慢性阻塞性肺病合并肺部真菌感染免疫功能的变化

摘要

目的：探讨慢性阻塞性肺病（慢阻肺）合并肺部真菌感染患者免疫功能的变化及其意义。方法对2010年1月至2012年12月在徐州市中心医院呼吸科（含呼吸ICU）住院患者中慢性阻塞性肺病（chronic obstructive pulmonary disease，COPD）合并肺部念珠菌感染患者53例及合并肺部曲霉菌感染患者25例作为研究对象，对其免疫功能进行检测，并与20名正常健康人群（健康对照组）进行对比分析。采用流式细胞仪检测周血T淋巴细胞亚群（CD3+CD4+、CD3+CD8+、CD4+/CD8+）的表达率，采用全自动蛋白分析仪检测患者血清IgM、IgG、IgA含量。结果念珠菌组和曲霉菌组的CD3+CD4+百分比及CD4+/CD8+均明显低于健康对照组（P＜0.01），念珠菌组及曲霉菌组CD3+CD8+百分比高于健康对照组（P＜0.05），念珠菌组的CD3+CD4+百分比及CD4+/CD8+均低于曲霉菌组（P＜0.01），而CD3+CD8+百分比在曲霉菌组及念珠菌组之间无统计学差异。与健康对照组比较，念珠菌组和曲霉菌组的IgG明显低于健康对照组，（P＜0.01），IgA均高于健康对照组，（P＜0.05），念珠菌组的IgG高于曲霉菌组（P＜0.01），而念珠菌组及曲霉菌组IgA比较及三组间IgM比较，无统计学差异。结论慢性阻塞性肺病合并肺部念珠菌及曲霉菌感染时，细胞免疫及体液免疫均受损，其中合并曲霉菌感染时的免疫受损状况较合并念珠菌感染时更重。%Objective To investigate the changes of immune function in patients with invasive pulmonary fungal infections by chronic obstructive pulmonary disease. Methods 78 patients with invasive pulmonary fungal infections by chronic obstructive pulmonary disease were slected, in which ,53 patients were pulmonary candidiasis and 25 patients were pulmonary aspergillosis. The T lymphocyte subsets in peripheral whole blood samples were derected by flow cytometry. The levels of IgM,IgG, IgA were measured by full automatic protein analysis meter. Results The percentages of CD3+CD4+and CD4+/CD8+ratio in candidiasis group and aspergillosis group were lower than those in normal control group(P<0.01). The percentages of CD3+CD8+in candidiasis group and aspergillosis group were higher than those in normal control group(P<0.05). The percentages of CD3+CD4+and CD4+/CCD8+ratio in candidiasis group were lower than those in aspergillosis group(P<0.01).There were no significant differences between candidiasis group and aspergillosis group in the percentages of CD3+CD8+.The levels of IgG in candidiasis group and aspergillosis group were lower than those in normal control group(P<0.01) while the levels of IgA in the two study groups were higher than those in normal control group (P<0.05).The levels of IgG in candidiasis group were higher than those in aspergillosis group(P<0.01).There were no significant differences in the levels of IgA between candidiasis group and aspergillosis group and in the levels of IgM among all there groups. Conclusion The results reveal that both cellular immunity and humoral immunity are impaired in patients with pulmonary candidiasis and pulmonary aspergillosis by COPD. The impairment in patients of pulmonary aspergillosis is more severe than that in patients of pulmonary candidiasis.