吸入性糖皮质激素停用后的哮喘加重与诱导痰白介素－8水平增高及中性粒细胞数量增多有关
2007/11/02
中性粒细胞在哮喘急性发作中的作用目前尚不明确。Maneechotesuwan K等通过随机双盲法观察了停用布地奈德对24例中度稳定期哮喘患者诱导痰炎性指标的影响。
通过12周的研究，结果显示：停用布地奈德（400 μg bid）导致75％（8/12）的受试者哮喘加重，而布地奈德组只有10％（1/10）出现哮喘加重。哮喘加重的患者诱导痰白介素－8水平显著增高、中性粒细胞数量显著增多，两者的变化呈正相关，并且以上变换早于哮喘加重前出现。
由此可见过早停用吸入性糖皮质激素将导致哮喘加重，而诱导痰中白介素－8水平的增高、中性粒细胞数量的增多先于哮喘加重。
(蔡闯 广州医学院第一附属医院 广州呼吸病研究所 510120 摘译）
(Chest 2007; 132:98–105)
Loss of control of asthma following inhaled corticosteroid withdrawal is associated with increased sputum interleukin-8 and neutrophils.
Maneechotesuwan K, MD, PhD, Essilfie-Quaye S, BSc, Kharitonov SA, MD, PhD, Adcock IM, PhD, Barnes PJ, DM, DSc, FCCP.
Background
The role of neutrophils in exacerbations of asthma is poorly understood. We examined the effect of withdrawal of inhaled corticosteroids on sputum inflammatory indexes in a double-blind study in patients with moderate, stable asthma.
Methods
Following a 2-week run in period, 24 subjects were randomized to receive either budesonide (400 μg bid) or placebo, and the study was continued for another 10 weeks.
Results
Loss of asthma control developed in 8 of 12 patients over the 10-week period of steroid withdrawal, whereas only 1 of 10 patients with budesonide treatment had exacerbations. Those with an exacerbation had increased sputum interleukin (IL)-8 (p < 0.0001) and increased sputum neutrophil numbers (p < 0.0001) compared to those without an exacerbation. The significant elevation in sputum IL-8 and neutrophil counts initially occurred 2 weeks prior to an exacerbation. Sputum neutrophilia correlated positively with changes in IL-8 levels (r2＝0.76, p＝0.01).
Conclusions
Rapid withdrawal of inhaled corticosteroids results in an exacerbation of asthma that is preceded by an increase in sputum neutrophils and IL-8 concentrations, in contrast to an increase in eosinophils reported in previous studies in which inhaled steroids are slowly tapered.
Keywords asthma; exacerbation; interleukin-8; neutrophil
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