| ObjectiveCOPD cases were collected and TCM syndrome differentiation was carried out,and pulmonary function indexes were tested,flow cytometric analysis of cytokines associated with T lymphocyte subsets in blood samples,the distribution of TCM Syndromes of COPD and its relationship with pulmonary function indexes and T lymphocyte subsets related cytokines were discussed,The differences of lung function and T lymphocyte subsets related cytokines between COPD patients and those without COPD were compared,the correlation between pulmonary function indexes and cytokines associated with T lymphocyte subsets was analyzed by statistical analysis,to provide reference for clinical syndrome differentiation of COPD.Methods115 cases of COPD patients in Guangdong Second Hospital of traditional Chinese medicine and Guangdong Province Traditional Chinese Medical Hospital from March 2017 to July 2017 were selected as experimental subject,and during the same period,20 cases without COPD were set as normal control group.COPD patients were differentiation into 8 syndromes according to TCM syndrome,comparison and analysis the T lymphocyte subsets in different TCM Syndromes.80 patients with COPD and 20 subjects without COPD were all involved in the detection of lung function and detection of T lymphocyte subsets.Comparative analysis of the differences between the groups in lung function and T lymphocyte subsets index,and analyze the correlation between lung function and T lymphocyte subsets of related cytokines.Results(1)the syndrome differentiation of TCM Syndromes of 115 cases of COPD patients was as follows:2 cases of The invasion of lung by wind and cold syndrome(1.74%),1 cases of exterior cold internal drinking syndrome(0.87%),22 cases of syndrome of phlegm-heat obstructing lung(19.13%),29 cases of syndrome of phlegm dampness obstructing lung(25.22%),21 cases of syndrome of qi deficiency of spleen and lung(18.26%),6 cases of syndrome of qi and yin deficiency of the lung and kidney(5.22%),23 cases of syndrome of qi deficiency of lung and kidney(20.00%),11 cases of syndrome of blood stasis due to qi deficiency(9.57%).(2)a total of 80 COPD subjects participated in the detection of complete lung function and detection of complete T lymphocyte subsets,the results of TCM syndrome differentiation are as follows:1 cases of The invasion of lung by wind and cold syndrome(1.25%),0 cases of exterior cold internal drinking syndrome(0.00%),19 cases of syndrome of phlegm-heat obstructing lung(23.75%),20 cases of syndrome of phlegm dampness obstructing lung(25.00%),17 cases of syndrome of qi deficiency of spleen and lung(21.25%),1 cases of syndrome of qi and yin deficiency of the lung and kidney(1.25%),19 cases of syndrome of qi deficiency of lung and kidney(23.75%),3 cases of syndrome of blood stasis due to qi deficiency(3.75%).Due to the number of cases of The invasion of lung by wind and cold syndrome,exterior cold internal drinking syndrome,syndrome of qi and yin deficiency of the lung and kidney,syndrome of blood stasis due to qi deficiency observed is too small to be statistically analyzed,the syndrome of phlegm dampness obstructing lung,syndrome of phlegm-heat obstructing lung,syndrome of qi deficiency of spleen and lung,syndrome of qi deficiency of lung and kidney were selected for comparative analysis.Lung function tests showed that:there was no significant difference in FVC%between the 4 groups(P>0.05),there was no significant difference in FEV1%and FEV1/FVC between the syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group(P>0.05);the FEV1%and FEV1/FVC in the syndrome of qi deficiency of lung and kidney group were lower than syndrome of qi deficiency of spleen and lung group,the syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group.(P<0.05),the FEV1%and FEV1/FVC in the syndrome of qi deficiency of spleen and lung group were lower than the syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group.(P<0.05).The FEV1%and FEV1/FVC according to the syndrome of phlegm-heat obstructing lung group=syndrome of phlegm dampness obstructing lung group>syndrome of qi deficiency of spleen and lung group>syndrome of qi deficiency of lung and kidney group distribution,showed a significantly decreasing trend,the difference was statistically significant(P<0.05).Comparison of cytokines associated with T lymphocyte subsets:there was no significant difference in Treg cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction and IL-22+ cell fraction between syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group(P>0.05),The Th17 cell fraction of syndrome of phlegm dampness obstructing lung group was lower than that of syndrome of phlegm-heat obstructing lung group,the difference was statistically significant(P<0.05),there was no significant difference in Th17 cell fraction,Treg cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction and IL-22+ cell fraction between syndrome of qi deficiency of spleen and lung group and syndrome of qi deficiency of lung and kidney group(P>0.05),The Th17 cell fraction,Treg cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction and IL-22+ cell fraction of syndrome of qi deficiency of spleen and lung group and syndrome of qi deficiency of lung and kidney group were lower than that of syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group,the difference was statistically significant(P<0.05),The Treg cell fraction of syndrome of qi deficiency of spleen and lung group and syndrome of qi deficiency of lung and kidney group were higher than that of syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group,the difference was statistically significant(P<0.05),(3)80 COPD subjects were compared with 20 normal subjects without COPD:Due to the number of cases of The invasion of lung by wind and cold syndrome,exterior cold internal drinking syndrome,syndrome of qi and