MMP-9水平均明显高于对照组患者（均P＜0.05）;而急性加重期组患者的第1s用力呼气量（FEV₁）、用力肺活量（FVC）、第1s用力呼气量（FEV₁）与用力肺活量（FVC）的比值（FEV₁%）、最大呼气峰流速（PEF）以及最大呼气中期流速（MMEF）明显低于稳定期组和对照组患者,稳定期组患者的FEV₁、FVC、FEV₁/FVC、PEF、MMEF明显低于对照组患者（均P＜0.05）。COPD患者的血清CyPA、CX3CL1、CRP、IL-6、MMP-9水平与FEV₁、FVC、FEV₁/FVC、PEF、MMEF呈负相关（P<0.05）。与治疗前相比较,急性加重期组患者在治疗后血清CyPA、CX3CL1、CRP、IL-6、MMP-9水平明显下降,而FEV₁、FVC、FEV₁/FVC、PEF、MMEF明显上升（均P＜0.05）。结论：COPD患者的血清CyPA、CX3CL1、CRP、IL-6、MMP-9水平可在一定程度上预测患者的严重程度,同时也可以作为急性加重期治疗后效果的评价指标。     

The effects of depression,anxiety and sleep disturbances on cognitive impairment in patients with chronic obstructive pulmonary disease

The purpose of this study was to investigate the effects of depression, anxiety and sleep disturbances on cognitive functions in chronic obstructive pulmonary disease (COPD) patients. In this prospective case-control study, demographic data, smoking history, depression, anxiety, sleep quality and cognitive status of 48 COPD patients and 36 healthy volunteers aged 40–90 years were recorded. The Beck depression inventory (BDI), the Beck anxiety inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression, anxiety and sleep quality, respectively in COPD patients. Cognitive performance was studied by the mini-mental state examination. The mean age of patients with COPD was 65.3 ± 9.4 years, and disease duration was 9.6 ± 7.8 years. Male sex ratio, smoking, BDI score, BAI score, total PSQI score, sleep latency, sleep duration, average use of sleep aids and sleep disturbances in patients with COPD were significantly higher than the control group (p < 0.05). When cognitive impairment was compared by age, FVC, FEV, FEV/FVC, PEF values and smoking, no statistically significant relationship was found (p > 0.05). A statistically significant relationship was established between cognitive impairment and severity of disease, presence of anxiety, presence of depression and sleep quality. In our study, we found that sleep disorders, depression and anxiety comorbid with COPD increased cognitive impairment as well as the severity of disease. We believe that this finding is important in terms of reducing the risk of cognitive impairment, preventing misdiagnosis and treatment of the aforementioned comorbid diseases.     

舒利迭无创通气对慢性阻塞性肺疾病合并呼吸衰竭患者肺功能及动脉血 气分析的影响

目的:探讨舒利迭联合无创通气对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者肺功能和动脉血气的影响。方法:选取2013年5月-2015年5月在我院接受治疗的COPD合并呼吸衰竭患者92例,根据治疗方法不同,将患者分为研究组和对照组。对照组患者给予控制感染、化痰、平喘等常规治疗,研究组在此基础上给予舒利迭无创通气治疗。采用血气分析仪检测两组患者治疗前后二氧化碳分压(PaCO_2)、血氧分压(PaO_2)及酸碱度(pH)等动脉血气指标。应用肺功能检测仪检测患者用力肺活量(FVC)、呼气高峰流量(PEFR)以及1 s用力呼气容积(FEV1)等肺功能指标。结果:治疗前,两组患者PaCO_2,PaO_2,pH,FVC,PEFR及FEV1比较,差异均无统计学意义(P0.05);治疗后,两组患者PaCO_2较治疗前明显下降,而PaO_2与pH明显上升,差异具有统计学意义(P0.05);治疗后,研究组PaCO_2低于对照组,而PaO_2与pH高于对照组,差异具有统计学意义(P0.05);治疗后,两组患者FVC,PEFR及FEV1明显上升,且研究组高于对照组,差异均具有统计学意义(P0.05)。结论:舒利迭联合无创通气对COPD合并呼吸衰竭患者肺功能及动脉血气具有明显的改善作用,值得临床推广及应用。     

