外周血Th17细胞对慢性阻塞性肺疾病症状严重程度及预后的评估价值

 目的: 观察Th17细胞水平与慢性阻塞性肺疾病(COPD)患者症状严重程度及预后因素的相关性,以期探讨Th17细胞水平在判断COPD临床预后方面的可能价值。方法: 选取2013年5月～2014年12月我院就诊的110例COPD患者为研究对象,40例健康体检者为对照组。根据COPD全球倡议(GOLD)将COPD患者分为A组(低危、症状轻)、B组(低危、症状重)、C组(高危、症状轻)及D组(高危、症状重),给予吸入性糖皮质激素/长效β₂受体激动剂或吸入性糖皮质激素/长效β₂受体激动剂+长效胆碱能药物治疗,收集患者治疗前及治疗3个月后相关临床资料,包括外周血Th17细胞比例、细胞因子(IL-17和IL-6)、慢性阻塞性肺疾病评估测试(CAT)评分、年龄、体重指数、肺功能指标及诊断前12个月COPD急性加重(AECOPD)次数,分析Th17细胞水平与其它临床特征间的相关性。结果: COPD患者外周血Th17细胞、IL-17及IL-6水平显著高于对照组(P < 0.05)。随着COPD症状严重程度的增加,B、D组COPD患者外周血Th17细胞、细胞因子(IL-17和IL-6)水平及CAT评分显著高于A、C组患者(P < 0.05)。单变量相关分析发现,治疗前B、D组外周血Th17细胞水平与CAT评分呈正相关(P < 0.05),而与FEV₁ 、FEV₁%Pred、FVC及FVC%Pred呈负相关(P < 0.05);A、C组外周血Th17细胞水平与CAT评分、FEV₁、FEV₁%Pred、FVC及FVC%Pred无明显相关性。治疗后外周血Th17细胞水平与CAT评分呈正相关(P < 0.05),而与FEV₁、FEV₁%Pred、FVC及FVC%Pred呈负相关(P<0.05)。结论: 外周血Th17细胞水平与COPD患者IL-17、IL-6、CAT评分及肺功能指标有较好的相关性,具有评估COPD患者症状严重程度及预后的潜在临床价值。

Diagnostic value of Th17 cells in symptom severity and prognosis of chronic obstructive pulmonary disease

AIM: To observed the correlation between Th17 cell level and the symptom severity and prognostic factors of chronic obstructive pulmonary disease (COPD), and to explore the clinical application value of Th17 cell level in assessing the prognosis of patients with COPD. METHODS: The patients with diagnosed COPD (n=110) in our hospital during May 2013 to December 2014, and 40 healthy subjects were enrolled in the study. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the COPD patients were divided into group A (low risk, less symptoms), group B (low risk, more symptoms), group C (high risk, less symptoms) and group D (high risk, more symptoms), which were given inhaled corticosteroid/long-acting β₂ agonist or corticosteroid/long-acting β₂ agonist+long-acting antimuscarinic agent treatment for 3 months. The proportion of Th17 cells, cytokines (IL-17 and IL-6), the COPD assessment test (CAT) score, age, body mass index, pulmonary function and the times of acute exacerbation of COPD in previous 1 year were observed before and after treatment. The correlation analysis between the level of Th17 cells and other clinical characteristics was performed. RESULTS: Th17 cell, IL-17 and IL-6 levels in COPD group were significantly higher than those in control group (P < 0.05). With the increase in the severity of COPD symptoms, Th17 cells, cytokines (IL-17 and IL-6) and CAT score in groups B and D were significantly higher than those in groups A and C (P < 0.05). The univariate analysis showed that the levels of Th17 cells in groups B and D before treatment were positively correlated with the CAT score (P < 0.05), which were negatively correlated with FEV₁ , FEV₁% Pred, FVC and FVC% Pred. The levels of Th17 cells were not correlated with the CAT score, FEV₁, FEV₁% Pred, FVC and FVC% Pred in groups A and C. The levels of Th17 cells after treatment were positively correlated with the CAT score, which were negatively correlated with FEV₁ , FEV₁% Pred, FVC and FVC% Pred (P < 0.05). CONCLUSION: The peripheral Th17 cell level has a good correlation with IL-17, IL-6, CAT score and pulmonary function in COPD patients, suggesting a potential value to predict the symptom severity and prognosis of COPD.