严重哮喘患者和非严重哮喘患者的气道炎症生物标记物
2009/09/16
背景：尽管使用了糖皮质激素（CS）治疗，但是仍然有5～10％的哮喘患者无法得到有效控制。
目的：本试验比较了严重哮喘患者和非严重哮喘患者之间的炎症生物标记物差异。
方法：研究纳入19名严重哮喘患者和20名非严重哮喘患者。收集患者的痰液、支气管肺泡灌洗液（BAL）和支气管活检标本。
结果：活检结果显示，支气管粘膜下层中的嗜酸性粒细胞（主要碱基蛋白阳性）、中性粒细胞、巨噬细胞、T细胞和肥大细胞在两组之间未见显著性差异；但活检中的基底膜（SBM）厚度和平滑肌面积显著增加。两组诱导痰液中的炎症细胞也未见显著性差异。BAL内的中性粒细胞显著增加，而巨噬细胞则明显降低。严重哮喘患者痰液和BAL中的嗜酸性粒细胞增加三倍，但差异无统计学意义。严重哮喘患者痰液上清液中IL-8和IL-13显著增加。支气管扩张剂使用后的第1秒用力呼气体积与乙酰甲胆碱诱导FEV1下降20％的浓度和SBM厚度呈显著负相关。
结论：严重哮喘患者炎症细胞相比非严重哮喘患者的差异在于在BAL仅发现明显的中性粒细胞增加和巨噬细胞下降，嗜酸性粒细胞数量有增加的趋势。最显著的特征是严重哮喘患者的支气管管壁重构，表现为SBM和平滑肌面积的增加。
（林江涛 审校）
Macedo P, Hew M, Torrego A, et al. Clin Exp Allergy. 2009 Jul 20.
[Epub ahead of print]
Inflammatory biomarkers in airways of patients with severe asthma compared with non-severe asthma.
Macedo P, Hew M, Torrego A, Jouneau S, Oates T, Durham A, Chung KF.
Experimental Studies, Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK.
Background About 5-10% of patients with asthma suffer from poorly-controlled disease despite corticosteroid (CS) therapy.
Objective We determined whether there were any differences in inflammatory biomarkers between severe and non-severe asthma patients.
Methods Nineteen severe and 20 non-severe asthma patients were recruited and underwent collection of induced sputum, bronchoalveolar lavage (BAL) fluid and bronchial biopsies.
Results Biopsy results showed no differences in eosinophils (major basic protein positive), neutrophils, macrophages, T cells and mast cells in the bronchial submucosa. However, subbasement membrane (SBM) thickness and smooth muscle area were increased in the biopsies. No significant differences were observed in the induced sputum inflammatory cells. In BAL fluid, there was a significant increase in neutrophils but a significant decrease in macrophages. Eosinophil counts were non-significantly increased threefold in both sputum and BAL in severe asthma. Increased levels of IL-8 and IL-13 were found in sputum supernatants of severe asthma patients. There was a significant inverse correlation between post-bronchodilator forced expiratory volume in 1 s and provocative concentration of methacholine causing a 20% fall in FEV(1) with SBM thickness.
Conclusion Differences in inflammatory cells were observed mainly in terms of increased neutrophils and reduction in macrophage numbers in BAL fluid with a trend towards increased eosinophils in severe asthma compared with non-severe asthma. However, the most notable features are the increase in features of airway wall remodelling of SBM thickness and smooth muscle area.
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能否通过住房环境指数建立室内风险指标与哮喘患者临床检测之间的关系？
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美国胸科学会/欧洲呼吸学会声明：对临床哮喘试验和临床实践中的哮喘控制和恶化进行标准化