乌司他丁联合布地奈德治疗支气管哮喘急性发作期的临床疗效及对患者血清PDCD5、S1P、OPN水平的影响

目的:探讨乌司他丁联合布地奈德治疗支气管哮喘急性发作期的临床疗效及对患者血清程序化细胞死亡因子5(PDCD5)、1-磷酸鞘氨醇(S1P)、骨桥蛋白(OPN)水平的影响。方法:选择2014年3月到2017年3月于我院进行治疗的170例支气管哮喘急性发作期患者作为研究对象,按照随机数表法分为观察组(n=90)和对照组(n=80)。对照组使用布地奈德治疗,观察组在对照组的基础上使用乌司他丁进行治疗。比较两组的临床疗效,治疗前后血清PDCD5、S1P、OPN水平、第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC水平的变化、临床症状改善情况及不良反应的发生情况。结果:治疗后,观察组临床疗效总有效率为95.56%,明显高于对照组(71.25%,P0.05);两组血清PDCD5、S1P、OPN水平较治疗前均显著降低(P0.05),且观察组血清以上指标均明显低于对照组(P0.05);两组FEV1、FVC、FEV1/FVC水平较治疗前均显著升高(P0.05),观察组以上指标均明显高于对照组(P0.05);观察组患者咳嗽、哮鸣音及胸闷气短消失时间均明显短于对照组(P0.05);观察组不良反应总发生率为6.67%,显著低于对照组(18.75%,P0.05)。结论:乌司他丁联合布地奈德治疗支气管哮喘急性发作期患者的临床效果显著优于单用布地奈德治疗,可能与其有效改善患者血清PDCD5、S1P、OPN水平有关。     

Assessment of Treg/Th17 axis role in immunopathogenesis of chronic injuries of mustard lung disease

Purpose: Sulfur mustard (SM) lung is a heterogeneous disease associated with abnormal inflammatory immune responses. The Th17/Treg axis imbalance is associated with the pathogenesis of chronic inflammatory pulmonary disease. We aimed to determine the distribution of different Th17 and Treg cells in patients with SM lung and chronic obstructive pulmonary disease (COPD) and evaluate the clinical implications in this homeostasis. Methods: In this analytical cross-sectional study, CD4?⁺?Foxp3^+?Treg and CD4⁺?IL-17^+?Th17 cells were measured in peripheral blood mononuclear cells (PBMCs) and transbronchial biopsy (TBB) samples of 15 SM-exposed patients, 12 COPD and 13 healthy controls (HCs). The potential correlation between the ratio of Th17/Tregs and lung function was evaluated with multivariate logistic regression (MLR) analysis. Results: The frequency of CD4?⁺?FoxP3⁺?Tregs and CD4?⁺?IL-17⁺?Th17 was increased ～1.7-fold (8.71/4.95) and ～2.7-fold (1.028/0.371) respectively, in the PBMC of SM patients compared with the health controls (p?<?0.001). The results indicated that there were increases in the frequency of Th17 and Tregs cells in the patients with COPD versus the HC, that is, ～2.6-fold (0.987/0.371) and ～1.4-fold (7.12/4.95), respectively; but they did not reach to SM level (p?≥?0.05). Moreover, in the TBB samples, the CD4?⁺?IL-17^+?Th17 and CD4⁺?FoxP3^+?Tregs numbers were significantly higher in SM and COPD patients than HC (p?<?0.05). The Th17 and Treg cells were inversely correlated with forced expiratory volume in 1s (FEV1%) (r?=??0.351, p =?0.001; r?=??0.344, p?=?0.021) and FEV1/FVC (r?=??0.44, p?=?0.001; r?=??0.302, p?=?0.011), respectively. Instead, positive correlations were found between Treg/Th17 ratios and forced FEV1%pred (r?=?0.156, p?=?0.007), as well as FEV1/FVC ratio (r?=?0.334, p?=?0.006). Conclusions: The imbalance of Th17/Treg has a key role in immunopathogenesis of chronic phase of mustard lung disease.     

