小气道功能障碍：过敏性鼻炎与过敏性哮喘的联系
2018/06/20
摘要
在哮喘中，已经发现其气道反应异常以及小气道产生一氧化氮过多。如果“同一种气道，同一种疾病”的概念是一致的，那么这种功能障碍也应该在变应性鼻炎患者的外周气道中被检查出来。
我们研究了外周气道反应性和NO过度产生是否会出现在变应性鼻炎患者的远端气道中。我们纳入了31例过敏性哮喘患者、23例变应性鼻炎患者和24例对照受试者，在诱导痰前后，检测其呼出气一氧化氮（FeNO），氦气（HE）及六氟化硫（SF6）单次呼气冲洗试验（SBWT）Ⅲ相的斜率（S）。SBWT对肺外周气道直径变化敏感。
与对照组比较，FeNO在哮喘和鼻炎组中下降更明显（分别为-55.1%、-50%比-40.8%）（P＝0.007，P＝0.029）。SSF6和SHe在所有组中均升高。鼻炎组（P＝0.004）和哮喘组（P＜0.001）均观察到ΔSHE＞ΔSSF6，而对照组ΔSSF6＝ΔSHE（P＝0.431）。
这项研究提供的证据表明，过敏性鼻炎患者外周气道的功能障碍与哮喘中描述非常相似。此外，过敏性鼻炎中大部分增加的NO似乎来源于外周气道。
Small airways dysfunction: the link between allergic rhinitis and allergic asthma
Haccuria A, Van Muylem A, Malinovschi A, Doan V, Michils A.
Eur Respir J; 2018; 51(2). pii: 1701749.
ABSTRACT
Abnormal airway reactivity and overproduction of nitric oxide (NO) occurring in small airways have been found in asthma. If the “one airway, one disease” concept is consistent, such dysfunctions should also be detected in the peripheral airways of patients suffering from allergic rhinitis.
We investigated whether peripheral airway reactivity and NO overproduction could be documented in distal airways in patients with allergic rhinitis. Exhaled NO fraction (FeNO) and the slope (S) of phase III of the single-breath washout test (SBWT) of helium (He) and sulfur hexafluoride (SF6) were measured in 31 patients with allergic asthma, 23 allergic rhinitis patients and 24 controls, before and after sputum induction. SBWT is sensitive to airway calibre change occurring in the lung periphery.
The FeNO decrease was more significant in asthma and rhinitis than in controls (−55.1% and −50.0%, respectively, versus −40.8%) (p=0.007 and p=0.029, respectively). SSF6 and SHe increased in all groups. Change in SHe (ΔSHe) > ΔSSF6 was observed in rhinitis (p=0.004) and asthma (p<0.001), whereas ΔSSF6 =ΔSHe in controls (p=0.431).
This study provides evidence of peripheral airway dysfunction in patients with allergic rhinitis quite similar to that described in asthma. Furthermore, a large proportion of the increased NO production reported in allergic rhinitis appears to originate in the peripheral airways.
在哮喘中，已经发现其气道反应异常以及小气道产生一氧化氮过多。如果“同一种气道，同一种疾病”的概念是一致的，那么这种功能障碍也应该在变应性鼻炎患者的外周气道中被检查出来。
我们研究了外周气道反应性和NO过度产生是否会出现在变应性鼻炎患者的远端气道中。我们纳入了31例过敏性哮喘患者、23例变应性鼻炎患者和24例对照受试者，在诱导痰前后，检测其呼出气一氧化氮（FeNO），氦气（HE）及六氟化硫（SF6）单次呼气冲洗试验（SBWT）Ⅲ相的斜率（S）。SBWT对肺外周气道直径变化敏感。
与对照组比较，FeNO在哮喘和鼻炎组中下降更明显（分别为-55.1%、-50%比-40.8%）（P＝0.007，P＝0.029）。SSF6和SHe在所有组中均升高。鼻炎组（P＝0.004）和哮喘组（P＜0.001）均观察到ΔSHE＞ΔSSF6，而对照组ΔSSF6＝ΔSHE（P＝0.431）。
这项研究提供的证据表明，过敏性鼻炎患者外周气道的功能障碍与哮喘中描述非常相似。此外，过敏性鼻炎中大部分增加的NO似乎来源于外周气道。
（韩宇宇 张红萍 王刚 四川大学华西医院中西医结合科呼吸组）
（Eur Respir J; 2018; 51(2). pii: 1701749.）
（Eur Respir J; 2018; 51(2). pii: 1701749.）
Small airways dysfunction: the link between allergic rhinitis and allergic asthma
Haccuria A, Van Muylem A, Malinovschi A, Doan V, Michils A.
Eur Respir J; 2018; 51(2). pii: 1701749.
ABSTRACT
Abnormal airway reactivity and overproduction of nitric oxide (NO) occurring in small airways have been found in asthma. If the “one airway, one disease” concept is consistent, such dysfunctions should also be detected in the peripheral airways of patients suffering from allergic rhinitis.
We investigated whether peripheral airway reactivity and NO overproduction could be documented in distal airways in patients with allergic rhinitis. Exhaled NO fraction (FeNO) and the slope (S) of phase III of the single-breath washout test (SBWT) of helium (He) and sulfur hexafluoride (SF6) were measured in 31 patients with allergic asthma, 23 allergic rhinitis patients and 24 controls, before and after sputum induction. SBWT is sensitive to airway calibre change occurring in the lung periphery.
The FeNO decrease was more significant in asthma and rhinitis than in controls (−55.1% and −50.0%, respectively, versus −40.8%) (p=0.007 and p=0.029, respectively). SSF6 and SHe increased in all groups. Change in SHe (ΔSHe) > ΔSSF6 was observed in rhinitis (p=0.004) and asthma (p<0.001), whereas ΔSSF6 =ΔSHe in controls (p=0.431).
This study provides evidence of peripheral airway dysfunction in patients with allergic rhinitis quite similar to that described in asthma. Furthermore, a large proportion of the increased NO production reported in allergic rhinitis appears to originate in the peripheral airways.
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预测哮喘急性发作未来风险的新型生物标志物-痰液与血清硫化氢比值
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种族对FeNO值有重大影响
