The Effect Of Glucocorticoid Therapy On The Ieve I Of TNF-α In Serum Of Patients With Acute Exacerbation Of The Chronic Obstructive Pulmonary Disease

Objective: The effect of glucocorticoid by intravenous drip on Ieve I of tumor necmsis factor-α(TNF-α)in serum of patients with acute exacerbation of the chronic obstructive pulmonary disease(AECOPD),and the single nucleotide polymorphisms(SNPs)of glucocorticoid receptor(GR)gene in D641 V and R477 H were studied to explore the sensitivity of SNPs to glucocorticoid therapy for patients with AECOPD.Methods: Eighty-four cases with AECOPD were collected for testing from The First people’s Hospital of Neijiang and met the criteria for diagnosis of COPD in 2017.All patients were excluded from serious diseases such as pleural effusion,arrhythmia,acute heart failure,asthma,pulmonary tuberculosis,cancer,etc,and the weight of them was between 50 kg and 60 kg.The patients who met the above criteria were given intravenous glucocorticoid(methylprednisolone 40 mg ivgtt qd)for 1 week in acute phase.extracting blood 4 ml with EDTA anticoagulant tube before and after 1 week treatment,and extraction of serum and blood cells keeping in the-70 refrigerator were used to determine the concentration of TNF-αand the SNP detection of the GR genes.Before and after treatment each patient will measure the lung function in strict accordance with the chronic obstructive pulmonary disease global initiative(GOLD)guidelines on determination method for determination of lung function。The same patient was treated as a control group before and after treatment to contrast the changes of the serum TNF-αconcentration and lung function,and the probability of mutation of gene locus D641 V and R477 H was calculated.Results: In the 84 patients with AECOPD,the symptoms of cough,expectoration,chest distress,sleep and mental states were all better than before.Examination such as pulmonary function,arterial blood gas analysis,blood routine is better than before,and can be gradually overextended to the stable treatment.In the treatment process,the patient’s condition is not aggravating and death,and the all can meet discharge standard and discharge smoothly.The numeric values of TNF-α and FEV1%pred(the first second force expiratory volume is the percentage of the estimated value)before receiving treatment were(9.34±5.64)pg/m L and(35.88±19.24)% and the numeric values after receiving treatment were(4.65±4.41)pg/m L and(42.96±23.20)%.Comparison before and after treatment,the difference was statistically significant(P<0.05).In the 81 cases,SNPs detection was performed,and results there was no gene mutation induced by gene mutation in D641 V and R477 H.Conclusions: After a week of systemic use of glucocorticoid in patients with AECOPD,the concentration of TNF-α in serum decreased,indicating that TNF-α played an important role in the pathogenesis of COPD patients.After glucocorticoid therapy the patients’ lung function was improved,and the inflammatory response of patients was reduced,indicating that the concentration of TNF-α in the serum of AECOPD patients reflected the therapeutic effect of the glucocorticoid in a certain degree.None of the 81 patients with AECOPD in this study were found to produce hormone resistance by gene mutation in D641 V and R477 H,indicating that the mutation rate of these two sites in the population of this region may be very low.So it need to expand the sample for further study.