目的:比较慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)、肺炎及正常人在肺泡灌洗液中分泌型免疫球蛋白A(sIgA)、免疫球蛋白A(IgA)及血液中T淋巴细胞亚群的差异,探讨检测肺泡灌洗液sIgA、血清IgA及血液中T淋巴细胞亚群的临床意义。方法:收集2018年12月至2020年3月包头市中心医院呼吸与危重症医学科住院患者及包头市中心医院健康体检中心体检健康人员。慢性阻塞性肺疾病合并肺炎组(COPD-P组)29人,单纯慢性阻塞性肺疾病组(S-COPD组)26例,单纯肺炎组(S-P组)27例,体检健康人员为对照组(CG组)27例。收集肺泡灌洗液检测sIgA和血清中IgA、CD4+T细胞百分数、CD8+T细胞百分数、T淋巴细胞绝对数,CD4+T/CD8+T的比值等数据。运用 SPSS 20.0 软件进行数据分析。结果:4组间血清IgA、T淋巴细胞绝对数、CD4+T细胞百分数差异无统计学意义(P＞0.05);4组间sIgA水平、CD4+T细胞/CD8+T细胞比值、CD8+T细胞百分数差异具有统计学意义(P＜0.05)。结论:在S-COPD和COPD-P患者的肺泡灌洗液中sIgA含量明显降低,提示黏膜表面缺乏sIgA导致了黏膜屏障受损。感染与黏膜表面的sIgA缺乏相关,黏膜的sIgA缺乏可能是COPD感染机会增多的原因之一。在COPD患者血清中的CD8+T细胞增高,CD4+T细胞/CD8+T细胞比值的失衡在COPD患者中普遍存在,提示细胞免疫存在功能紊乱。在COPD中检测T淋巴细胞亚群,把CD4+T/CD8+T细胞的比值作为预测T淋巴细胞亚群内部细胞组成成分紊乱的指标之一,具有提示效应。
Objective: To explore the clinical significance of sIgA in alveolar lavage fluid, serum IgA and blood T lymphocyte subsets in patients with chronic obstructive pulmonary disease, pneumonia and healthy people by comparing their differences. Methods: The inpatients from the Department of Respiratory and Critical Care Medicine of Baotou Central Hospital and the health personnel from the Health examination Center of Baotou Central Hospital from December 2018 to March 2020 were collected. There were 29 patients with chronic obstructive pulmonary disease combined with pneumonia (COPD-P group), 26 patients with simple chronic obstructive pulmonary disease (S-COPD group), 27 patients with simple pneumonia (S-P group), and 27 health personnel in the control group (CG group). sIgA and serum levels of IgA, CD4+T cells, CD8+T cells, absolute number of T lymphocytes, CD4+T/CD8+T ratio and other data were detected in alveolar lavage fluid. SPSS 20.0 software was used for data analysis. Results: There was no significant difference in serum IgA, T lymphocyte absolute number and CD4+T cell percentage among the four groups (P＞0.05). sIgA level, CD4+T cell /CD8+T cell ratio, and percentage of CD8+T cell were significantly different among the four groups (P＜0.05). Conclusion: sIgA content in alveolar lavage fluid was significantly reduced in patients with S-COPD and COPD P, suggesting that the lack of sIgA on the mucosal surface caused mucosal barrier damage. Infection is associated with a lack of sIgA on the mucosal surface, which may be one of the reasons for the increased chance of COPD infection. The level of CD8+T cells in the serum of COPD patients increased, and the imbalance of the ratio of CD4+T cells /CD8+T cells was common in COPD patients, indicating the dysfunction of cellular immunity. In COPD, the ratio of CD4+T/CD8+T cells was used as one of the indicators to predict the disturbance of the internal cell composition of T lymphocyte subsets, which has a suggestive effect.
[1] Global initiative for chronic obstructive lung disease.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2018 report[EB/OL].(2017-12) [2017-12-05].http://www.goldcopd.org.
[2] Richmond BW, Brucker RM, Han W, et al.Airway bacteria drive a progressive COPD-like phenotype in mice with polymeric immunoglobulin receptor deficiency[J].Nat Commun, 2016, 7: 11240.
[3] Polosukhin VV, Richmond BW, Du RH, et al.Secretory IgA deficiency in individual small airways is associated with persistent inflammation and remodeling[J].Am J Respir Crit Care Med, 2017, 195(8): 1010-1021.