慢性阻塞性肺疾病急性加重期患者血清SAA水平与肺功能、炎性因子的相关性及其诊断价值分析

目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清淀粉样蛋白A(SAA)水平与肺功能及炎性因子的相关性,并分析其诊断价值。方法:选取2013年6月-2018年6月中国人民解放军第970医院收治的204例慢性阻塞性肺疾病(COPD)患者作为研究对象,其中COPD稳定期患者132例作为COPD稳定组,AECOPD患者72例作为AECOPD组。另选取同期于中国人民解放军第970医院进行健康体检的50例健康体检者作为健康组。比较三组受试者血清SAA水平、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)水平及肺功能,采用Pearson相关性分析AECOPD患者血清SAA水平与肺功能及炎性因子的相关性,并分析SAA对AECOPD的诊断价值。结果:AECOPD组患者血清SAA、PCT、CRP、IL-6、IL-8水平较COPD稳定组及健康组升高(P0.05),COPD稳定组患者血清SAA、IL-6、IL-8、PCT、CRP水平均高于健康组,差异有统计学意义(P0.05);AECOPD组患者第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、第一秒用力呼吸容积占用力肺活量的百分比(FEV1/FVC%)、第一秒用力呼气容积占预计值百分比(FEV1%)低于COPD稳定组及健康组,差异有统计学意义(P0.05),COPD稳定组患者FEV1、FVC、FEV1/FVC%、FEV1%低于健康组,差异有统计学意义(P0.05)。Pearson相关性分析显示,AECOPD患者血清SAA水平与IL-8、IL-6、CRP、PCT呈正相关,与FEV1%、FEV1/FVC%、FEV1、FVC呈负相关(P0.05)。受试者工作特征(ROC)曲线结果显示,SAA对AECOPD诊断的敏感度为80.85%,特异度为80.07%,曲线下面积为0.832。结论:AECOPD患者血清SAA水平明显升高,其与患者肺功能及炎症因子存在相关性,具有较高的诊断价值,可用于AECOPD患者病情的评估。     

Enhanced expression of human β-defensin 2 in peripheral lungs of patients with chronic obstructive pulmonary disease

Human β-defensin 2 (hBD-2) has antimicrobial activity and may play a role in airway mucosal defense, but studies have not yet examined its expression in lung tissue of patients with chronic obstructive pulmonary disease (COPD). Here we investigated hBD-2 levels in lung tissues of COPD patients and analyzed their correlations with IL-8, IL-1β, cigarette smoking and lung function in order to see whether the protein may be involved in pathogenesis of the disease. Peripheral lung tissue specimens were obtained from 51 patients who underwent lung resection for peripheral lung cancer: healthy non-smokers (n = 8), healthy current smokers (n = 7), non-smokers with COPD (n = 11), and current smokers with COPD (n = 25). RT-PCR and immunohistochemical staining were used to detect expression levels of hBD-2, IL-8 and IL-1β. Expression of hBD-2 mRNA was significantly higher in COPD patients than in healthy controls, and significantly higher in current smokers than in non-smokers (p < 0.05). Among healthy controls, hBD-2 mRNA levels were similar between current smokers and non-smokers. Immunohistochemistry showed hBD-2 protein to be expressed mainly in epithelia of distal bronchioles and its expression pattern among our patient groups mirrored that of the mRNA. IL-8 mRNA levels were significantly higher in COPD patients than in healthy controls (p < 0.05), while IL-1β mRNA levels did not differ significantly among the groups. Levels of hBD-2 mRNA positively correlated with levels of IL-8 mRNA (r = 0.545, p = 0.002), and negatively correlated with FEV1/FVC ratios and with predicted FEV1% values (r = −0.406, p = 0.011). Our results indicate that hBD-2 expression is elevated in distal airways of COPD patients and that it may be involved in pathogenesis of the disease. Our data implicate cigarette smoking as a factor that may elevate hBD-2 levels in lung tissues of COPD patients.     

沙美特罗联合噻托溴铵对慢性阻塞性肺疾病患者血清MMP-2, MMP-9及IL-8水平的影响

目的:探讨沙美特罗联合噻托溴铵对慢性阻塞性肺疾病患者血清炎症因子水平及肺功能的影响。方法:选择2014年5月-2016年5月我院收治的慢性阻塞性肺病患者83例作为研究对象,根据治疗方法不同,将所选患者分为研究组(45例)和对照组(38例)。研究组患者采用沙美特罗联合噻托溴铵吸入治疗,对照组患者采用沙美特罗治疗。观察并比较两组患者治疗前后血清MMP-2,MMP-9及IL-8水平及肺功能指标的变化情况。结果:治疗前两组患者血清MMP-2,MMP-9及IL-8水平比较,差异无统计学意义(P0.05);治疗后两组患者血清MMP-2,MMP-9及IL-8水平均低于治疗前,且研究组低于对照组,差异均具有统计学意义(P0.05)。与治疗前比较,两组患者治疗后FEV1/FVC,FEV1及MVV均升高,差异具有统计学意义(P0.05);与对照组比较,研究组患者治疗后FEV1/FVC,FEV1及MVV较高,差异具有统计学意义(P0.05)。结论:沙美特罗联合噻托溴铵治疗慢性阻塞性肺疾病的临床效果显著,不仅能够降低患者血清炎症因子水平,还可改善患者肺功能,值得临床推广应用。