Study On The Expression Of Airway Inflammatory Makers In Different TCM Syndromes Of AECOPD

Objective:Respiratory infection related indexes,lung function and immune function of patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）were collected from the HIS system of the First affiliated hospital of Henan university of traditional Chinese medicine.The results were analyzed to explore the characteristics between different TCM syndromes and clinical diagnosis of western medicine in AECOPD patients.At the same time,by detecting the levels of cytokines in plasma and sputum of some patients,the difference of expression of airway inflammatory factors in patients with different TCM syndromes was studied.In order to provide quantitative basis for the objective of TCM syndrome differentiation and clinical diagnosis and treatment.MethodsExperiment 1:235 cases of inpatients of the first affiliated hospital of Henan university of TCM with phlegm heat obstructing lung syndrome and phlegm obstructing lung syndrome from Mar 31 to November 31,2017 was selected,including 128 cases of phlegm heat obstruction syndrome and 107cases of phlegm obstructing lung syndrome.The hospital HIS and LIS system were used to record the laboratory examination such as blood routine and the test data of T cell subsets and lung function will be compared and analyzed.Experiment 2:40 cases of inpatients of the first affiliated hospital of Henan university of TCM whom with phlegm heat obstructing lung syndrome and phlegm obstructing lung syndrome were collected,6 cases dropped out,34cases were included,including 18 cases of phlegm heat obstructing lung syndrome and 16 cases of phlegm obstructing lung syndrome.Plasma and sputum samples were collected when patients were admitted to hospital（the first time）,before taking traditional Chinese medicine（the second time）and discharged from hospital（the third time）,20 healthy volunteers were selected as control group and the sample detection results were compared with each other.Detection methods:The detection of cytokines in sputum and plasma wasperformed by suspension chip technique,and the operation was carried out instrict accordance with cytokine detection kit instruction.Statistical methods:The detection data were in the format of mean value adding and substrcting standard error（x±s）.Statistical processing of data compared with each group was carried out by SPSS 22.0 software.If the measurement data were conformed to the conditions,the group design t test and variance analysis were adopted,and the grade data or two classification variables were tested byχ² test or rank sum test.The P value less than 0.05was expressed the statistical significance in differences.ResultsExperiment 1:（1）Routine blood examination was determined after blood sample collection.The neutrophil count and lymphocyte count in patients with phlegm heat obstructing lung syndrome was much more than that in patients with phlegm obstructing lung syndrome（P<0.05）.Compared with phlegm obstructing lung syndrome,White blood cell count,eosinophilic granulocyte count,and the number of basophil was more than that of phlegm heat obstructing lung syndrome（P>0.05）.（2）Compared with the syndrome of phlegm obstructing lung syndrome,the proportion of CD3⁺cells and CD8⁺cells in T cell subsets of patients with phlegm heat obstructing lung syndrome was less than that in patients with phlegm obstructing lung syndrome（P<0.05）.The proportion of CD4⁺cells in patients with phlegm heat obstructing lung syndrome was lower than that in patients with phlegm obstructing lung syndrome（P>0.05）.（3）Compared with the syndrome of phlegm obstructing lung syndrome,the count of FEV₁/prediction and FEV₁/FVC%in patients with phlegm heat obstructing lung syndrome was more than that of patients with phlegm obstructing lung syndrome,while the difference was not significant（P>0.05）.Experiment 2:（1）Compared with the control group,the count of neutrophils in the patients with phlegm heat obstructing lung syndrome and phlegm obstructing lung syndrome was higher than that in the control group（P<0.05）,and the lymphocyte count and basophilic count were smaller than those in the control group,the difference was not statistically significant（P>0.05）。There was no statistically difference in eosinophil count（P>0.05）and no significant difference in eosinophil count（P>0.05）.The count of neutrophils in patients with phlegm heat obstructing lung syndrome was higher than that in patients with phlegm obstructing lung syndrome（P>0.05）,but the count of eosinophils was less than that of patients with phlegm obstructing lung syndrome,there was no significant difference in basophilic granulocytes（P>0.05）.（2）Blood B natriuretic of phlegm heat obstructing lung syndrome was higher than phlegm obstructing lung syndrome,the difference was not significant（P>0.05）.（3）Proportion of CD3⁺cells,CD8⁺cells,CD4⁺cells and CD4⁺/CD8⁺cells in T cell subtypes in pations with phlegm heat obstructing lung syndrome was lower than phlegm obstructing lung syndrome,the difference was not statis tically significant（p>0.05）.