支气管哮喘患者外周血CD4+T、CD8+T、Th 17、IL-17表达水平与肺功能的相关性研究

摘要

目的 探讨支气管哮喘患者体内炎性细胞和炎性因子(CD4+T、CD8+T、Th17、IL-17)表达水平与肺功能的相关性.方法 收集268例支气管哮喘患者,其中间歇-轻度142例,中重度126例,同时以60例健康体检者作为对照组.①测定所有入组者血液酸碱度(pH)、动脉血氧分压(arterial oxygen partial pressure,PaO2)、动脉血氧饱和度(arterial oxygen saturation,SaO2)和动脉血二氧化碳分压(arterial carbon dioxide pressure,PaCO2);②测定所有入组者肺活量(vital capacity,VC),1秒钟用力呼气容积与预计值的百分比(FEV1/Pre%)及呼气流量峰值(peak expiratory flow,PEF);③检测所有入组者外周血 CD4+T、CD8+T、Th17、IL-17的表达水平;④探讨患者CD4+T、CD8+T、Th17、IL-17表达水平与肺功能的相关性.结果 ①中重度组和间歇-轻度组 PaCO2较健康对照组明显偏高(P<0.05);中重度组与间歇-轻度组相比,pH 值、PaO2、SaO2均明显偏低(P<0.05).②与健康对照组相比,间歇-轻度组和中重度组肺功能指标明显偏低(P<0.05);中重度组与间歇-轻度组比较,肺功能指标显著降低(P<0.05).③间歇-轻度组和中重度组 Th17、CD8+T、IL-17水平显著高于健康对照组,CD4+T 明显低于健康对照组(P<0.05);中重度组Th17、CD8+T、IL-17水平高于间歇-轻度组,CD4+T细胞水平低于间歇-轻度组(P<0.05).④哮喘患者体内 CD4+T 细胞水平与 VC、FEV1/Pre 及 PEF 均呈正相关;Th17、CD8+T、IL-17水平与 VC、FEV1/Pre及PEF均呈负相关.⑤中重度组与间歇-轻度组相比,CD4+T、CD8+T、Th17细胞及炎性因子 IL-17水平与肺功能的相关性更高.结论 CD4+T、CD8+T、Th17和 IL-17表达水平可作为支气管哮喘病情变化的判断指标,临床诊治中应结合患者机体内环境的变化情况,制定科学合理的治疗方案.%Objective To investigate the correlation between the level of inflammatory cells, inflammatory factors(CD4+T,CD8+T,Thl7,IL-1 7)and pulmonary functions of patients with bronchial asthma.Methods Two hundred and sixty-eight patients with bronchial asthma were enrolled in this study.One hundred and forty-two cases of moderate intermittent-mild,1 2 6 cases of moderate to severe and 60 cases of healthy subjects were collected as control group.①The blood pH (pH),arterial oxygen partial pressure(PaO2),arterial oxygen saturation(SaO2),and arterial carbon dioxide pressure(PaCO2)were measured.②The vital capacity (VC),the forced expiratory volume in one second/predicted value%(FEV1/Pre%)and peak expiratory flow(PEF) were measured for all participants.③The levels of CD4+T,CD8+T,Thl7,IL-1 7 in peripheral blood were detected.④Correlation between the expression of CD4+T,CD8+T,Th1 7,IL-1 7 and pulmonary functions were explored.Results ①The PaCO2value of the moderate to severe group and the intermittent-mild group were significantly higher than that of the healthy control group (P<0.05).The pH,PaO2and SaO2were significantly lower in the moderate to severe group than those in the intermittent-mild group(P<0.05).②Compared with the control group,the pulmonary function indexes of the patients in the intermittent-mild group and the moderate to severe group were significantly lower than those in the control group(P<0.05).The pulmonary function indexes were significantly lower in the moderate to severe group than those in the intermittent-mild group(P<0.05).③The levels of Th17,CD8+T,IL-17 in the intermittent-mild group and the moderate to severe group were significantly higher than those in control group.CD4+T cells were lower than those in control group.The levels of Th1 7,CD8+T,IL-1 7 in the moderate to severe group were significantly higher than those in intermittent-mild group, CD4+T cells were lower than those in the intermittent-mild group(P<0.05).④CD4+T cell level was positively correlated with VC,FEV1/Pre and PEF in asthmatic patients.Th1 7,CD8+T and IL-1 7 levels were negatively correlated with VC,FEV1/Pre% and PEF.⑤The correlation between CD4+T,CD8+T,Th1 7,IL-1 7 levels and pulmonary functions in the moderate and severe group were higher than those in the intermittent-mild group.Conclusion The expression levels of CD4+T,CD8+T,Th1 7 and IL-1 7 could be used as indicators for the in vivo changes of bronchial asthma.In the clinical diagnosis and treatment,we should give a scientific and reasonable treatment plan combined with the changes of the in vivo environment of the patients.