CAJ | 학술논문

目的探讨老年慢性阻塞性肺疾病(COPD)患者急性期自然免疫功能的缺陷,并研究免疫干预治疗的作用.方法采用随机的方法将70例老年COPD住院患者分成干预组35例、对照组35例,另设老年健康对照组20例.患者入院后行常规检查治疗,老年干预组加用口服的非特异免疫调节药匹多的莫德(pidotimod),观察30 d,前15 d,口服匹多的莫德,2次/d,2片/次(400 mg/片),后15 d维持量,1次/d,2片/次,分别于第1天、第30天用流式细胞仪检测患者外周血CD_(14)、CD_(158b)、HLA-DR的改变,同时观察第10天时临床症状的改善情况.结果干预组、对照组、健康对照组最终纳入分析患者分别为30、28、20例.干预组、对照组外周血CD_(14)、CD_(158b)、HLA-DR参数均较健康对照组低,差异均有统计学意义(P＜0.05).在常规治疗一致的前提下,加用匹多的莫德的干预组上述免疫参数在治疗30 d时均明显升高,差异有统计学意义(P＜0.05).第10天老年干预组的临床症状如咳嗽、咳痰、肺部湿啰音的改善均较对照组明显,差异有统计学意义(P＜0.05).结论老年COPD在急性期发作期间自然免疫功能低下.加用非特异性免疫调节剂匹多的莫德(Pidotimod)片后,可改善自身的免疫功能,同时加快了临床症状的恢复.
목적 탐토노년만성조새성폐질병(COPD)환자급성기자연면역공능적결함,병연구면역간예치료적작용.방법 채용수궤적방법장70례노년COPD주원환자분성간예조35례、대조조35례,령설노년건강대조조20례.환자입원후행상규검사치료,노년간예조가용구복적비특이면역조절약필다적막덕(pidotimod),관찰30 d,전15 d,구복필다적막덕,2차/d,2편/차(400 mg/편),후15 d유지량,1차/d,2편/차,분별우제1천、제30천용류식세포의검측환자외주혈CD_(14)、CD_(158b)、HLA-DR적개변,동시관찰제10천시림상증상적개선정황.결과 간예조、대조조、건강대조조최종납입분석환자분별위30、28、20례.간예조、대조조외주혈CD_(14)、CD_(158b)、HLA-DR삼수균교건강대조조저,차이균유통계학의의(P＜0.05).재상규치료일치적전제하,가용필다적막덕적간예조상술면역삼수재치료30 d시균명현승고,차이유통계학의의(P＜0.05).제10천노년간예조적림상증상여해수、해담、폐부습라음적개선균교대조조명현,차이유통계학의의(P＜0.05).결론 노년COPD재급성기발작기간자연면역공능저하.가용비특이성면역조절제필다적막덕(Pidotimod)편후,가개선자신적면역공능,동시가쾌료림상증상적회복.
Objective To investigate innate immune deficiency in elderly patients with chronic obstructive pulmonary disease during acute exacerbations (AECOPD) and effects of the immunostimuulating agent Pidotimod in AECOPD patients.Methods A total of 70 elderly patients with AECOPD were randomized recruited as trial group (n=35) and control group (n=35),with a additional health control group of 20 elderly people. After admission the patients were given routine treatment,but the patients in the trial group were orally given nonspecific immunoregulatory agent Pidotimod for 30 days,for the first 15 days,800 mg (two tables),twice a day;and for the second 15 days 800 mg as maintenance dose,once a day. The levels of CD_(14),CD_(158b) and HLA-DR in peripheral blood were measured by flow cytometry at the 1st,15th and 30th day. Meanwhile,the clinical conditions at the 10th day were evaluated.Results The final subjects in the study were 30 in the trial group,28 in the control group and 20 in the health group. The levels of CD_(14),CD_(158b) and HLA-DR of the patients in the trial and control groups were lower than those in the health group (P＜0.05). Before treatment, The eldely COPD intervention group showed lower levels of CD_(14),CD_(158b), HLA-DR,as compared with the 30 d of pidotimod treatment(P<0.05).At the 10th day the clinical symptoms such as cough,amount of expectoration,pulmonary wet rales were obviously improved,with a significant difference as compared with in the control group (P＜0.05).Conclusion Innate immune responses are suppressed in elderly patients with AECOPD. The medication of nonspecific immune regulatory agent Pidotimod can improve the self immunity,and promote the appearance of clinical symptoms.