甘露醇激发试验在评价哮喘患者气道反应性、气道炎症及炎症表型中的作用
2010/02/23
背景：由于治疗应反依赖于炎症表型，因此对哮喘患者气道炎症的评价的重要性日益突出。
目的：本试验旨在评价甘露醇与高渗盐水相比在检测哮喘患者气道反应性和气道炎症中的作用。
方法：55例稳定期哮喘患者在两次不同就诊时间内完成了高渗盐水（4.5%）激发试验和甘露醇激发试验，两次间隔时间为48～72小时，检测次序随机化。
结果：高渗盐水激发试验和甘露醇激发试验中分别有49例患者（89％）和42例（76％）患者获得诱导痰（P>0.05）。高渗盐水激发试验和甘露醇激发试验之间第一秒用力呼气量（FEV1）最大下降值（r=0.6, P<0.0001）、剂量反应斜率（r=0.73）、累积剂量（r=0.55）和PD15（r=0.46）存在显著相关性。甘露醇激发试验中，FEV1最大下降值在非嗜酸性粒细胞性哮喘患者中较低。甘露醇激发试验诱导的痰液中，总体细胞计数低于高渗盐水激发试验，然而两者诱导痰中嗜酸性粒细胞和中性粒细胞数未见显著差异。通过甘露醇激发试验，大部分患者分类为嗜酸性粒细胞性哮喘。两种试验诱导痰中的IL-8、中性粒细胞弹性酶和基质金属蛋白酶9含量未见显著差异。
结论：我们认为，甘露醇激发试验能用于诱导高质量痰液，对于分析炎症介质和预测哮喘炎症类型具有一定帮助。
（刘国梁 审校）
Clin Exp Allergy. 2009 Oct 30. [Epub ahead of print]
Mannitol challenge for assessment of airway responsiveness, airway inflammation and inflammatory phenotype in asthma.
Wood LG, Powell H, Gibson PG.
Summary Background Assessment of airway inflammation in asthma is becoming increasingly important, as the inflammatory phenotype underpins the treatment response. Objective This study aimed to evaluate mannitol as a tool for assessing airway responsiveness and airway inflammation in asthma, compared with hypertonic saline. Methods Fifty-five subjects with stable asthma completed a hypertonic (4.5%) saline challenge and a mannitol challenge at two separate visits, performed 48-72 h apart, in random order. Results Induced sputum was obtained from 49 (89%) subjects during the saline challenge and 42 (76%) subjects during the mannitol challenge (P>0.05). There was a significant correlation between the greatest percentage fall in forced expiratory volume in 1 s (FEV(1)) (r=0.6, P<0.0001), the dose-response slope (r=0.73), cumulative dose (r=0.55) and PD15 (r=0.46) for mannitol and hypertonic saline. The greatest percentage fall in FEV(1) to mannitol was less in non-eosinophilic asthma. There was a lower total cell count in mannitol vs. hypertonic-saline-induced sputum. However, sputum eosinophils and neutrophils were not significantly different. Using mannitol, a higher proportion of subjects were classified as having eosinophilic asthma. There were no differences in IL-8, neutrophil elastase or matrix-metalloproteinase 9 concentrations in sputum samples induced with mannitol or hypertonic saline. Conclusion We conclude that mannitol can be used to induce good-quality sputum, useful for analysis of inflammatory mediators and for predicting the inflammatory phenotype in asthma.
Wood LG, Powell H, Gibson PG.Clin Exp Allergy. 2009 Oct 30. [Epub ahead of pr
目的：本试验旨在评价甘露醇与高渗盐水相比在检测哮喘患者气道反应性和气道炎症中的作用。
方法：55例稳定期哮喘患者在两次不同就诊时间内完成了高渗盐水（4.5%）激发试验和甘露醇激发试验，两次间隔时间为48～72小时，检测次序随机化。
结果：高渗盐水激发试验和甘露醇激发试验中分别有49例患者（89％）和42例（76％）患者获得诱导痰（P>0.05）。高渗盐水激发试验和甘露醇激发试验之间第一秒用力呼气量（FEV1）最大下降值（r=0.6, P<0.0001）、剂量反应斜率（r=0.73）、累积剂量（r=0.55）和PD15（r=0.46）存在显著相关性。甘露醇激发试验中，FEV1最大下降值在非嗜酸性粒细胞性哮喘患者中较低。甘露醇激发试验诱导的痰液中，总体细胞计数低于高渗盐水激发试验，然而两者诱导痰中嗜酸性粒细胞和中性粒细胞数未见显著差异。通过甘露醇激发试验，大部分患者分类为嗜酸性粒细胞性哮喘。两种试验诱导痰中的IL-8、中性粒细胞弹性酶和基质金属蛋白酶9含量未见显著差异。
结论：我们认为，甘露醇激发试验能用于诱导高质量痰液，对于分析炎症介质和预测哮喘炎症类型具有一定帮助。
（刘国梁 审校）
Clin Exp Allergy. 2009 Oct 30. [Epub ahead of print]
Mannitol challenge for assessment of airway responsiveness, airway inflammation and inflammatory phenotype in asthma.
Wood LG, Powell H, Gibson PG.
Summary Background Assessment of airway inflammation in asthma is becoming increasingly important, as the inflammatory phenotype underpins the treatment response. Objective This study aimed to evaluate mannitol as a tool for assessing airway responsiveness and airway inflammation in asthma, compared with hypertonic saline. Methods Fifty-five subjects with stable asthma completed a hypertonic (4.5%) saline challenge and a mannitol challenge at two separate visits, performed 48-72 h apart, in random order. Results Induced sputum was obtained from 49 (89%) subjects during the saline challenge and 42 (76%) subjects during the mannitol challenge (P>0.05). There was a significant correlation between the greatest percentage fall in forced expiratory volume in 1 s (FEV(1)) (r=0.6, P<0.0001), the dose-response slope (r=0.73), cumulative dose (r=0.55) and PD15 (r=0.46) for mannitol and hypertonic saline. The greatest percentage fall in FEV(1) to mannitol was less in non-eosinophilic asthma. There was a lower total cell count in mannitol vs. hypertonic-saline-induced sputum. However, sputum eosinophils and neutrophils were not significantly different. Using mannitol, a higher proportion of subjects were classified as having eosinophilic asthma. There were no differences in IL-8, neutrophil elastase or matrix-metalloproteinase 9 concentrations in sputum samples induced with mannitol or hypertonic saline. Conclusion We conclude that mannitol can be used to induce good-quality sputum, useful for analysis of inflammatory mediators and for predicting the inflammatory phenotype in asthma.
Wood LG, Powell H, Gibson PG.Clin Exp Allergy. 2009 Oct 30. [Epub ahead of pr
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血管通透性增加先于细胞炎症预示哮喘控制的恶化
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