关键词: 肺疾病, 慢性阻塞性；烟草；戒烟；诱导痰；气道局部免疫；生活质量；抑郁；焦虑

Abstract: Background　Smoking is harmful to the local airway immune function and life quality of COPD patients. The harm of tobacco is huge，quitting smoking is imminent. Smoking cessation can benefit quitters. There are currently many literatures on smoking cessation interventions，but fewer studies on moking cessation and local airway immunity，and also fewer studies on smoking cessation intervention for early COPD. Objective　To investigate the effect and clinical significance of smoking cessation intervention on airway local immunity and life quality in patients with early stable COPD. Methods　A total of 170 patients with stable COPD who met the following inclusion and exclusion criteria enrolled by People's Hospital of Quzhou in Zhejiang Province from June 2016 to June 2019 were selected and divided into smoking cessation group（106 cases）and non-smoking group（64 cases）. The smoking cessation group was divided into a successful cessation group（48 cases）and a smoking cessation group（58 cases）according to the success or failure of smoking cessation. The gender，age，smoking index，etc of the patients were collected.All patients in the three groups were followed up for 12 months after enrollment（ie：0 month，0.5 month，1 month，3 months，6 months，9 months and 12 months）. Induced sputum immune indicators including T lymphocyte subsets（CD3+，CD4+，CD4+/CD8+，CD8+），immunoglobulins（IgG，IgA，lgM）and complement C3，C4；lung function test result〔first second end of expiration volume（FEV1）〕；life quality indicators including cough（cough score），sputum expectoration（sputum expectoration score），dyspnea〔Dyspnea Scale（mMRC）score〕，COPD condition〔chronic obstructive pulmonary disease assessment test（CAT）Score〕，tobacco dependence（tobacco dependence score），smoking severity index，exhaled CO value，combined anxiety/depression〔depression and anxiety scale（HAD）score〕were recorded.The incidence of respiratory tract infection and the acute exacerbation of COPD within 1 year before the follow-up and during the follow-up were also recorded. The chages in related indicators during follow-up were compared. Results　There is an interaction between the group and time in terms of cough score，expectoration score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，number of respiratory infections and acute exacerbations during follow-up（P<0.05）. The group has the significant main effect on cough score，sputum score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，number of respiratory infections during follow-up，and number of acute exacerbations during follow-up Significant（P<0.05），time in the cough score，sputum score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，respiratory tract infections during follow-up（P<0.05）. With the extension of follow-up time，the non-smoking group cough score，expectoration score，CAT score，mMRC score，HAD score，tobacco dependence score，smoking severity index，exhaled CO value，number of respiratory infections and acute exacerbation of COPD during follow-up gradually increased，and FEV1 gradually decreased（P<0.05）. There is an interaction between group and time in CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05）；the main effect of the group was significant on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05），and the main effect of the time was significant on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05）. The levels of CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，complement C3，and complement C4 in the successful smoking cessation group were compared at the rest of the follow-up time with that at the 6-month follow-up，and the differences were statistically significant（P<0.05）. The IgM level of the successful smoking cessation group was compared at the rest of the follow-up time with that at the 12-month follow-up，and the difference was statistically significant（P<0.05）. The levels of CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4 in the smoking cessation failure group were compared at the rest of each follow-up time with that at 1 month，and the difference was statistically significant（P<0.05）. At the beginning of the follow-up，the CD3+，CD4+，CD4+/CD8+，IgA，IgG，IgM，complement C3，complement C4 and FEV1 in three groups were positively correlated（P<0.05），and were negatively correlated with HAD score，tobacco dependence score，smoking severity index score and exhaled CO detection（P<0.05）. CD8+ was negatively correlated with FEV1（P<0.05），and positively correlated with HAD score，tobacco dependence score，smoking severity index score and expiratory CO value（P<0.05）. At the end of the follow-up，CD3+，CD4+，CD4+/CD8+，IgA，IgG，IgM，complement C3，and complement C4 were positively correlated with FEV1 in the successful and non-quit smoking group（P<0.05），and were negatively correlated with cough score，sputum score，HAD score，tobacco dependence score，smoking severity index score and exhaled CO value（P<0.05）. CD8+ was negatively correlated with FEV1（P<0.05），and positively correlated with HAD score，tobacco dependence score，smoking severity index score，and exhaled CO value（P<0.05）. Conclusion　Tobacco is harmful to the local airway immune function and life quality of patients with early COPD. Smoking cessation intervention is conducive to airway immune function and life quality. Those who succeed in smoking cessation benefit more，even if smoking cessation fails，patients who quit smoking in the short term can also benefit.However，the harm of tobacco to the human body is continuous，and the indicators can be significantly improved at least 6 months after quitting smoking. Local airway immune function is related to the quality of life. The improvement of airway immune function can improve the life quality and prognosis of patients，among them，T cell subgroups and IgA and IgG can better reflect the airway immune status.

Key words: Pulmonary disease, chronic obstructive；Tobacco；Smoking cessation；Induced sputum；Airway local immune；Life quality；Anxiety；Depression