吸烟哮喘患者对糖皮质激素的全身敏感性
2007/03/12
Livingston研究了吸烟哮喘患者气道以外组织对糖皮质激素的反应，以确定吸烟哮喘患者对糖皮质激素的不敏感性是否仅集中在气道。
作者采用随机双盲方式，对75位哮喘患者（其中39位吸烟者）和78位健康对照（其中30位吸烟者）进行观察性研究，测定皮肤和外周血淋巴细胞对糖皮质激素的反应。以不同浓度的倍氯米松溶液测试皮肤血管对局部皮质激素的收缩反应；以地塞米松对PHA所致淋巴细胞增殖的抑制程度表示外周血淋巴细胞对皮质激素的敏感性。研究发现，在皮肤血管对倍氯米松的收缩反应方面，吸烟哮喘患者与不吸烟哮喘患者的反应评分分别为5.39±3.58和7.26±3.05，而吸烟者和不吸烟者分别为6.47±3.33和7.86±2.81，两组间均有统计学差异。而两组在淋巴细胞对糖皮质激素的敏感性方面相当。
因而，作者认为吸烟能破坏皮肤对局部皮质激素的血管收缩反应，这一发现提示吸烟哮喘患者对皮质激素的不敏感性不限在于气道内，还包括气道外组织。
（韩伟 山东青岛大学附属青岛市立医院东院 266071 摘译）
(Eur.Respir.J.,Jan 2007,29:64-71)Systemic sensitivity to corticosteroids in smokers with asthma
Eur. Respir. J., Jan 2007; 29: 64 - 71.
Cigarette smokers with asthma are insensitive to the therapeutic effects of corticosteroids. It is not known whether this insensitivity to corticosteroids in smokers affects tissue sites beyond the airways.
A total of 75 asthmatic subjects (39 smokers) and 78 healthy controls (30 smokers) were recruited to an observational study. The cutaneous and peripheral blood lymphocyte responses to corticosteroids were measured. The cutaneous vasoconstrictor response to topical beclometasone was measured by applying different concentrations of beclometasone solutions to the skin in a random double-blind manner. The degree of blanching at each concentration was graded after 18 h. The sensitivity of peripheral blood lymphocytes to corticosteroids was assessed by measuring the suppressive effect of dexamethasone on lymphocyte proliferation stimulated by phytohaemagglutinin (PHA).
Total mean±SD cutaneous vasoconstrictor response score to beclometasone was reduced in smokers with asthma to 5.39±3.58 versus 7.26±3.05 in never-smokers with asthma; and in all smokers to 6.47±3.33 versus 7.86±2.81 in all never-smokers. The sensitivity to corticosteroids of lymphocytes stimulated by PHA was similar between groups.
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持续性哮喘患者运动期间主诉呼吸困难症状的变化
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妊娠和高危妊娠期应用吸入类固醇激素导致高血压的巢式病例对照研究
