哮喘患者运动诱发的支气管痉挛对皮质激素的反应以及痰中嗜酸细胞的相关研究
2008/04/30
为检验嗜酸细胞相关的气道炎症与运动性支气管痉挛（EIB）之间的关系，以及其对吸入皮质激素（ICS）的反应疗效，MyLinh Duong等人将26个未使用激素的有EIB的哮喘患者随机双盲分成两组，每组13人，每一组吸入两种剂量的环索奈德3周，观察过程还包括了3到8周的清除期。一组剂量是每天40或160 µg ，另一组是每天80 或320 µg，初始和之后每周行一次运动激发试验和痰学检查。统计数据得出有10例在基线时痰中嗜酸细胞 5%。只有吸入大剂量皮质激素组（160 和 320 µg的）痰中嗜酸细胞比率有明显下降。而痰嗜酸细胞比率与EIB的严重程度明显相关，此可预示EIB对大剂量激素治疗的反应效果，而对小剂量(40和80 µg)无明显相关性。EIB应用一周小剂量ICS后有明显下降，之后几乎没有改善，与基线时的嗜酸细胞计数无明显相关。相反，EIB合并嗜酸细胞增多者经过大剂量ICS治疗后较那些嗜酸细胞<5%（即不伴有嗜酸细胞增多）的治疗后改善更明显。在第一周应用大剂量ICS治疗后,两组EIB改善的差异显著，且这种改善差异随着时间而增多。此研究表明嗜酸性气道炎症可能在改善EIB的严重程度和对ICS疗效评价上起重要作用。
因此，痰的嗜酸细胞百分比检测可能在预测EIB对不同剂量ICS的反应和短期疗效中有用。
因此，痰的嗜酸细胞百分比检测可能在预测EIB对不同剂量ICS的反应和短期疗效中有用。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2008; 133:404-411)
Sputum Eosinophils and the Response of Exercise-Induced Bronchoconstriction to Corticosteroid in Asthma*
MyLinh Duong, MBBS; Padmaja Subbarao, MD, MSc; Ellinor Adelroth, MD, PhD; George Obminski, BSc; Tara Strinich, BSc; Mark Inman, MD, PhD; Soren Pedersen, MD, PhD and Paul M. O’Byrne, MB, FCCP
Abstract
Background: The relationship between eosinophilic airway inflammation and exercise-induced bronchoconstriction (EIB), and the response to inhaled corticosteroid (ICS) therapy was examined.
Methods: Twenty-six steroid-naïve asthmatic patients with EIB were randomized to two parallel, double-blind, crossover study arms (13 subjects in each arm). Each arm compared two dose levels of inhaled ciclesonide that were administered for 3 weeks with a washout period of 3 to 8 weeks, as follows: (1) 40 vs 160 µg daily; and (2) 80 vs 320 µg daily. Baseline and weekly assessments with exercise challenge and sputum analysis were performed.
Results: Data were pooled and demonstrated that 10 subjects had baseline sputum eosinophilia 5%. Only high-dose ICS therapy (ie, 160 and 320 µg) significantly attenuated the sputum eosinophil percentage. Sputum eosinophil percentage significantly correlated with EIB severity, and predicted the magnitude and temporal response of EIB to high-dose therapy, but not to low-dose therapy (ie, 40 and 80 µg). Low-dose ICS therapy provided a significant reduction in EIB at 1 week, with little additional improvement thereafter, irrespective of baseline sputum eosinophil counts. In contrast, high-dose ICS therapy provided a significantly greater improvement in EIB in subjects with sputum eosinophilia compared to those with an eosinophil count of < 5%. The difference between the eosinophilic groups in the magnitude of improvement in EIB was evident after the first week of high-dose ICS therapy and increased with time.
Conclusions: These results suggest that eosinophilic airway inflammation may be important in modifying the severity of EIB and the response to ICS therapy. Measurements of sputum eosinophil percentage may, therefore, be useful in predicting the magnitude and temporal response of EIB to different dose levels of ICSs.
Key Words: exercise-induced bronchoconstriction • inhaled corticosteroids • sputum eosinophils • steroid responsiveness
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肺炎支原体诱导哮喘患者气道上皮细胞表达MUC5AC
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中度及重度哮喘气道细胞因子差异性比较
