很大一部分青少年哮喘患者缺乏气道炎症反应
2016/06/20
摘要
背景和目标：中性粒细胞炎症在成年非嗜酸性粒细胞哮喘（NEA）患者中时有发生，但我们对儿童或青少年NEA的情况知之甚少。我们评估了青少年NEA患者的临床和炎症特点。
方法：我们对77个患有哮喘和68个无哮喘的青少年（12-17岁）的气道炎症、痰中内毒素、气道高反应性、特应性和肺功能进行了评估。哮喘的诊断是基于喘息和哮喘史。
结果：非嗜酸细胞性哮喘（NEA）的比例（痰嗜酸性粒细胞＜2.5%）为54%。在这个群体中，特应性、痰中性粒细胞、嗜酸性粒细胞、嗜酸性粒细胞阳离子蛋白（ECP）、内毒素、中性粒细胞弹性蛋白酶和IL-8水平与那些没有哮喘的患者并无差异性。相反，嗜酸细胞性哮喘（EA）与特应性、痰中嗜酸性粒细胞阳离子蛋白和IL-8相关。大多数非嗜酸细胞性哮喘患者没有炎症；仅14%的患者有中性白细胞增多（≥61%中性粒细胞），在嗜酸性粒细胞性哮喘（EA）患者和无哮喘的人中，分别有11%和15%有中性粒细胞增多。EA和NEA之间FEV1（NS）有较小的差异，但症状的发生率和严重程度没有差异（63%的EA患者和52%的NEA患者为中度至重度）。
结论：非嗜酸细胞性哮喘在青少年哮喘患者中较为普遍，与嗜酸细胞性哮喘具有相似的临床特征。中性粒细胞在青少年非嗜酸细胞哮喘中似乎不起作用，其潜在的机制可能并不涉及气道炎症反应。
（苏欣 审校）
Respirology. 2016 Apr;21(3):460-6. doi: 10.1111/resp.12701. Epub 2015 Dec 22.
Absence of airway inflammation in a large proportion of adolescents with asthma.
Brooks CR1, van Dalen CJ1, Zacharasiewicz A2, Simpson JL3,4, Harper JL5, Le Gros G5, Gibson PG3, Pearce N1,6, Douwes J1.
Author information
Abstract
BACKGROUND AND OBJECTIVE:Neutrophilic inflammation has been implicated in non-eosinophilic asthma (NEA) in adults, but little is known about NEA in children/adolescents. We assessed clinical and inflammatory characteristics of NEA in adolescent asthma.
METHODS:Airway inflammation, sputum endotoxin, airway hyper-reactivity, atopy and lung function were assessed in 77 adolescents with asthmaand 68 without asthma (12-17 years). Asthma was identified on the basis of wheeze and asthma history.
RESULTS:The proportion of NEA (sputum eosinophils <2.5%) was 54%. In this group, atopy, sputum neutrophil, eosinophil, eosinophil cationic protein (ECP), endotoxin, neutrophil elastase and IL-8 levels were not different from those without asthma. In contrast, eosinophilic asthma (EA) was associated with atopy and sputum ECP and IL-8. The majority of NEA had no evidence of inflammation; only 14% had neutrophilia (≥61% neutrophils), compared with 11% of EA, and 15% of those without asthma. Small differences in FEV1 (NS) were found between EA and NEA, but symptom prevalence and severity was not different (63% of EA and 52% of NEA were classified moderate to severe).
CONCLUSION:NEA is common in adolescent asthma and has similar clinical characteristics as EA. Neutrophils do not appear to play a role in NEA in adolescents, and underlying mechanisms may not involve airway inflammation.
© 2015 Asian Pacific Society of Respirology.
KEYWORDS:adolescent; airway inflammation; asthma; eosinophil; induced sputum
Respirology. 2016 Apr;21(3):460-6. doi: 10.1111/resp.12701. Epub 2015 Dec 22.
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