哮喘联盟

摘要
   背景：美国世贸中心（WTC）爆炸案的营救人员和社区暴露者的灰尘和烟雾暴露与哮喘样呼吸道症状发作有关。在某些哮喘患者，出现了伴随有肺和外周嗜酸性粒细胞增多的嗜酸性粒细胞性炎症。我们认为，WTC暴露者的持续性哮喘样症状与以外周血嗜酸性粒细胞增多为特征的全身炎症相关。
   方法：WTC环境健康中心（WTC-EHC）是针对出现WTC相关症状的当地居民、工人和清洁工的一个治疗项目。患者接受标准化的评价，包括问卷调查和全血细胞计数。在2005年9月至2009年3月间，2462名受试者入选本项目，并进行分析。除外2001年9月之前有呼吸道症状或肺部疾病以及目前吸烟或者吸烟较多的对象。
   结果：1517名受试者满足入选标准。患者平均年龄为47岁，女性占51%，种族分布广泛。在WTC灰尘/烟雾暴露后持续出现的症状包括：劳力后呼吸困难（68%）、咳嗽（57%）、胸闷（47%）和喘息（33%）。与无喘息的患者相比，大部分伴喘息的患者外周血嗜酸性粒细胞增多（21% vs. 13%, p < 0.0001）。外周血嗜酸性粒细胞增多的受试者，肺活量检测时更有可能出现气流受阻（16% vs. 7%, p = 0.0003）。
   结论：在诸多WTC暴露人群中出现的外周嗜酸性粒细胞与喘息和气流受阻相关。这些数据显示，在出现WTC相关哮喘症状的人群中，嗜酸性粒细胞可能参与了肺部炎症。

（苏楠 审校）
J Asthma. 2012 Dec 11. [Epub ahead of print] 
 

Elevated Peripheral Eosinophils Are Associated with New-Onset and Persistent Wheeze and Airflow Obstruction in World Trade Center-Exposed Individuals.

Kazeros A, Maa MT, Patrawalla P, Liu M, Shao Y, Qian M, Turetz M, Parsia S, Caplan-Shaw C, Berger KI, Goldring R, Rogers L, Reibman J.

Source
Department of Medicine, Bellevue Hospital, New York University , NY , USA.

Abstract
BACKGROUND：Exposure to World Trade Center (WTC) dust and fumes is associated with the onset of asthma-like respiratory symptoms in rescue and recovery workers and exposed community members. Eosinophilic inflammation with increased lung and peripheral eosinophils has been described in subpopulations with asthma. We hypothesized that persistent asthma-like symptoms in WTC-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils.
METHODS：The WTC Environmental Health Center (WTC EHC) is a treatment program for local residents, local workers, and cleanup workers with presumed WTC-related symptoms. Patients undergo a standardized evaluation including questionnaires and complete blood count. Between September 2005 and March 2009, 2462 individuals enrolled in the program and were available for analysis. Individuals with preexisting respiratory symptoms or lung disease diagnoses prior to September 2001 and current or significant tobacco use were excluded,
RESULTS：One thousand five hundred and seventeen individuals met the inclusion criteria. Patients had a mean age of 47 years, were mostly female (51%), and had a diverse race/ethnicity. Respiratory symptoms that developed after WTC dust/fume exposure and remained persistent included dyspnea on exertion (68%), cough (57%), chest tightness (47%), and wheeze (33%). A larger percentage of patients with wheeze had elevated peripheral eosinophils compared with those without wheeze (21% vs. 13%, p < .0001). Individuals with elevated peripheral eosinophils were more likely to have airflow obstruction on spirometry (16% vs. 7%, p = .0003).
CONCLUSION：Peripheral eosinophils were associated with wheeze and airflow obstruction in a diverse WTC-exposed population. These data suggest that eosinophils may participate in lung inflammation in this population with symptoms consistent with WTC-related asthma.

J Asthma. 2012 Dec 11. [Epub ahead of print]