Changes of Th17/Treg and serum cytokines in peripheral blood of patients with acute exacerbation of chronic obstructive pulmonary disease and secondary pulmonary fungal infection / 中国综合临床

ABSTRACT

Objective:To explore the changes of peripheral blood Th17/Treg and serum cytokines in AECOPD patients with secondary pulmonary fungal infection.Methods:Selected the clinical data of 27 AECOPD patients who were admitted between January 2018 to March 2020 in the Department of Respiratory Medicine, Hai'an People's Hospital Affiliated to Nantong University with fungal infection (fungal infection group), and 58 AECOPD patients without fungal infection (non-fungal infection group) who received treatment in the hospital during the same period. Compared the general clinical data, peripheral blood Th17 and Treg cell levels, Th17/Treg ratio, interleukin-17 (IL-17), interleukin-23 (IL-23), interferon-γ (interferon-γ, IFN-γ), and transforming growth factor-β (TGF-β) levels. Meanwhile, compared the levels of Th17 and Treg cells in peripheral blood, the ratio of Th17/Treg and serum cytokines in patients with different infection severity in fungal infection group. The measurement data with normal distribution were compared by independent samplet t-test between the two groups, one-way ANOVA between multiple groups, LSD-t test for pairwise comparision, and χ 2 test for counting data. Results:In the 27 AECOPD patients with fungal infection group, the pathogen distribution was 65.52% (19/27) of candida albicans, 10.34% (3/27) of candida tropicalis,10.34% (3/27) of candida albicans, and 6.90% (2/27) of Aspergillus. The level of Th17 [(16.18±3.15) % and (12.34±2.64) %, t=5.87, P<0.001)], the ratio of Th17/Treg [(4.70±0.85) and (2.41±0.51), t=22.87, P<0.001] in Patients with fungal infection group were higher than those in the non-fungal group. The level of Treg [(3.42±0.42) % and (5.13±0.51) %, t=20.77, P<0.001] in Patients with fungal infection group was lower than those in the non-fungal group. The levels of IL-17 [(85.67±21.51) μg/L and (53.64±14.36) μg/L, t= 8.12, P<0.001], and IL-23 [(61.38±16.58) μg/L and (38.29±12.60) μg/L, t=7.10, P<0.001] in Patients with fungal infection group were higher than those in non-fungal infection group, but the levels of IFN-γ ((47.75±17.72) μg/L and (62.37±19.06) μg/L, t=3.37, P=0.001) and TGF-β ((110.34±26.03) μg/L and (131.40±35.03) μg/L, t=2.87, P=0.007) were lower than those in non-fungal infection group, and the differences were statistically significant. There were statistically significant differences in the ratio of Th17/Treg, and the levels of Th17, Treg cells and cytokine among patients with different infection severity in the fungal infection group. With the increase of infection severity, the levels of Th17 ((13.06±1.98)%, (15.94±2.11)%, (17.75±2.20)%, F=10.19, P<0.001), the ratios of Th17/Treg ((5.01±0.60), (5.66±0.69), (6.52±0.65), F=10.77, P<0.001), the levels of IL-17 ((63.39±11.64) μg/L,(78.66±12.82) μg/L, F=9.01, P=0.001), and IL-23 ((42.52±13.11) μg/L, (59.97±15.25) μg/L, (69.75±14.30) μg/L, F=7.41, P=0.003) were increase, the levels of Treg ((4.33±0.39)%, (3.32±0.42)%, (2.50±0.35)%, F=44.42, P<0.001), IFN-γ ((57.78±10.52) μg/L, (48.82±10.39) μg/L, (38.90±10.56) μg/L, F=6.50, P=0.006), TGF-β ((126.62±18.94) μg/L, (115.34±13.66) μg/L, (102.52±17.73) μg/L, F=4.25, P=0.026) were significantly decreased. Conclusion:The imbalance of Th17/Treg ratio and related serum cytokines play an important role in the process of lung fungal infection in AECOPD patients, and their imbalance is related to the severity of fungal infection. Therefore, the levels of Th17/Treg and serum cytokines should be closely monitored in AECOPD patients.