【摘要】 目的探讨老年慢性阻塞性肺疾病(COPD)患者急性加重期T细胞免疫功能的改变及其影响因素,并观察免疫干预治疗的作用。方法采用随机的方法将75例老年COPD住院患者分为老年COPD干预组37例、老年COPD对照组38例,另设非老年COPD对照组28例,老年健康对照组20例。患者入院后行常规检查治疗,老年COPD干预组口服非特异免疫促进药匹多莫德,分别于第1天、第15天、第30天,用流式细胞仪检测患者外周血CD3+、CD4+、CD8+、CD4+／CD8+的改变,同时观察临床症状的改善情况对患者进行评估。结果老年COPD干预组、老年COPD对照组、非老年COPD对照组最终纳入分析患者分别为32、34、25例。老年COPD干预组和老年COPD对照组入院当天一般临床情况相似,两组的T细胞亚群与老年健康对照组及非老年COPD对照组比较,CD4+下降、CD8+上升、CD4+／CD8+倒置,差异均有统计学意义(分别为P<0．05、P<0．01)。老年COPD干预组治疗前CD3+、CD4+、CD8+、CD4+／CD8+值分别为(63．77±11．09、26．23±5．73、35．42±7．82、0．78±0．28),第30天分别为(67．83±10．04、36．80±9．82、27．28±10．00、1．36±0．46),差异有统计学意义(均为P<0．01)。老年COPD干预组住院时间(18．0±6．4)d,费用(10 266±6574)元,与老年COPD对照组比较,差异有统计学意义(均为P<0．05)。结论老年COPD患者在急性加重期细胞免疫功能下降。应用非特异性免疫促进剂匹多莫德,可改善其细胞免疫功能,同时减少了住院天数及费用。更多还原

【Abstract】 Objective To investigate the adaptive immune responses in elderly patients with chronic obstructive pulmonary disease during acute exacerbations (ECOPD) and effects of the immunostimulating agent Pidotimod in ECOPD patients. Methods A randomized, prospective clinical trial was held, and 103 patients with ECOPD were recruited into the study. Seventy-five patients aged 65 years and over were divided into two groups: 38 patients with general treatment as a control group and 37 patients with general treatment plus pidotimod as an experimental group. Another non-elderly groups comprised 28 patients younger than 65, and 20 healthy individuals served as the healthy elderly control. Levels of CD3+ , CD4+ , CD8+ , CD4+ /CD8+ in peripheral blood were measured by flow cytometry at baseline (the 1st day) and at the 15th and 30th treatment day, meanwhile, the clinical conditions were evaluated. Results Ninety-one patients completed the trial (32 in experimental group,34 in control group and 25 in non-eldely group). The experimental group and control group were statistically homogeneous. The aged COPD intervention group and aged COPD control had a more decreased CD4+ level, CD4+/CD8+ ratio and more increased CD8+ level, while compared with aged health control and non-elderly COPD control (all P<0. 05). Before treatment, the elderly COPD intervention group showed lower levels of CD3+ (63. 77±11.09 vs 67.83±10.04), CD4+ (26. 23±5. 73 vs 36. 80±9. 82) and CD4/CD8+ ratio(0. 78±0. 28 vs 1. 36±0. 46), and higher level of CD8+ (35. 42±7. 82 vs 27. 28±10. 00) ,as compared with the 30 d of pidotimod treatment(all P<0. 05). Conclusions T-cell immune responses are suppressed in elderly patients with ECOPD. Pidotimod treatment can improve the cell immune response.更多还原