夜间哮喘患者呼吸功能及白三烯昼夜节律的研究

Study of circadian rhythm of respiratory function and leukotriene in nocturnal asthma

目的:观察夜间哮喘患者通气功能的昼夜节律,并探讨炎症介质白三烯与夜间哮喘的关系。方法:于4、8、16、22时测定哮喘夜间发作组(n=20)、哮喘非夜间发作组(n=22)和健康对照组(n=20)的用力呼气流速峰值(PEF)、1s用力呼气量占预计值百分比(FEV1%)及呼吸驱动指标口腔阻断压(P0.1);同时动态监测尿液中白三烯E4(LTE4)浓度。结果:哮喘夜间发作组PEF、FEV1%于16时达峰值,凌晨4时降到低谷;且其夜间PEF、FEV1%的降低与P0.1的升高呈显著负相关(P<0.01)。哮喘夜间发作组LTE4浓度(pg/mgcreatinine)21:01～次日9:00段(324.22±222.51)显著高于哮喘非夜间发作组(194.95±76.52)及健康对照组(201.11±68.57)(P均<0.05);且哮喘夜间发作组21:01～次日9:00段显著高于9:01～15:00段(P<0.01)。结论:夜间哮喘患者通气功能具有昼夜节律;白三烯多肽的昼夜变化与夜间哮喘的发生密切相关。

Objective： To observe the circadian rhythm of ventilation function in nocturnal asthma and the relationship of inflammation mediator leukotriene （LT） and nocturnal asthma. Methods： Three groups were studied： 20 patients with nocturnal asthma; 22 asthmatic patients without nocturnal attacks; 20 control subjects. PEF, FEV1% and mouth closed pressure（P0.1） were measured at 04：00, 08：00, 16：00 ＆ 22：00.LTE4 was measured by EIA. Results： In nocturnal asthmatic group ventilation function was highest at 16：00 and lowest at 04：00. A significant correlation was observed between the increase of P0.1, and the decreased PEF, FEV1% at night in nocturnal asthma （P〈0.01）. At 21：01± 9：00, LTE4 was significantly higher in nocturnal asthma（324.22±222.51） than in non-nocturnal asthma（194.95±76.52） and health（201.11 ±68.57）. And in nocturnal asthma LTE4 at 21：01 - 9：00 was significantly higher than that of 9：01-15：00 （P〈0.01）. Conclusion： In nocturnal asthma, ventilation function takes on circadian rhythm. The change of LT may contribute to the nocturnal worsening of asthma.