The Levels And Meaning Of Serum IL-21,IL-17 And IL-6 In Patients With Chronic Obstructive Pulmonary Disease

Objective:We test the expression of serum IL – 21,IL-17,IL-6 and RORγt among chronic obstructive pulmonary disease patients with acute aggravating period and stable period and healthy patients,analyzing the relationship of the severity of disease and clinical indicators.we further study the relationship between inflammation reaction shaft of IL-21-RORγt – IL-21,IL-17,and shaft of IL-6/IL-21-pulmonary with inflammation of COPD emphysema and pulmonary vascular lesions,so as to offers a new theoretical basis for the treatment of chronic obstructive pulmonary disease and direction.Methods:We select 120 cases of COPD patients from the patients which are treated by the Qingdao university hospital in September 2015 to September 2016.60 patients in acute aggravating period are as acute phase group;60 patients in plateau are as plateau group;60 patients with health physical examination for the same period are as the healthy control group.All patients are extracted since morning fasting venous blood and determined the content of serum IL-21,IL-17 and IL-6,tested the index of FEV1,FVC,FEV1 / FVC,inner diameter of pulmonary artery and the pulmonary artery pressure.We explore the index of the difference amog three groups of data,using spss22 for statistical analysis.Results:1.IL-21 IL-17,IL-6,RORγtIn terms of IL-21,the acute exacerbation period was 279.107±17.836 pg/ml,the stable period was 224.109±30.051 pg/ml,the normal group was 170.201±25.197 pg/ml;Three groups of datas arestatistically significant differences among acute exacerbation period and stable period and normal groups(t=11.8、26.63;P<0.05).Stable period is higher than the normal group(t=10.34,P<0.05).In terms of IL-17,the acute exacerbation period was 145.114±19.961 pg/ml,the stable period was 49.830±7.735 pg/ml,the normal group was 25.819±4.376 pg/ml;Three groups of datas arestatistically significant differences among acute exacerbation period and stable period and normal groups(t=33.34、44.07;P<0.05).Stable period is higher than the normal group(t=20.35,P<0.001).In terms of IL-6,the acute exacerbation period was 39.414±3.225 pg/ml,the stable period was 32.598±3.475 pg/ml,the normal group was 24.831±2.121 pg/ml.Three groups of datas arestatistically significant differences among acute exacerbation period and stable period and normal groups(t=10.81、28.52;P<0.05).Stable period is higher than the normal group.(t=14.31;P<0.05).In terms of RORγt,the acute exacerbation period was 3.206±0.263 ng/ml,the stable period was 2.527±0.469 ng/ml,the normal group was 2.095±0.271 ng/ml.Three groups of datas arestatistically significant differences among acute exacerbation period and stable period and normal groups(t=8.33、18.4;P<0.05).Stable period is higher than the normal group.(t=2.69;P<0.05).2.Detection of three groups of respiratory functionIn terms of FEV1,FEV1 / FVC,acute aggravating period there is significant differences to the stability and the normal group,Stability is lower than the normal group,data statistically significant differences in the three groups.In terms of FVC,compared with normal group,acute aggravating period falls slightly。3.The expression of C-reactive protein.blood sedimentation and D – dimerC-reactive protein of acute aggravating period exists significant difference to the stability and the normal group.Stability is higher than the normal group,blood sedimentation in three groups are not statistical significant differences.4.The inner diameter of pulmonary artery,pulmonary artery pressure,and right ventricular diameterIn terms of pulmonary artery diameter,the acute exacerbation period was 27.05 ± 2.708 mm,the stable period was 24.98 ± 1.833 mm,the normal group was 23.77 ± 1.851mm;In terms of pulmonary artery pressure,the acute exacerbation period was 52.64 ± 9.064 mm Hg,the stable period was 42.82 ± 7.510 mm Hg,the normal group was 28.85 ± 2.641 mm Hg;In terms ofright ventricular diameter,the acute exacerbation period was 28.42±3.731 mm,the stable period was 26.41±3.218 mm,the normal group was 25.91±3.878 mm.Three groups of datas arestatistically significant differences among acute exacerbation period and stable period and normal groups(P<0.05).Stable period is higher than the normal group.(P<0.05).5.The expression of IL-21 of among COPD combined with pulmonary hypertension,COPD nonunion with pulmonary hypertension and normal groupIn terms of pulmonary artery diameter,the acute exacerbation period was 26.61±2.59 mm,the stable period was25.51±2.34 mm,the normal group was 23.72±1.89 mm;In terms ofpulmonary artery pressure,the acute exacerbation period was56.23±6.89 mm Hg,the stable period was 40.31±5.30 mm Hg,the normal group was 228.81±2.59 mm Hg;In terms of IL-21,the acute exacerbation period was 273.26±23.45 pg/ml,the stable period was230.88±39.02 pg/ml,the normal group was 170.84±25.34 pg/ml;In terms of IL-6,the acute exacerbation period was 37.32±4.76 pg/ml,the stable period was34.48±4.79 pg/ml,the normal group was 24.73±2.13 pg/ml;Three groups of datas arestatistically significant differences among acute exacerbation period and stable period and normal groups(P <0.05).Stable period is higher than the normal group.(P<0.05).6.The related analysisThere was a significant positive correlation between serum IL-21,IL-17 and RORγt(r=0.795,0.775,0.686,P<0.05).There was a significant positive correlation between serum IL-21,FEV1 / FVC and FEV1(r=-0.729,-0.830,P<0.05);There was a significant positive correlation between serum IL-21,pulmonary artery mean diameter and pulmonary artery pressure(r=0.448,0.802,P<0.05);There was a significant positive correlation between serum IL-21 and CRP(r=0.611,P<0.05).Conclusion:1.The level of serum IL-21 in patients with acute exacerbation and stable stage of chronic obstructive pulmonary disease increased,is more significant than others in COPD acute exacerbation,and is significantly positively correlated with IL-6,IL-17,RORγt.It Suggests that IL-21 is involved in COPD airway inflammation and may play an important role in the progression of chronic obstructive pulmonary disease through IL-21-RORγt(TH17)-IL-17 axis.2.IL-21 is negatively correlated with airflow restriction index FEV1 / FVC and negative correlation with FEV1,Suggesting that it is closely related to clinical symptoms and severity of the disease.The results show that IL-21 is involved in the inflammatory process of COPD,playing a certain role in the role of inflammation and the bridge.3.There is a significant difference in IL-21 and IL-6 expression whether COPD with or without pulmonary hypertension.There is a significant positive correlation among IL-21,IL-6,and mean pulmonary artery diameter and pulmonary artery pressure.It suggests that IL-21 may be involved intheprocess of pulmonary arterial changes and pulmonary hypertension by IL-6-IL-21-pulmonary vascular pathways.