不同方案治疗良性支气管狭窄的临床疗效及对T淋巴细胞亚群及Th1/Th2平衡的影响
|
摘要
目的研究球囊扩张术联合冷冻和球囊扩张术联合氩离子体凝固治疗良性支气管狭窄的临床疗效及对T淋巴细胞亚群及Th1/Th2平衡的影响。方法选择120例良性支气管狭窄患者,随机分为A组和B组,每组60例,其中A组给予球囊扩张术+冷冻治疗。B组给予球囊扩张术+APC治疗,观察临床治疗效果及对T淋巴细胞亚群及Th1/Th2平衡的影响。结果经支气管镜下治疗后2组支气管直径,FEV1和FVC水平较前明显升高,气促分级水平较前明显下降,与治疗前相比较差异均有统计学意义(P<0.05),其中A组治疗后支气管直径,FEV1和FVC水平高于B组,气促分级低于B组,差异均有统计学意义(P<0.05),A组经治疗后T淋巴亚群细胞水平变化差异无统计学意义(P>0.05),而B组CD_3~+,CD_4~+和CD_4~+/CD_8~+水平明显下降,而CD_8~+水平明显上升,与A组和治疗前比较,差异均有统计学意义(P<0.05),2组术后均出现Th1细胞减少、Th2细胞增加,Th1/Th2比值下降,其中A组与治疗前比较变化无明显的统计学意义(P>0.05),B组Th1细胞明显下降、Th2细胞增加,Th1/Th2比值下降,与A组和治疗前比较,差异均有统计学意义(P<0.05),2组均未发生严重的不良反应。结论球囊扩张术联合冷冻治疗良性支气管狭窄的临床治疗效果优于球囊扩张术联合氩离子体凝固,可能与其对免疫功能影响较小等因素有关。
Objective To investigate the therapeutic effects of balloon dilatation combined with cryotherapy and balloon dilatation combined with argon plasma coagulation( APC) on benign bronchial stenosis and their effects on T lymphocyte subsets and balance of Th1/Th2. Methods One hundred and twenty patients with benign bronchial stenosis were randomly divided into two groups,with 60 patients in each group. the patients in group A were treated by balloon dilatation +cryotherapy,however,the patients in group B were treated by balloon dilatation + APC. The therapeutic effects and their effects on T lymphocyte subsets as well as balance of Th1/Th2 were observed and compared between two groups. Results After treatment,the bronchial diameter,levels of FEV1 and FVC in both groups were incaresed,however,dyspnea grading was significantly decreased,as compared with those before treatment( P < 0. 05). Moreover the bronchial diameter,levels of FEV1 and FVC in group A were obviously higher than those in group B,but the dyspnea grading in group A was significantly lower than that in group B( P < 0. 05). After treatment,there were no significant differences in the changes of T lymphocyte subsets cellular levels in group A( P > 0. 05),however,the levels of CD_3~+,CD_4~+,CD_4~+/CD_8~+in group B were significantly decreased,but the levels of CD_8~+ were obviously increased,as compared with those before treatment and those in group A( P <0. 05). The decrease of Th1 cells,increase of Th2 cells and decrease of Th1/Th2 ratio were found in both groups,in which,there were no significant differences in these changes of group A,as compared with those before treatment( P > 0. 05),however,there were significant differences in these changes of group B,as compared with those in before treatment and those in group A( P < 0. 05). Besides no severe adverse reactions were observed in both groups. Conclusion The clinical effects of balloon dilatation combined with cryotherapy on benign bronchial stenosis are superior to those of balloon dilatation combined with argon plasma coagulation,which may be correlated to its less influences on immune function of patients.
