哮喘和慢性咳嗽患者诱导痰黏蛋白的浓度
2010/12/07
背景：黏液高分泌是呼吸道疾病的重要病理生理指标。痰液中分泌型粘蛋白的测定在哮喘中已有报道，但在伴或不伴咯痰的慢性咳嗽中尚不清楚。
方法：我们研究了49例典型哮喘（CA），39例咳嗽变异性哮喘（CVA），9例确诊为鼻窦支气管综合征（SBS）和5例诊断为胃食管反流病（GERD）的慢性咳嗽，及11例健康人。典型哮喘中有17例，而非其它组的患者，正在服用抗炎药物。诱导痰上清液粘蛋白的检测通过酶联免疫吸附方法（ELISA）,后者可进行包括MUC5AC和MUC5B气道粘蛋白的检测。
结果：典型哮喘（674.2±548.8 μg/mL）和鼻窦支气管综合征（638.4±650.7 μg/mL）患者黏蛋白水平高于健康对照组（212.0 ±167.1 μg/mL）（P=0.0037 和 0.044)。典型哮喘患者黏蛋白水平亦高于咳嗽变异性哮喘患者（350.4 ±374.0 μg/mL）和胃食管反流病患者（134.3±93.1 μg/mL）( P=.0016和0.015),但后两组患者和健康对照组比较则没有差异。将四组病例合并，发现频繁咯痰患者的黏蛋白水平较偶有痰(P= .0023)或没有痰的患者( P < .0001)显著增加。典型哮喘患者黏蛋白水平与脉冲振荡法测定的呼吸阻抗指数和吸入乙酰胆碱后气道的反应性呈负相关。
结论：不同呼吸疾病痰黏蛋白水平存在差异，与健康对照比较，主要反映了痰液产生的程度。就哮喘而言，至少在哮喘急性发作的间期，气道黏蛋白可能有一定的保护作用，但该作用有待进一步研究。
（王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译）
(CHEST. 2010; 137(5):1122–1129)
(CHEST. 2010; 137(5):1122–1129)
Induced sputum concentrations of mucin in patients with asthma and chronic cough
Jinnai M, Niimi A, Ueda T, Matsuoka H, Takemura M, Yamaguchi M, Otsuka K, Oguma T, Takeda T, Ito I, Matsumoto H, Mishima M.
CHEST. 2010; 137(5):1122–1129
Background: Mucus hypersecretion is an important pathophysiologic index of airway disease. Measurement of secreted mucin in sputum has been reported in asthma, but not in chronic cough with or without increased sputum production.
Methods: We studied 49 patients with classic asthma (CA), 39 with cough-variant asthma (CVA), nine and five with chronic cough associated with sinobronchial syndrome (SBS) and gastroesophageal reflux disease (GERD), respectively, and 11 healthy controls. Seventeen patients with CA, but none from the other groups, were taking antiinflammatory medications. Mucin levels in induced sputum supernatants were measured by enzyme-linked immunosorbent assay, which detects airway mucin, probably including MUC5AC and MUC5B.
Results: Mucin levels were higher in patients with CA (674.2 ± 548.8 µg/mL) and SBS (638.4 ± 650.7 µg/mL) than in controls (212.0 ± 167.1 µg/mL) (P = .0037 and .044). They were also higher in patients with CA than in those with CVA (350.4 ± 374.0 µg/mL) and GERD (134.3 ± 93.1 µg/mL) (P = .0016 and 0.015), but results did not differ between the latter groups and controls. When the four disease groups were combined, patients with frequent sputum production had greater mucin levels than those with occasional (P = .0023) or no sputum production (P < .0001). Patients with CA showed negative correlations of mucin levels with respiratory resistance indices on impulse oscillation and with airway sensitivity to methacholine.
Conclusions: Sputum mucin levels differ in various respiratory conditions when compared with controls, primarily reflecting the degree of sputum production. Airway mucin might possibly exert protective effects in asthma, at least between exacerbations, but this issue needs to be further clarified by future studies.
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肥胖与非肥胖哮喘患者之比较：探索哮喘¬肥胖的交互关系
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烟曲霉特异性IgE增高与哮喘患者肺功能下降相关
