The Change And Clinical Significance Of T Lymphocyte Subsets And Soluble Vascular Cell Adhesion Molecule-1,tumor Necrosis Factor-? In Patients With Respiratory Overlap Syndrome

Chronic obstructive pulmonary disease?COPD?and obstructive sleep apneaand hyperpnoea syndrome?OSAS?are two common respiratory diseases.The co-existence of COPD and OSAS is called the“overlap syndrome”?OS?,which is associated with more severe cardiovascular damage and higher mortality.The prevalence of OS in men is reported to be about 1%in the literature,and the prevalence of asymptomatic airway obstruction with sleep-disordered breathing is about 4%.To infer that OS patients in China at least 8-10 million,it is necessary to conduct a thorough study of its serious multi-system damage mechanism.Vascular endothelial dysfunction is the basis of cardiovascular disease,mainlymanifested in the damage of vascular endothelial cells,which can lead to cardiovascular disease and systemic inflammatory damage.Prior studies have shown that T lymphocyte immunity plays an important role in the pathogenesis of vascular endothelial dysfunction in OSAS and COPD patients.Serum levels of soluble vascular cell adhesion molecule-1?sVCAM-1?were also up-regulated in patients with COPD and OSAS,suggesting different degrees of endothelial damage.Although the pathogenesis of OS endothelial dysfunction is unclear and few studies have been reported,based on the results of existing OSAS and COPD studies,we believe that OS patients may lead to more serious systemic inflammatory response,endothelial function damage and immune function decline.Since prior studies found that OSAS had little effect on nocturnal oxygen saturation in patients with mild-to-moderate COPD,it exacerbates hypoxia in patients with moderate-to-severe COPD,so this study will be based on pulmonary function as moderate to severe COPD and OS patients.To observe the expression of sVCAM-1 and T lymphocyte subsets with OS patients,explore the possible pathogenesis of OS during vascular endothelial injury and provide the necessary theoretical and experimental evidences.Objectives1.To study the expression of soluble vascular cell adhesion molecule-1,tumor necrosis factor-??TNF-??and T lymphocyte subsets in patients with overlap syndrome.2.To study the effect of T-lymphocyte subsets on the damage of vascular endothelial function in patients with overlap syndrome.MethodThe prospective study was performed at the Respiratory Department of Tianjin Medical University General Hospital between January 2017 and December 2017.The study was enrolled stable COPD,OSAS,OS patients 25 cases respectively,healthy volunteers 20 cases,and all the enrolled researchers were divided into COPD group,OSAS group,OS group and Control group.The general data,lung function and sleep monitoring indicators of each group were recorded,including age,smoking index?pack^*years?,gender,body mass index,percentages of the predicted forced expiratory volume one second?FEV1%?,forced expiratory volume 1 second/forced vital capacity?FEV1/FVC?,apnea hypopnea index?AHI?,sleep time with SpO₂<90%?TSat90?,pulse oxygen saturation?S_PO₂?.Flow cytometry and enzyme-linked immunosorbent assay were used to detect the levels of T lymphocyte subsets,sVCAM-1 and TNF-?in the above four groups.Data analysis was performed using SPSS 20.0 and Graphpad prism 6 software.Measurement data were presented as the mean±standard deviation.Difference among multiple groups was analyzed by one-way analysis of variance?ANOVA?followed by pairwise comparison with the method of Fisher's LSD.Pearson's correlation analysis was used to analyze the relationship between CD4⁺/CD8⁺and sVCAM-1,TNF-?.The confidence interval of our research was maintained at 95%,a p-value<0.05 was considered to be statistically significant.Result1.Comparison of general information There were no significant difference in ratio of gender,age,smoking on the four groups?P>0.05?.The body mass index in the OSAS and OS groups was significantly higher than that in the control group and COPD group?P<0.01?.2.Comparison of pulmonary function and sleep monitoring indicators There was no significant difference between FEV1 and FEV1/FVC in the OS group and COPD group?P>0.05?,but both were significantly lower than those in the control group and OSAS group?P<0.01?.There was no significant difference between OS and OSAS group in AHI?P>0.05?,but both were significantly higher than those in the control group and COPD group?P<0.01?.TSat90 in the OS group was significantly higher than that in the other three groups,the lowest SPO2 was significantly lower than that in the other three groups.There were significant differences in TSat90 and lowest SPO2 on the four groups?P<0.01?.3.Comparison of the expression levels of sVCAM-1 and TNF-?The expression levels of sVCAM-1 and TNF-?in the OS group were significantly higher than those in other three groups?P<0.05?.4.Comparison of the level of T lymphocyte subsets There were significant difference in the level of CD3⁺lymphocyte subsets on the four groups?P>0.05?. The percentage of CD4⁺lymphocytes?CD4⁺%?and CD4⁺/CD8⁺in the OS group were significantly lower than those in other three groups?P<0.05?,while the percentage of CD8⁺lymphocytes?CD8⁺%?in the OS group was significantly higher than that in other three groups?P<0.01?.5.Correlation between sVCAM-1,TNF-?and CD4⁺/CD8⁺The levels of sVCAM-1 and TNF-?were negatively correlated with CD4⁺/CD8⁺?r=-0.773,P<0.01,r=-0.826,P<0.01 respectively?.The level of sVCAM-1 was positively correlated with TNF-??r=0.919,P<0.01?.6.Comparison of the level of sVCAM-1,TNF-?and T lymphocyte subsets in different subgroups of OS group In the OS subgroup,the expression of sVCAM-1,TNF-?and CD8⁺?%?in severe OSAS patients were significantly higher than those in moderate OSAS patients,while CD4⁺/CD8⁺?%?was significantly lower than those in moderate OSAS patients,all the above differences were all statistically significant?P<0.05?.In the OS subgroup,the expression of sVCAM-1,TNF-?and CD4⁺?%?in severe COPD patients was significantly higher than those in moderate COPD patients,while CD4+/CD8+?%?was significantly lower than that in moderate COPD patients,all the above differences were all statistically significant?P<0.05?.Conclusion1.The expression of TNF-?and sVCAM-1 in the OS group were significantly increased,suggesting that the OS hypoxia model may lead to more severe systemic inflammatory response and endothelial dysfunction.2.The expression of CD4⁺?%?and CD4⁺/CD8⁺?%?in the OS group were significantly decreased,while the expression of CD8⁺?%?was significantly increased,suggesting that the OS hypoxia model may lead to more severe immune dysfunction.3.The levels of sVCAM-1 and TNF-?were negatively correlated with CD4⁺/CD8⁺?%?,and the level of sVCAM-1 was positively correlated with TNF-?,suggesting that the injury of vascular endothelial function may be closely related to the immune function and inflammatory response.4.In the OS subgroup,the expression of sVCAM-1,TNF-?,and CD8⁺?%?in the severe OSAS group was significantly higher than that in the moderate OSAS group,while CD4⁺/CD8⁺?%?was significantly lower than that in the moderate OSAS group.In the OS subgroup,the expression of sVCAM-1,TNF-?and CD4⁺?%?in severe COPD group was significantly higher than that in moderate COPD group,but CD4⁺/CD8⁺?%?was significantly lower than that in moderate COPD group,suggesting that the severity of OSAS and COPD may be severely affect the immune function,inflammatory response and endothelial function damage in patients with OS.