摘要目的 探讨炎症因子水平在慢性阻塞性肺疾病(COPD)伴肺结核患者中的变化及其与患者结核病变程度的相关性.方法 选取2016年12月至2018年6月在绍兴市中心医院和绍兴市立医院确诊的82例COPD患者,69例肺结核患者,75例COPD伴肺结核患者(轻度26例,中度26例,重度23例)为研究对象,观察炎症因子在COPD伴肺结核患者中的变化,并与结核病变程度进行相关性分析.结果 肺结核组和COPD伴肺结核组患者的血清TNF-α、IL-6、IFNγ、可溶性IL-2受体(sIL-2R)水平分别为(54.67±11.03) ng/L、(45.23 ±9.12) ng/L、(42.32±8.15)ng/L、(173.38±32.30)pmol/L和(70.85±13.16)ng/L、(47.56±10.08) ng/L、(45.28±9.82) ng/L、(210.65±40.81) pmol/L,均明显高于COPD组(P均＜0.05).COPD伴肺结核组患者的TNF-α、sIL-2R水平明显高于肺结核组(P均＜0.05),COPD伴肺结核组和肺结核组患者的IL-6、IFNy水平差异无统计学意义(P均＞0.05).中度和重度COPD伴肺结核患者的TNF-α、IL-6、IFNγ、sIL-2R水平分别为(69.87±11.22)ng/L、(45.59±9.17)ng/L、(45.87±8.07) ng/L、(215.35 ±42.62)pmol/L和(79.51±14.36) ng/L、(56.74±11.22)ng/L、(52.36±10.24)ng/L、(246.27±48.66) pmol/L,均明显高于轻度组(P均＜0.05),且重度组明显高于中度组(P均＜0.05).炎症因子TNF-α、IL-6、IFNγ、sIL-2R水平与结核病变程度呈正相关(r=0.557,0.657,0.659,0.533,P均＜0.05).结论 COPD伴肺结核患者的炎症因子水平失衡比COPD患者和肺结核患者更加严重.患者肺结核病情越重,其炎症因子水平失衡越严重.

abstractsObjective To explore the changes of inflammatory factor levels in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary tuberculosis and the relationship with severity of tuberculosis.Methods A total of 82 patients with COPD,69 patients with pulmonary tuberculosis,75 patients with COPD complicated with pulmonary tuberculosis (26 cases in mild group,26 cases in moderate group,23 cases in severe group) in Central Hospital of Shaoxing and Shaoxing Municipal Hospital from December 2016 to Junuary 2018 were enrolled.The changes of inflammatory factor levels were observed in these patients,and the correlation with the severity of tuberculosis was analyzed.Results The levels of TNF-α,IL-6,IFNγ,soluble intedeukin 2 receptors (sIL-2R) were (54.67±11.03) ng/L,(45.23±9.12)ng/L,(42.32±8.15)ng/L and (173.38±32.30)pmol/L in the pulmonary tuberculosis group,and (70.85±13.16)ng/L,(47.56±10.08) ng/L,(45.28±9.82)ng/L,and (210.65±40.81) pmol/L in COPD complicated with pulmonary tuberculosis group,which were all higher than those in COPD group (P all ＜0.05).The levels of TNF-α and sIL-2R were significantly higher in COPD complicated with pulmonary tuberculosis group than those in pulmonary tuberculosis group (P all ＜0.05),and there were no significantly differences in IL-6 and IFNγ between the two groups (P all＞0.05).The levels of TNF-α,IL-6,IFNγand slL-2R were(69.87±11.22)ng/L,(45.59±9.17) ng/L,(45.87±8.07) ng/L,(215.35±42.62) pmol/L in moderate group,and (79.51±14.36) ng/L,(56.74±11.22) ng/L,(52.36±10.24) ng/L and (246.27±48.66) pmol/L in severe group,which were significantly higher than those in mild group (P all＜0.05).The levels in severe group were significantly higher than those in moderate group (P all＜0.05).The inflammatory factors of TNF-α,IL-6,IFNγand sIL-2R showed positive significant correlations with severity of tuberculosis (r=0.557,0.657,0.659 and 0.533,P all ＜0.05).Conclusions The imbalance of inflammatory factors in patients with COPD complicated with tuberculosis is more serious than that in COPD or pulmonary tuberculosis.The severer the pulmonary tuberculosis is,the more serious the imbalance of inflammatory factors is.