Objective To investigate the therapeutic effects of balloon dilatation combined with cryotherapy and balloon dilatation combined with argon plasma coagulation( APC) on benign bronchial stenosis and their effects on T lymphocyte subsets and balance of Th1/Th2. Methods One hundred and twenty patients with benign bronchial stenosis were randomly divided into two groups,with 60 patients in each group. the patients in group A were treated by balloon dilatation +cryotherapy,however,the patients in group B were treated by balloon dilatation + APC. The therapeutic effects and their effects on T lymphocyte subsets as well as balance of Th1/Th2 were observed and compared between two groups. Results After treatment,the bronchial diameter,levels of FEV1 and FVC in both groups were incaresed,however,dyspnea grading was significantly decreased,as compared with those before treatment( P < 0. 05). Moreover the bronchial diameter,levels of FEV1 and FVC in group A were obviously higher than those in group B,but the dyspnea grading in group A was significantly lower than that in group B( P < 0. 05). After treatment,there were no significant differences in the changes of T lymphocyte subsets cellular levels in group A( P > 0. 05),however,the levels of CD_3~+,CD_4~+,CD_4~+/CD_8~+in group B were significantly decreased,but the levels of CD_8~+ were obviously increased,as compared with those before treatment and those in group A( P <0. 05). The decrease of Th1 cells,increase of Th2 cells and decrease of Th1/Th2 ratio were found in both groups,in which,there were no significant differences in these changes of group A,as compared with those before treatment( P > 0. 05),however,there were significant differences in these changes of group B,as compared with those in before treatment and those in group A( P < 0. 05). Besides no severe adverse reactions were observed in both groups. Conclusion The clinical effects of balloon dilatation combined with cryotherapy on benign bronchial stenosis are superior to those of balloon dilatation combined with argon plasma coagulation,which may be correlated to its less influences on immune function of patients.
引文
1 Rojas-Solano J,Becker HD.Bronchoscopic application of mitomycin-C as adjuvant treatment for benign airway stenosis.J Bronchology Interv Pulmonol,2011,18:53-55.
2 陆瑶,何元兵,齐曼古力·吾守尔,等.支气管镜下冷冻结合球囊扩张治疗支气管结核所致气道狭窄24例.中国内镜杂志,2013,19:389-392.
3 厉为良,李永华,吕丽辉,等.氩等离子体凝固联合球囊扩张并支架置入术治疗大气道狭窄.现代实用医学,2010,22:1330-1332.
4 Stulbarg RC,Adams L.Textbook of respiratory medicine.Philadelphia:Saunders,1994.511-512.
5 Fu EQ,Jin FG.Novel bronchoscopic balloon dilation for patients with bronchostenosis caused by bronchial tuberculosis:a case report.J Med Case Rep,2014,8:225-227.
6 常秀军,王子彤,段勇,等.支气管内膜结核126例的临床分析.中国防痨杂志,2016,38:154-156.
7 李亚强,李强,白冲,等.良性中央气道狭窄386例病因分析及腔内介入治疗的疗效评价.中华结核和呼吸杂志,2008,31:364-368.
8 朱春梅.冷冻及球囊扩张等多方式介入治疗结核性气管狭窄观察.临床肺科杂志,2012,17:667-668.
9 段鸿飞,傅瑜.纤维支气管镜下球囊扩张治疗结核性支气管狭窄的有效性与安全性.中华结核和呼吸杂志,2007,30:339-342.
10 王莉,徐爱晖.经纤支镜介入冷冻治疗支气管结核的疗效分析.临床肺科杂志,2013,18:1450-1452.
11 Fernando HC,Dekeratry D,Downie G,et al.Feasibility of spray cryotherapy and balloondilation for non-malignant strictures of the airway.Eur J Cardio thorac Surg,2011,40:1177-1180.
12 马长秀,陆友金,赵卉,等.氩等离子体凝固治疗气道阻塞性病变的临床观察.临床肺科杂志,2011,16:1879-1880.
13 李朝霞,张睢扬,闫春连,等.氩气刀联合高频电刀及冷冻刀治疗气道狭窄的临床疗效.临床肺科杂志,2012,17:1031-1033.
14 翟慧,刘一典,唐神结,等.肺结核患者外周血NKT细胞、NK细胞、T淋巴细胞亚群的变化及意义同济大学学报(医学版),2010,31:42-46.
