老年慢阻肺合并肺结核感染血清细胞因子水平变化与结核病变程度的关系

摘要

目的 探讨老年慢性阻塞性肺疾病(慢阻肺)合并肺结核患者血清细胞因子水平变化及与患者肺结核病变程度的关系.方法 选取我院确诊的72例老年慢阻肺合并肺结核患者(A组)、83例单纯慢阻肺老年患者(B组)、45例单纯肺结核老年患者(C组),所有患者收集时间范围为2010年4月至2015年12月,检测三组患者血清细胞因子并进行比较分析,并根据肺结核病变程度将A组患者进行亚组分析.结果 A、B、C三组患者的血清TNF-α、IL-6、IFN-γ、sIL-2R、IL-5差异具有统计学意义(P>0.05),A组患者的血清TNF-α、IL-6、IFN-γ、sIL-2R水平高于B组(P<0.05),A组患者血清IL-5水平高于C组(P<0.05),A组和B组患者的血清IL-5水平差异无统计学意义(P>0.05);A组患者的血清TNF-α、IL-6、IFN-γ、sIL-2R水平高于B组(P<0.05),C组患者的IL-5水平低于A组、B组(P<0.05);A、B、C三组患者的血清IL-1水平差异无统计学意义(P>0.05);轻度、中度、重度慢阻肺合并肺结核患者血清IL-1、IL-5水平差异无统计学意义(P>0.05),轻度、中度、重度慢阻肺合并肺结核患者血清TNF-α、IL-6、IFN-γ、sIL-2R水平呈逐渐升高的趋势,各组之间差异均具有统计学意义(P<0.05).讨论 老年慢阻肺合并肺结核患者免疫失衡较单纯慢阻肺或单纯肺结核患者更加严重,患者肺结核病情越严重,免疫功能失衡越严重.%Objective To investigate the changes of serum cytokine levels in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary tuberculosis (TB). Methods It selected 72 elderly COPD patients with pulmonary tuberculosis as the A group,83 elderly patients with COPD as the B group, and 45 elderly patients with pulmonary tuberculosis as the C group from April 2010 to December 2015. Their serum cytokines were comparatively analyzed,and the group A was subdivided into three groups according to the degree of pulmonary tuberculosis. Results There were significant differences in serum TNF-α,IL-6,IFN-γ,sIL-2R and IL-5 among the groups A,B and C(P<0.05). The levels of serum TNF-α,IL-6,IFN-c,and sIL-2R were obviously higher in the group A than in the group B(P<0.05),and the level of serum IL-5 was higher in the group A than in the group C (P<0.05). There was no significant difference in serum IL-5 level between the A group and the B group (P>0.05). The levels of serum TNF-α,IL-6,IFN-γ,and sIL-2R were obviously higher in the group C than in the group B (P<0.05),and the level of IL-5 was lower in the group C than in the group A and B(P<0.05). There was no significant difference in serum IL-1 level among the groups A,B and C(P>0.05). The levels of ser-um IL-1 and IL-5 showed no significant difference in the mild,moderate and severe COPD with pulmonary tuberculo-sis groups (P>0.05),but the levels of serum TNF-α,IL-6,IFN-α,and sIL-2R were gradually rising in the three groups (P<0.05). Conclusion The immune imbalance of elderly COPD patients complicated with pulmonary tu-berculosis is more serious than that of patients with simple COPD or pulmonary tuberculosis. The more serious the TB patients are,the more serious the imbalance of immune function is.