yin deficiency of the lung and kidney,syndrome of blood stasis due to qi deficiency observed is too small to be statistically analyzed,the invasion of lung by wind and cold syndrome,exterior cold internal drinking syndrome,syndrome of phlegm-heat obstructing lung and syndrome of phlegm dampness obstructing lung were set as empirical group,syndrome of qi deficiency of spleen and lung,syndrome of qi deficiency of lung and kidney,syndrome of qi and yin deficiency of the lung and kidney,syndrome of blood stasis were set as deficiency syndrome group.Normal subjects without COPD were set as normal control group.Lung function tests showed that:there was no significant difference in FVC%between the 3 groups(P>0.05),the FEV1%and FEV1/FVC of the deficiency syndrome group were lower than those of the normal control group and the empirical group(P<0.05),the FEV1%and FEV1/FVC of the empirical group were lower than those in the normal control group(P<0.05).The FEV1%and FEV1/FVC according to the normal control group>the empirical group>the deficiency syndrome group distribution,showed a significantly decreasing trend,the difference was statistically significant(P<0.05).Comparison of cytokines associated with T lymphocyte subsets:There were significant differences in Th17 cell fraction,Treg cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction,and IL-22+cell fraction between the 3 groups(P<0.05),the Th17 cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction,and IL-22+cell fraction of the empirical group were higher than those of the normal control group and the deficiency syndrome group,and the deficiency syndrome group were higher than the normal control group(P<0.05).The Treg cell fraction of the empirical group were lower than those in the normal control group and the deficiency syndrome group,and the deficiency syndrome group were lower than those in the normal control group(P<0.05).Treg cell fraction according to empirical group<deficiency syndrome group<normal control group trend distribution,Th17 cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction,IL-22+cell fraction according to the normal control group<deficiency syndrome group<empirical group trend distribution.(4)Correlation analysis of lung function index and T lymphocyte subsets cell fraction:Pearson correlation analysis showed that Treg cell fraction was positively correlated with FEV1%and FEV1/FVC(P<0.01),Th17 cell fraction,Th17/Treg cell ratio,Th22 cell fraction,IL-22+cell fraction were negatively correlated with FEV1%and FEV1/FVC(P<0.01).ConclusionAmong the 8 syndromes,the syndrome of phlegm-heat obstructing lung,syndrome of phlegm dampness obstructing lung,syndrome of qi deficiency of spleen and lung,syndrome of qi deficiency of lung and kidney accounted for the largest proportion,It is suggested that in the development of COPD patients,deficiency of qi is the main factor of weakness,qi deficiency and phlegm with to take disease progression.The lung function according to the syndrome of phlegm-heat obstructing lung group=syndrome of phlegm dampness obstructing lung group>syndrome of qi deficiency of spleen and lung group>syndrome of qi deficiency of lung and kidney group distribution,showed a significantly decreasing trend,the results showed that the subjects were from the normal control group to the empirical group and then to the deficiency syndrome group.With the development of the disease,the degree of qi deficiency gradually increased,and the lung function decreased gradually.Therefore,the pulmonary function index can be used as one of the reference indexes for the clinical differentiation of TCM in COPD.The Th17 cell fraction,Treg cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction and IL-22+cell fraction of syndrome of qi deficiency of spleen and lung group and syndrome of qi deficiency of lung and kidney group were lower than that of syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group,The Treg cell fraction of syndrome of qi deficiency of spleen and lung group and syndrome of qi deficiency of lung and kidney group were higher than that of syndrome of phlegm-heat obstructing lung group and syndrome of phlegm dampness obstructing lung group.It is suggested that the inflammatory reaction and immune imbalance are relatively aggravating in syndrome of phlegm-heat obstructing lung and syndrome of phlegm dampness obstructing lung,the proportion of pro-inflammatory cytokines(Th17)increases and the proportion of Treg that mediates immune responses decreases.The increase of Th22 cell fraction and IL-22+cell fraction also suggests that IL-22 plays an important role in inflammatory response and immune imbalance,and is one of the reasons for the aggravation of inflammatory reaction and immune imbalance.Th17 cell fraction,Th17 cell/Treg cell ratio,Th22 cell fraction,IL-22+cell fraction increased gradually from the normal control group to the deficiency syndrome group and to the empirical group,It is suggested that the persistent chronic inflammation and autoimmune imbalance are closely related to the changes of COPD,is an important cause of COPD patients change from the empirical group to the deficiency syndrome group,Cytokines associated with T lymphocyte subsets are associated with lung function impairment,the imbalance between pro-inflammatory cytokines and cytokines mediated autoimmunity leads to persistent airway inflammation in patients with COPD,the imbalance between pro-inflammatory cytokines and autoimmune cytokines leads to persistent airway inflammation in COPD patients,which may eventually lead to epithelial cell damage and even airway remodeling,maybe is the cause of lung function damage.The related T lymphocyte subsets index and pulmonary function index can provide some reference for the standardization of TCM syndrome differentiation. |
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