河北医科大学学报 ›› 2024, Vol. 45 ›› Issue (4): 389-394.doi: 10.3969/j.issn.1007-3205.2024.04.004

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AECOPD患者治疗前后Th17/Treg免疫平衡、FeNO水平变化及对预后的影响

  

  1. 河北省胸科医院呼吸科，河北 石家庄 050041

  • 出版日期:2024-04-25 发布日期:2024-04-22
  • 作者简介:李星虹（1983-），女，河北石家庄人，河北省胸科医院副主任医师，医学硕士，从事呼吸科疾病诊治研究。
  • 基金资助:
    河北省医学科学研究课题计划（20191036）

Changes in Th17/Treg immune balance and FeNO level in AECOPD patients before and after treatment and their effect on prognosis

  1. Department of Respiration, Hebei Chest Hospital, Shijiazhuang 050041, China

  • Online:2024-04-25 Published:2024-04-22

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摘要： 目的 探讨慢性阻塞性肺疾病急性加重期（acute exacerhation of chronic obstructive pulmonary disease，AECOPD）患者治疗前后Th17/Treg免疫平衡、呼出气一氧化氮（fraction of exhaled nitric oxide，FeNO）水平变化及对预后的影响。
方法 选取AECOPD患者126例，采用肺功能检测仪测定第1秒用力呼气量（forced expiratory volume in one second，FEV1）、第1秒用力呼气量占预计值百分比（FEV1%）、用力肺活量（forced vital capacity，FVC）、用力肺活量占预计值百分比（FVC%）、第1秒用力呼气量占用力肺活量的百分比（FEV1/FVC）。并使用一氧化氮测定仪检测FeNO水平，采用全身炎性反应综合征（systemic inflammaton response syndrome，SIRS）评分进行评分，采用流式细胞仪检测血清辅助性T细胞17（T help 17cells，Th17）、调节性T细胞（T Regulatory cells，Treg）水平，比较治疗前后患者肺功能指标、FeNO水平、SIRS评分、Th17/Treg水平等指标变化情况。
结果 治疗3个月后，AECOPD患者FEV1%、FEV1/FVC、Th17、Th17/Treg水平显著高于治疗前，FeNO、血清Treg水平、SIRS评分显著低于治疗前（P＜0.05）。126例AECOPD患者治疗3个月后存活94例（74.60%）；死亡32例（25.40%）。存活组FEV1%、FEV1/FVC、Treg水平显著高于死亡组，FeNO、Th17、Th17/Treg及SIRS评分显著低于死亡组（P＜0.05）。多因素Logistic回归分析结果显示，治疗前FEV1% 、FEV1/FVC、Treg是AECOPD患者预后的危险因素（P＜0.05）；FeNO、Th17、Th17/Treg、SIRS评分是AECOPD患者预后的保护因素（P＜0.05）。
结论 AECOPD患者治疗后肺功能提高，Th17/Treg、FeNO降低，肺功能、Th17/Treg免疫平衡、FeNO水平对AECOPD患者疗效评估及预后判断具有重要意义。


关键词: 肺疾病, 慢性阻塞性, Th17细胞, T淋巴细胞, 调节性

Abstract: Objective To investigate the changes in Th17/Treg immune balance and fraction of exhaled nitric oxide (FeNO) level in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before and after treatment and their effect on prognosis. 
Methods A total of 126 patients with AECOPD were selected, and forced expiratory volume in one second (FEV1), the percentage of predicted value of FEV1(FEV1%), forced vital capacity (FVC), the percentage of predicted value of FVC (FVC%), and FEV1/FVC were measured by pulmonary function detector. FeNO levels were detected using nitric oxide analyzer, and the scores were assessed using systemic inflammaton response syndrome (SIRS) scores. Serum T help 17cells (Th17) and Tregulatory cells (Treg) were detected using flow cytometry. The changes in pulmonary function index, FeNO level, SIRS score and Th17/Treg level before and after treatment were compared. 
Results At 3 months after treatment, the levels of FEV1%, FEV1/FVC, Th17 and Th17/Treg in AECOPD patients were significantly higher than those before treatment, while FeNO, serum Treg level and SIRS score were significantly lower than those before treatment (P＜0.05). Of 126 AECOPD patients, 94 (74.60%) survived and 32 (25.40%) died at 3 months after treatment. The levels of FEV1%, FEV1/FVC and Treg in survival group were significantly higher than those in death group, while the scores of FeNO, Th17, Th17/Treg and SIRS in survival group were significantly lower than those in death group (P＜0.05). Multivariate Logistic regression analysis showed that FEV1%, FEV1/FVC and Treg were the risk factors for prognosis of AECOPD patients before treatment (P＜0.05), where as FeNO, Th17, Th17/Treg and SIRS scores were protective factors for the prognosis of AECOPD patients (P＜0.05). 
Conclusion After treatment, the pulmonary function of patients with AECOPD is improved, while Th17/Treg and FeNO are decreased. Pulmonary function, Th17/Treg immune balance and FeNO level are of great significance for the efficacy evaluation and prognosis judgment of patients with AECOPD.


Key words: pulmonary disease, chronic obstructive, Th17 cells, T lymphocytes, regulatory

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