The Study Of Serum Inflammation And Airway Obstruction In Patients With Tuberculosis-associated Obstructive Pulmonary Disease

Objective:To analyze the characteristics of serum inflammatory and pulmonary function in patients with tuberculosis-associated obstructive pulmonary disease（TOPD）,explore the possible mechanism of airflow limitation in patients with TOPD,and provide a theoretical basis for patients with old pulmonary tuberculosis in prevention and treatment of irreversible airflow limitation.It is expected to further slow down the progressive damage of lung function in patients with TOPD from the etiology and improve the prognosis of patients.Methods:Patients with COPD and TOPD in acute and stable phase who met the inclusion and exclusion criteria in our department from October 2020 to October2021 were collected as the case group,30 patients in every group;and 30 patients with old pulmonary tuberculosis during the same period were selected as the case group in the physical examination center.FEV₁%Pred,FEV₁/FVC,MMEF%Pred were collected and the expression levels of IL-6,NE,MMP-9 and TNF-αwere determined in each group.The BODE score was evaluated in patients with TOPD and COPD groups.The differences of pulmonary function indexes,the expression levels of inflammatory factor and the BODE score were compared among the groups.The correlation between inflammatory factors and pulmonary function and BODE score in TOPD group was analyzed.Results:The expression levels of IL-6,TNF-α,MMP-9 and NE in acute TOPD were higher than stable TOPD and the old tuberculosis group,and the stable TOPD was higher than the old tuberculosis group（P<0.05）.The FEV₁%Pred in acute TOPD was lower than stable TOPD;and FEV₁%Pred,FEV₁/FVC,MMEF%Pred in acute and stable TOPD were lower than old tuberculosis group（P<0.05）.BODE score in acute TOPD was higher than acute COPD and stable TOPD（P<0.05）.The acute TOPD and COPD had no significant difference in IL-6,TNF-α,MMP-9,NE,FEV₁%Pred,FEV₁/FVC,MMEF%Pred（P>0.05）.The expression levels of IL-6,MMP-9,NE and the BODE score in stable TOPD were higher than stable COPD（P<0.05）;the FEV₁%Pred in stable TOPD was lower than stable COPD（P<0.05）.There was no significant difference in TNF-α,FEV₁/FVC and MMEF%Pred between COPD and TOPD stable groups（P>0.05）.The FEV₁%Pred was negatively correlated with IL-6,TNF-a,MMP-9,NE in acute TOPD（r_s=-0.463,-0.474,-0.431,-0.547,P<0.05）;and it was negatively correlated with IL-6,TNF-a,MMP-9,and NE in stable TOPD（r=-0.525,-0.488,-0.496,-0.436,P<0.05）.The BODE score was positively correlated with IL-6,TNF-a,MMP-9,and NE in acute TOPD（r_s=0.502,0.572,0.449,0.587,P<0.05）;and it was positively correlated with IL-6,TNF-a,MMP-9,NE in acute TOPD（r_s=0.551,0.588,0.600,0.510,P<0.05）.Conclusions:1.The expression levels of IL-6,TNF-α,MMP-9 and NE in TOPD patients were higher than those in old tuberculosis group,which suggested that acute and chronic inflammatory response was involved in the pathogenesis of TOPD;2.The expression levels of IL-6,TNF-α,MMP-9 and NE in stable and acute TOPD were negatively correlated with FEV₁%Pred,and positively correlated with BODE score.It showed that the expression level of inflammatory factors has certain clinical significance for the assessment of disease severity in patients with TOPD;3.The levels of IL-6,TNF-α,MMP-9,and NE in stable TOPD were higher than stable COPD,and the FEV₁%Pred was lower than stable COPD,which suggested that the inflammatory response in TOPD patients was more obvious,and the lung function damage was more significant.