15 王敏,蒋强,刘赛云,等.结核患者检测T淋巴细胞亚群的意义.海南医学,2010,21:122-123.
16 耿书军,刘建玲,高官聚,等.经支气管镜局部注射辅助治疗耐多药肺结核的疗效及对患者免疫功能的影响.中国内镜杂志,2015,21:243-245.
17 石彬,刘德若,郭永庆,等.经纤维支气管镜冷冻治疗中、晚期中心型肺癌致气道梗阻的疗效.中国微创外科杂志,2008,8:965-966.
18 Wang SY,Li TY,Zheng YQ.Effects of cardiopulmonary bypass on plasma pentraxin-3 level and the balance of Th1/Th2 function in children with congenital heartmalformations.Zhonghua Yi Xue Za Zhi,2009,89:1024-1027.
2 陆瑶,何元兵,齐曼古力·吾守尔,等.支气管镜下冷冻结合球囊扩张治疗支气管结核所致气道狭窄24例.中国内镜杂志,2013,19:389-392.
3 厉为良,李永华,吕丽辉,等.氩等离子体凝固联合球囊扩张并支架置入术治疗大气道狭窄.现代实用医学,2010,22:1330-1332.
4 Stulbarg RC,Adams L.Textbook of respiratory medicine.Philadelphia:Saunders,1994.511-512.
5 Fu EQ,Jin FG.Novel bronchoscopic balloon dilation for patients with bronchostenosis caused by bronchial tuberculosis:a case report.J Med Case Rep,2014,8:225-227.
6 常秀军,王子彤,段勇,等.支气管内膜结核126例的临床分析.中国防痨杂志,2016,38:154-156.
7 李亚强,李强,白冲,等.良性中央气道狭窄386例病因分析及腔内介入治疗的疗效评价.中华结核和呼吸杂志,2008,31:364-368.
8 朱春梅.冷冻及球囊扩张等多方式介入治疗结核性气管狭窄观察.临床肺科杂志,2012,17:667-668.
9 段鸿飞,傅瑜.纤维支气管镜下球囊扩张治疗结核性支气管狭窄的有效性与安全性.中华结核和呼吸杂志,2007,30:339-342.
10 王莉,徐爱晖.经纤支镜介入冷冻治疗支气管结核的疗效分析.临床肺科杂志,2013,18:1450-1452.
11 Fernando HC,Dekeratry D,Downie G,et al.Feasibility of spray cryotherapy and balloondilation for non-malignant strictures of the airway.Eur J Cardio thorac Surg,2011,40:1177-1180.
12 马长秀,陆友金,赵卉,等.氩等离子体凝固治疗气道阻塞性病变的临床观察.临床肺科杂志,2011,16:1879-1880.
13 李朝霞,张睢扬,闫春连,等.氩气刀联合高频电刀及冷冻刀治疗气道狭窄的临床疗效.临床肺科杂志,2012,17:1031-1033.
14 翟慧,刘一典,唐神结,等.肺结核患者外周血NKT细胞、NK细胞、T淋巴细胞亚群的变化及意义同济大学学报(医学版),2010,31:42-46.
15 王敏,蒋强,刘赛云,等.结核患者检测T淋巴细胞亚群的意义.海南医学,2010,21:122-123.
16 耿书军,刘建玲,高官聚,等.经支气管镜局部注射辅助治疗耐多药肺结核的疗效及对患者免疫功能的影响.中国内镜杂志,2015,21:243-245.
17 石彬,刘德若,郭永庆,等.经纤维支气管镜冷冻治疗中、晚期中心型肺癌致气道梗阻的疗效.中国微创外科杂志,2008,8:965-966.
18 Wang SY,Li TY,Zheng YQ.Effects of cardiopulmonary bypass on plasma pentraxin-3 level and the balance of Th1/Th2 function in children with congenital heartmalformations.Zhonghua Yi Xue Za Zhi,2009,89:1024-1027.