咳嗽变异型哮喘的支气管炎症及变态反应特征

Chronic airway inflammation and atopic features in cough variant asthma

目的阐明咳嗽变异型哮喘（ＣＶＡ）的支气管炎症和变态反应特征。方法采用过敏原皮肤点刺试验、支气管肺泡灌洗术（ＢＡＬ）、支气管粘膜嗜酸性粒细胞计数及屋尘螨和兔抗人ＩｇＥ诱导灌洗液中肥大细胞释放组织胺试验，观察１７例ＣＶＡ患者的气道炎症及变态反应特征。结果ＣＶＡ组ＢＡＬＦ中嗜酸性粒细胞、肥大细胞和过敏指数（ＡＩ）均显著高于对照组（Ｐ＜０．０５）；屋尘螨诱导支气管肺泡灌洗液（ＢＡＬＦ）中肥大细胞释放组织胺试验，呈现一种浓度－反应正相关。结论ＣＶＡ存在有嗜酸性粒细胞和肥大细胞参与的气道慢性炎症，并有Ｉ型变态反应参与。

Objective To elucidate the chronic airway inflammation and atopic features in 17 patients with cough variant asthma (CVA). Methods (1) Allergen skin prick test, and the atopy index (AI) calculation. (2) Fiberoptic bronchoscopy, inflammatory score of airway membrane under bronchoscopy. (3) Biopsy of the airway membrane and calculation of the eosinophil infiltration. (4) Bronchoalveolar lavage, classification of various cells in the BALF. (5) House dust mite and rabbit antihuman IgE induced histamine release from mast cell. The results were compared with those in 9 patients with typical asthma (Group 8) and 7 normal subjects (Group C). Results The number of EOS and mast cells in BALF and the AI of CVA group were found higher than in control group. Conclusion (1) Similar to typical asthma, IgE dependent type I allergic reaction plays an important role in the pathogenesis of CVA. (2) Chronic inflammation including eosinophil infiltration was shown in airway membrane in CVA. (3) Bronchial hyperresponsiveness and chronic inflammation of the airway membrane in CVA are less severe than those in typical asthma. (4) In patients who are in difficulty of making a diagnose of CVA clinically. BAL and biopsy of the bronchial membrane will help to make a definite diagnosis.