Immunological Functions Of T-Lymphocyte In The Elderly Patients With Chronic Obstructive Pulmonary Disease During Acute Exacerbation And Medication Intervention

OBJECTIVE To investigate the T-lymphocyte immune responses in elderly patients with chronic obstructive pulmonary disease during acute exacerbations (AECOPD) and effects of the immunostimulating agent Thymopeptide-α1 in AECOPD patients.METHOD A randomized, prospective clinical trial was held, thirty-seven patients with COPD who had hospitalization in the general respiration wards between October 2007 to December 2009 were recruited into the study. Eighteen patients with general treatment as a non-intervention group and nineteen patients with general treatment adding thymopeptide-α1 as an intervention group. Another fourteen healthy individuals served as the healthy elderly control group. Levels of CD4+, CD8+, CD4+/CD8+, IFN-γ, IL-4 in peripheral blood were measured by flow cytometry and enzyme linkedimmunosorbent assay (ELISA) at baseline (the 1st day) and after the anti-infective treatment. At the same time, the pulmonary function (forced expiratory volume in the first second, percentage of forced expiratory volume in the first second to the predicated value) were determined by pulmonary function meter. Meanwhile, the clinical conditions were evaluated. Recorded the stable period of time.RESULT Fifty-one patients completed the trial (19 in intervention treatment group, 18 in non-intervention treatment group and 14 in health control group). Compared with the health control group, COPD patients had decreased CD4+ level, increased CD8+ level and CD4+/CD8+ inversion (all p<0.05). After treatment, the COPD intervention group show lower levels of CD8+ ratio (29.42±6.37 vs 35.14±7.62), IL-4 (118.06±29.18ng/L vs 156.30±50.14 ng/L),and higher level of CD4+ (32.80±5.58 vs 25.35±6.74), CD4+/CD8+ ratio (1.25±0.22 vs 0.72±0.32), IFN-γ(26.40±4.62ng/L vs 18.54±5.63ng/L), IFN-γ/IL-4 (0.224±0.042 vs 0.119±0.063), FEV1%pred (44.55±8.40vs58.69±7.80%), and FEV1/FVC (35.10±10.36 vs 57.22±7.39%) as compared with the non-intervention group (P<0.05). The change value of FEV1%pred had positive correlation with IFN-γ/IL-4 (r=0.376, P<0.05); the change value of FEV1/FVC had significant positive correlation with CD4+/CD8+ ratio (r=0.560, P<0.05) and IFN-γ/IL-4 (r=0.483, p<0.05). The efficacy of immune intervention more significantly than non-intervention treatment. The survival curve was different between immune intervention and non-intervention group, intervention group had longer stable period than non-intervention group (P=0.008).CONCLUSION Elderly patients with COPD had decreased CD4+ level, increased CD8+ level and CD4+/CD8+ inversion. The ratio of Th1/Th2 is instating of imbalance in elderly patients with COPD, the transformation to Th2 during acute exacerbations and Th1 plays a main role in stable period. Thymopeptide-α1 treatment can stimulate IFN-γsecretion and reinforce Th1 dominance transformation. The recovery of CD4+/CD8+ ratio and Th1 dominance had positive correlation with the improvement of pulmonary function in AECOPD. Thymopeptide-α1 treatment can prolong the stable period.