哮喘患者呼出气冷凝液中三磷酸腺苷浓度
2011/04/15
背景：哮喘的发病机制涉及到嘌呤的信号转导。不仅腺苷而且三磷酸腺苷（adenosine triphosphate，ATP）可能都发挥了一定的作用，但尚缺乏相关人类的证据。ATP可在呼出气冷凝液（exhaled breath condensate ，EBC）中被测定，后者作为一无创气道标本适用于哮喘患者的监测。我们检测哮喘患者EBC ATP的浓度，观察其与疾病参数的关系，并计算气道ATP水平。
方法：收集45例持续期哮喘患者（年龄：34.7 6±13.2 岁; FEV1: 87.0± 15.5% 预测值)和32例健康对照受试者(年龄: 36.9 ± 12.6 岁; FEV1: 98.9 ± 9.9% 预测值）的EBC。同时进行呼出气一氧化氮（fractional exhaled nitric oxide, FeNO）和肺功能指标的测定，而且获得哮喘控制测试（Asthma Control Test ，ACT）分值。EBC ATP测定采用荧光素-荧光素酶分析（luciferin-luciferase assay）方法。气道ATP浓度采用以真空处理的EBC标本的传导性进行稀释方法计算。在分析中采用参数检验。ATP浓度和一氧化氮水平采用对数转换。
结果：哮喘EBC ATP和经计算的气道ATP浓度未见增高，而且两者与FeNO或ACT评分亦无任何相关性。.EBC ATP的浓度受气道小滴稀释方法的影响，而且经计算的气道ATP水平与FEV1存在相关性（r=-0.35, P<0.05）。
结论： EBC ATP浓度似乎不太适用于哮喘监测。EBC中介质的浓度与EBC传导性间的关系强调EBC测量方法需进一步标准化的重要性，以及尚需更多的研究以理解气道小滴的形成。
(王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译)
（Chest. 2010;138(3): 536-542）
Adenosine Triphosphate Concentration of Exhaled Breath Condensate in Asthma
Lázár Z, Cervenak L, Orosz M, Gálffy G, Komlósi ZI, Bikov A, Losonczy G, Horváth I.
Chest. 2010;138(3): 536-542
Background Purinergic signaling is involved in asthma pathogenesis. Not only adenosine but also adenosine triphosphate (ATP) might play a role, but human evidence is scarce. ATP can be measured in exhaled breath condensate (EBC), a noninvasive airway sample suggested as being suitable for patient monitoring. We determined EBC ATP concentration in asthma, investigated its relation to disease parameters, and calculated airway ATP level.
Methods: EBC was collected from 45 patients with persistent asthma (age 34.7 6±13.2 years; FEV1 , 87.0± 15.5% predicted; mean ± SD) and 32 healthy control subjects (age 36.9 ± 12.6 years; FEV1 , 98.9 6 9.9% predicted). Exhaled nitric oxide concentration (FeNO) and lung function were measured, and Asthma Control Test (ACT) score was obtained. EBC ATP was measured in luciferin-luciferase assay. Airway ATP concentration was calculated using dilution estimated from conductivity of vacuum-treated EBC samples. Parametric tests were applied in the analyses. ATP
concentrations and nitric oxide levels were logarithmically transformed.
Results: EBC ATP and calculated airway ATP concentrations were not elevated in asthma, and none of them was related to FeNO or ACT score. EBC ATP concentration was influenced by airway droplet dilution (r =-0.32, P <0.05), and there was a relation between calculated airway ATP level and FEV 1 ( r =- 0.35, P <0.05).
Conclusions: EBC ATP concentration does not seem to be useful for asthma monitoring. The relation between EBC mediator concentration and EBC conductivity highlights the importance of further standardization of EBC methodology and the need for more studies to understand airway droplet formation.
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成人阻塞性睡眠呼吸暂停风险与哮喘控制的相关性
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哮喘高风险儿童7岁时内毒素和尘螨过敏原暴露与哮喘和特异性致敏的关系