（4）The count of FEV₁/prediction and FEV₁/FVC of pulmonary function in patients with phlegm heat obstructing lung syndrome was greater than that in patients with phlegm obstructing lung syndrome,the difference was not statistically significant（P>0.05）.（5）According to the blood gas analysis,PH value in patients with phlegm heat obstructing lung syndrome is greater than that in patients with phlegm heat obstructing lung syndrome,PaCO₂ and PaO₂ are lower than that in patients with phlegm obstructing lung syndrome,the difference is not statistically significant（P>0.05）.（6）The levels of IL-4,IL-6,IL-8,TNF-α,IFN-γand GM-CSF in the plasma of patients with phlegm heat obstructing and phlegm turbid obstructing were significantly higher than those in the control group,and the levels of IL-2were significantly lower than those in the control group,the difference was statistically significant（P<0.05）.The content of IL-4,IL-6,IL-10,TNF-αand GM-CSF decreased after the treatment of integrated traditional Chinese medicine and western medicine compared with before taking medicine（P<0.05）,the levels of IFN-γdecreased the difference is not statistically significant（P>0.05）.The content of IL-2 was higher than before taking medicine（P<0.05）.Compared with the syndrome of phlegm turbid obstructing of lung,the level of IL-4,IL-10,IFN-γand IL-2 in the plasma of patients with phlegm heat obstructing lung syndrome was higher than that of patients with phlegm turbid lung obstructing,in which the differences of IL-2 were significantly higher（P<0.05）.The level of IL-6,IL-8,TNF-αand GM-CSF was significantly lower than that of patients with phlegm turbid lung obstruction（P<0.05）.（7）The level of IL-2 and IL-8 in sputum of patients with phlegm heat obstructing syndrome was higher than that of patients with phlegm turbid lung obstructing syndrome.The level of IL-4,IL-6,IL-10,TNF-α,IFN-γand GM-CSF in sputum was lower than that of patients with phlegm turbid lung obstructing syndrome and there was no significant difference.Comparison with before hospitalization,the level of IL-2,IL-4,IL-6,IL-8,IL-10,IFN-γand GM-CSF of patients took western medicine for one day was lower than before taking medicine.The level of IFN-γin sputum of patients took western medicine for one day was higher than patients before hospitalization and the difference was not statistically significant.（8）Compared with sputum,the level of IL-2 in plasma of patients was lower than that of sputum（P<0.05）,and the content of IL-6,IL-8 and TNF-αwas significantly lower than that of sputum（P<0.01）.The level of IL-10,IFN-γand GM-CSF was higher than that of sputum,in which the differences of IFN-γand GM-CSF are statistically significant（P<0.05）.The level of IL-4 in patients’plasma was lower than sputum.After taking one-day western medi-cine,the level of IL-4 in plasma was higher than sputum.The difference was not statistically significant（P>0.05）.Conclusion1 The level of IL-6、IL-8 and TNF-αin plasma of AECOPD patients with phlegm heat obstructing and phlegm turbid obstructing were lower than that in sputum,suggesting that there were inflammatory reactions in lung tissue and airway in patients with phlegm heat obstruction and phlegm turbid obstruction.2 Compared with the syndrome of phlegm turbid obstructing of lung syndrome,the levels of NEU、EOS and CRP in peripheral blood of patients and the levels of plasma IL-4、IL-10 and IFN-γwith phlegm heat obstructing lung syndrome were higher than those of patients with syndrome of phlegm turbid obstructing of lung,suggesting that there was more serious airway inflammation in patients with phlegm heat obstructing of lung syndrome.3 The expression of cytokines in plasma and sputum in patients with AECOPD syndrome of phlegm heat obstructing and phlegm turbid obstructing could be regulated by Integrated traditional Chinese and western medicine,the inflammatory reaction of patients could be controled effectively too.4 The level of plasma IL-2 in patients before and after treatment was lower than that in control group,suggestting that immunologic function of patients with phlegm heat obstructing syndrome and phlegm turbid obstructing of lung in AECOPD is low.The proportion of CD3⁺cells and CD8⁺cells in peripheral blood of patients with phlegm turbid obstruction lung syndrome and the ratio of CD4⁺/CD8⁺cells and plasma IL-2 were lower than those in patients with phlegm heat obstructing of lung syndrome,which suggested that the immune function of patients with phlegm turbid obstructing lung syndrome might be lower than that of patients with phlegm turbid obstructing lung syndrome.5 There was no significant difference in FEV₁/pre、BNP and blood gas analysis between patients with phlegm heat obstructing of lung and phlegm turbid obstructing of lung,indicating that there was no significant difference in the degree of airway obstruction and the degree of hypoxia between the two syndrome types.