[4] 瞿介明, 曹彬.中国成人社区获得性肺炎诊断和治疗指南(2016年版)修订要点[J].中华结核和呼吸杂志, 2016(4): 241-242.
[5] Paplińska-Goryca M, Rubinsztajn R, Nejman-Gryz P, et al.The association between serological features of chronic Chlamydia pneumoniae infection and markers of systemic inflammation and nutrition in COPD patients[J].Scand J Clin Lab Invest, 2017, 77(8): 644-650.
[6] Curtis JL.A hairline crack in the levee: focal secretory IgA deficiency as a first step toward emphysema[J].Am J Respir Crit Care Med, 2017, 195(8): 970-973.
[7] Du RH, Richmond BW, Blackwell TS, et al.Secretory IgA from submucosal glands does not compensate for its airway surface deficiency in chronic obstructive pulmonary disease[J].Virchows Arch, 2015, 467(6): 657-665.
[8] 彭睿, 林少芳.慢性阻塞性肺疾病患者T淋巴细胞亚群检测的临床应用探讨[J].云南医药, 2016, 37(5): 497-499.
[9] Domagała-Kulawik J, Hoser G, Dabrowska M, et al.CD4+/CD25+ cells in systemic inflammation in COPD[J].Scand J Immunol, 2011, 73(1): 59-65.
[10] 陈钢, 谢灿茂, 罗志扬, 等.慢性阻塞性肺疾病加重期和稳定期Th17和Treg细胞的表达[J].中山大学学报(医学科学版), 2013, 34(6): 917-921.
[11] Vargas-Rojas MI, Ramírez-Venegas A, Limón-Camacho L, et al.Increase of Th17 cells in peripheral blood of patients with chronic obstructive pulmonary disease[J].Respir Med, 2011, 105(11): 1648-1654.
[12] Kalathil SG, Lugade AA, Pradhan V, et al.T-regulatory cells and programmed death 1+ T cells contribute to effector T-cell dysfunction in patients with chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med, 2014, 190(1): 40-50.
[13] Boucherat O, Boczkowski J, Jeannotte L, et al.Cellular and molecular mechanisms of goblet cell Metaplasia in the respiratory airways[J].Exp Lung Res, 2013, 39(4/5): 207-216.
[14] Barnes PJ.Advances in chronic obstructive pulmonary disease[J].Trans Med Soc Lond, 2002, 119: 41-51.
[15] 张之海, 戴垚垚, 陈杰, 等.IL-17、TLR4、P2X7基因多态与慢性阻塞性肺疾病的关联研究[J].中华疾病控制杂志, 2018, 22(2): 142-146, 152.
[16] Filho MM, Aguiar PN, De Mello RA.Chronic obstructive pulmonary disease alters immune cell composition and immune checkpoint inhibitor efficacy in non-small cell lung cancer[J].Ann Transl Med, 2019, 7(suppl 1): S42.
[17] 包鹤龄, 方利文, 王临虹.1990—2014年中国40岁及以上人群慢性阻塞性肺疾病患病率Meta分析[J].中华流行病学杂志, 2016, 37(1): 119-124.
[18] Fang LW, Gao P, Bao HL, et al.Chronic obstructive pulmonary disease in China: a nationwide prevalence study[J].Lancet Respir Med, 2018, 6(6): 421-430.
[19] Wang C, Xu JY, Yang L, et al.Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health[CPH]study):a national cross-sectional study[J].Lancet,2018,391(10131):1706-1717.
[20] 张继华, 林明, 张毅, 等.慢性阻塞性肺疾病患者肺泡灌洗液SIgA表达水平与肺功能相关性研究[J].昆明医科大学学报, 2015, 36(6): 81-84.
[21] 韩利红, 张国俊.老年慢性阻塞性肺疾病患者血清细胞因子及细胞免疫的水平及意义[J].中国老年学杂志, 2014, 34(21): 6065-6066.
[22] Hogg JC, Chu F, Utokaparch S, et al.The nature of small-airway obstruction in chronic obstructive pulmonary disease[J].N Engl J Med, 2004, 350(26): 2645-2653.
[23] Peres A, Dorneles GP, Dias AS, et al.T-cell profile and systemic cytokine levels in overweight-obese patients with moderate to very-severe COPD[J].Respir Physiol Neurobiol, 2018, 247: 74-79.
[24] Bazett M, Biala A, Huff RD, et al.Attenuating immune pathology using a microbial-based intervention in a mouse model of cigarette smoke-induced lung inflammation[J].Respir Res, 2017, 18(1): 92.
