【摘要】 目的探讨慢性阻塞性肺疾病(COPD)病理机制中T淋巴细胞免疫平衡的变化。方法选取2015年1月至2016年12月该院收治的48例COPD急性加重期(AECOPD)患者为研究组;30例健康体检者为对照组;流式细胞技术检测外周血T细胞功能亚群,酶联免疫吸附试验(ELISA)方法检测细胞因子,比较两组间观察指标及其相关性变化;因子分析方法分析两组间主成分变化。结果研究组CD8~+T细胞较对照组降低[23.8%(17.5%,30.1%)vs.28.2%(23.8%,31.5%),P<0.05];Treg和Th17较对照组升高[8.5%(8.3%,9.0%)vs.5.6%(4.9%,6.1%),P<0.01;2.9%(2.8%,3.0%)vs.1.2%(1.2%,1.4%),P<0.01]。研究组IL-12[54.97pg/mL(31.20,161.59)pg/mL]、IL-22[17.70pg/mL(15.60,35.99)pg/mL]、IL-23[120.28pg/mL(82.97,169.27)pg/mL]、IL-23R[0.15pg/mL(0.15,0.71)pg/mL]和TNF-α[1 000pg/mL(1 000,1 000)pg/mL]高于对照组[31.20pg/mL(31.20,56.23)pg/mL、15.60pg/mL(15.60,15.60)pg/mL、78.10pg/mL(78.10,99.08)pg/mL、0.15pg/mL(0.15,0.15)pg/mL、722.16pg/mL(494.25,941.44)pg/mL,均P<0.05]。相关性分析显示:研究组Th17与Treg呈负相关(r=-0.883,P<0.01),IL-22与IL-23呈正相关(r=0.340,P<0.05)。对照组CD4与CD8~+T细胞、Th17与CD3~+T细胞、Th17与CD8~+T细胞的呈负相关(r分别为-0.578、-0.393、-0.569,P<0.05);Th17与Treg、IL-23与CD4~+T细胞及TNF-α与DNT呈正相关(r分别为0.403、0.440、0.392,P<0.05)。两组均有5个主成分,但研究组负荷变量较对照组有变化:依次为Th17/Treg、Th17、Treg vs.CD4~+T细胞/CD8~+T细胞、CD4~+T细胞、CD8~+T细胞;CD4~+T细胞/CD8~+T细胞、CD8~+T细胞vs.Th17/Treg、Treg;CD4~+T细胞、CD3~+T细胞vs.IL-12、IL-23R;IL-12、IL-23Rvs.CD3~+T细胞;IL-23、IL-22 vs.TNF-α、DNT。结论 COPD病理机制中,以IL-22与IL-23参与为主的Th17细胞功能超强所致免疫损伤可能是主要矛盾;并伴CD8细胞毒和双阴性T细胞(DNT)调节作用减弱。更多还原

【Abstract】 Objective To investigate the changes of T lymphocyte immune balance in the patients with COPD.Methods Forty-eight patients with AECOPD from January 2015 to December 2016 in this hospital were selected as study group and 30 healthy subjects as control.T cells and cytokines in peripheral blood were detected by flow cytometry and ELISA,respectively.The levels of them were compared between the two groups.The correlations of them and principal components were analyzed among the two groups.Results(1)CD8~+T cells in the study group decreased[23.8%(17.5%,30.1%)vs.28.2%(23.8%,31.5%),P<0.05],Treg and Th17 increased[8.5%(8.3%,9.0%)vs.5.6%(4.9%,6.1%),P<0.01;2.9%(2.8%,3.0%)vs.1.2%(1.2%,1.4%),P<0.01],respectively.(2)In the study group,IL-12 [54.97 pg/mL(31.20,161.59)pg/mL],IL-22[17.70 pg/mL(15.60,35.99)pg/mL],IL-23[120.28 pg/mL(82.97,169.27)pg/mL],IL-23 R[0.15 pg/mL(0.15,0.71)pg/mL]and TNF-α[1 000 pg/mL(1 000,1 000)pg/mL]were higher than that of the control group[31.20 pg/mL(31.20,56.23)pg/mL,15.60 pg/mL(15.60,15.60)pg/mL,78.10 pg/mL(78.10,99.08)pg/mL,0.15 pg/mL(0.15,0.15)pg/mL,722.16 pg/mL(494.25,941.44)pg/mL,P<0.05].(3)Correlation analysis showed that there was a negative correlation between Th17 and Treg(r=-0.883,P<0.01)in the study group(r=-0.883,P<0.01),and IL-22 was positively correlated with IL-23(r=0.340,P<0.05).In the control group,there was a negative correlation between CD4~+T cells and CD8~+T cells,Th17 and CD3~+T cells,Th17 and CD8~+T cells(r was-0.578,-0.393 and-0.569,respectively,P<0.05),and a positive correlation between Th17 and Treg,IL-23 and CD4~+T cells,TNF-αand DNT(r=0.403,0.440 and 0.392,respectively.(4)There were 5 main components among each group,but the variable factors differed in the study group from the controls,as that:Th17/Treg,Th17,Treg vs.CD4~+T/CD8~+T cells,CD4~+T cells,CD8~+T cells and CD4~+T/CD8~+T cells,CD8~+T cells vs.Th17/Treg,Treg and CD4~+T cells,CD3~+T cells vs.IL-12,IL-23 RandIL-12,IL-23 Rvs.CD3~+T cells and IL-23,IL-22 vs.TNF-α,DNT.Conclusion The increasing immune function of Th17 cells with IL-22 and IL-23 may be involved in the pathological mechanism of COPD,which accompanied with the weakened toxicity of CD8~+T cells and regulation of DNT.更多还原