屋尘螨激发后加重无哮喘症状的持续变应性鼻炎患者气道炎症和气道高反应性
2015/12/29
摘要
研究背景：在中国，屋尘螨可使鼻炎和哮喘患者致敏，是最常见的过敏原。本文研究鼻炎患者在屋尘螨鼻激发试验后其上、下气道炎症和气道高反应性变化情况。
研究方法：研究分四组，每组15人，分别为伴有气道高反应非哮喘的屋尘螨致敏鼻炎患者（AR+AHR+），不伴有气道高反应屋尘螨致敏鼻炎患者(AR+AHR-),屋尘螨致敏的健康对照组(HC+DP+)和无屋尘螨致敏的健康对照组(HC+DP-)，所有研究对象行屋尘螨激发试验，采取鼻部症状视觉模拟评分(VAS)、鼻腔灌洗液和鼻气道阻力测量(NAR)，诱导痰，FEV1 评估，组胺支气管激发试验评估气道高反应性（PD20 -FEV1）以及呼出气一氧化氮（FeNO）检测。
研究结果：AR+AHR+组患者鼻气道阻力显著升高，所有研究对象在激发试验30min时鼻部症状视觉模拟评分均有升高，6h降到基线值，且AR+AHR+ 和 AR+AHR-组症状评分明显高于对照组（p<0.05）。AR+AHR+ 和 AR+AHR-组在组织胺支气管激发试验后鼻腔灌洗液和诱导痰中嗜酸粒细胞升高(P<0.001)。仅AR+AHR+ 组激发试验后FEV1% 和 PD20-FEV1降低而FeNO增加 (P<0.05)。鼻腔灌洗液嗜酸粒细胞计数与痰嗜酸粒细胞计数和FeNO水平成正相关，而与FEV1和 PD20呈负相关。
研究结论：屋尘螨鼻激发试验可诱导和加重无哮喘症状的持续过敏性鼻炎患者上下气道炎症和气道高反应性。
评论：本研究直接证明了对单纯过敏性鼻炎患者行屋尘螨激发试验后其上下气道炎症和气道高反应性明显加重。由于这些患者发展为哮喘的风险更高，应予以密切随访。
研究背景：在中国，屋尘螨可使鼻炎和哮喘患者致敏，是最常见的过敏原。本文研究鼻炎患者在屋尘螨鼻激发试验后其上、下气道炎症和气道高反应性变化情况。
研究方法：研究分四组，每组15人，分别为伴有气道高反应非哮喘的屋尘螨致敏鼻炎患者（AR+AHR+），不伴有气道高反应屋尘螨致敏鼻炎患者(AR+AHR-),屋尘螨致敏的健康对照组(HC+DP+)和无屋尘螨致敏的健康对照组(HC+DP-)，所有研究对象行屋尘螨激发试验，采取鼻部症状视觉模拟评分(VAS)、鼻腔灌洗液和鼻气道阻力测量(NAR)，诱导痰，FEV1 评估，组胺支气管激发试验评估气道高反应性（PD20 -FEV1）以及呼出气一氧化氮（FeNO）检测。
研究结果：AR+AHR+组患者鼻气道阻力显著升高，所有研究对象在激发试验30min时鼻部症状视觉模拟评分均有升高，6h降到基线值，且AR+AHR+ 和 AR+AHR-组症状评分明显高于对照组（p<0.05）。AR+AHR+ 和 AR+AHR-组在组织胺支气管激发试验后鼻腔灌洗液和诱导痰中嗜酸粒细胞升高(P<0.001)。仅AR+AHR+ 组激发试验后FEV1% 和 PD20-FEV1降低而FeNO增加 (P<0.05)。鼻腔灌洗液嗜酸粒细胞计数与痰嗜酸粒细胞计数和FeNO水平成正相关，而与FEV1和 PD20呈负相关。
研究结论：屋尘螨鼻激发试验可诱导和加重无哮喘症状的持续过敏性鼻炎患者上下气道炎症和气道高反应性。
评论：本研究直接证明了对单纯过敏性鼻炎患者行屋尘螨激发试验后其上下气道炎症和气道高反应性明显加重。由于这些患者发展为哮喘的风险更高，应予以密切随访。
（南方医科大学南方医院 王燕红 赵海金 ）
Wang, W., et al., Aggravation of airway inflammation and hyperresponsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma. Allergy, 2015.
Wang, W., et al., Aggravation of airway inflammation and hyperresponsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma. Allergy, 2015.
Aggravation of airway inflammation and hyperresponsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma
Abstract
BACKGROUND:House dust mites are the most prevalent allergen causing sensitizations in patients with rhinitis and asthma in China. We aimed to investigate the changes in both upper and lower airway inflammation and responsiveness following Dermatophagoides pteronyssinus (Der-p) nasal provocation test (NPT) in rhinitis patients.
METHODS:Study subjects included 15 non-asthmatic Der-p sensitized rhinitis (AR) patients with airway hyperresponsiveness (AHR) (AR+AHR+), 15 AR patients without AHR (AR+AHR-), 15 healthy control (HC) with Der-p sensitization (HC+DP+) and 15 HC without Der-p sensitization (HC+DP-). All subjects underwent Der-p NPT. Visual analogue scoring (VAS) of nasal symptoms, nasal lavage and nasal airway resistance (NAR) measurement, sputum induction, and forced expiratory volume in 1 second (FEV1 ) were performed. Airway responsiveness to histamine bronchoprovocation (PD20 -FEV1 ) and exhaled nitric oxide (FeNO) were determined.
RESULTS:NAR increased significantly in all subjects with the greatest effect seen in AR+AHR+ individuals. VAS increased in all subjects at 30 min and returned to baseline at 6 hrs, with significant higher levels in AR+AHR+ and AR+AHR- subjects (p<0.05). Eosinophils in nasal lavage fluid and sputum increased significantly after NPT in AR+AHR+ and AR+AHR- subjects (P<0.001). FEV1 % and PD20 -FEV1 decreased and FeNO increased significantly after NPT only in AR+AHR+ subjects (P<0.05). Nasal lavage eosinophil count was positively correlated with sputum eosinophil count and the level of FeNO, and negatively correlated with FEV1 and PD20 .
CONCLUSIONS:House dust mite nasal provocation test induces and aggravates both upper and lower airway inflammation and hyperresponsiveness in patients with persistent allergic rhinitis without asthmatic symptoms. This article is protected by copyright. All rights reserved.
Wang, W., et al., Aggravation of airway inflammation and hyperresponsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma. Allergy, 2015.
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