诱导痰气道炎症指标与支气管哮喘病情关系的探讨

The study of the relationship between the airway inflammation of induced sputum and the state of asthma

目的探讨气道炎症指标对支气管哮喘(简称哮喘)患者病情监测及治疗的意义。方法收集2004年1月至2006年1月在北京大学第三医院呼吸科门诊就诊的近半年来未使用口服或吸入激素治疗的哮喘患者87例。进行哮喘症状评分、肺功能检查、诱导痰上清液检测白介素-8(IL-8)浓度及嗜酸粒细胞阳离子蛋白(ECP)浓度,对所有患者病情分级状况和气道炎症指标进行分析,探讨病情严重程度与气道炎症之间的关系;分析急性发作与气道炎症之间的关系。结果(1)重度哮喘患者中性粒细胞、IL-8水平较轻中度患者明显增高;(2)急性发作期患者嗜酸性粒细胞(EOS)、ECP较缓解期明显增高;(3)中性粒细胞与第1秒用力呼气量(FEV1)呈负相关(r=-0.522,P<0.05);中性粒细胞与IL-8呈正相关(r=0.832,P<0.05);(4)ECP、EOS与FEV1、症状评分均无相关性(r=-0.209,r=-0.189,P均>0.05;r=-0.289,r=-0.229,P均>0.05);ECP与EOS呈正相关(r=0.852,P<0.01);(5)中性粒细胞对重度哮喘的阳性预测值为91%,EOS对哮喘急性发作的阳性预测值为92.5%,ECP对哮喘急性发作的阳性预测值98.5%。结论(1)中性粒细胞、IL-8与病情严重程度有关,重度哮喘患者中性粒细胞、IL-8明显增高;(2)ECP、EOS与哮喘的急性发作有关,急性发作期哮喘患者ECP、EOS明显增高;(3)气道炎症指标可用于监测哮喘病情和调整哮喘治疗。

Objective To estimate the significance of airway inflammation to monitor and treat the asthma. Methods Eighty-seven asthmatic patients,who had not received corticosteroids in the 6 months preceding the study were examined. All patients underwent spirometry, symptom scores and sputum induction. The level of IL-8 and eosinophi cationic protein in the sputum supernatants were measured. We analysed the relationships between the different degrees of asthma and airway inflammation of all asthmatic patients. We also analysed the relationships between the acute attack and airway inflammation of all asthmatic patients. Results Sputum neutrophil and the level of IL-8 were significantly higher in severe asthmatic patients than in mild and moderate asthmatic patients. Sputum eosinophil percentages （EOS） and the level of ECP were significantly higher in acute attack asthmatic patients than in non-acute attack asthmatic patients. Neutrophil negatively correlated with FEV1 （ r = - 0. 522, P 〈 0.05 ） ; IL-8 positively correlated with neutrophil （ r = 0. 832, P 〈 0. 05 ） ; ECP and EOS both had no correlation with symptom scores and FEV1 （r = - 0. 209, r = - 0. 189, r = - 0. 289, r = - 0. 229,P 〉 0. 05） ; the level of ECP positively correlated with EOS （ r = 0. 852, P 〈 0.01 ）. Sputum neutrophil had high positive predictive value（91% ）for the severe asthma. Sputum EOS had high positive predictive value（92. 5% ）for the acute attack of asthma. The level of ECP had high positive predictive value（92. 5% ）for the acute attack of asthma. Conclusion （ 1 ） Neutrophil and IL-8 correlate with the degrees of asthma, and are significantly higher in severe asthmatic patients than in miht and moderate asthmatic patients; （2） EOS% and ECP are significantly higher in acute attack asthmatic patients than in non-acute attack asthmatic patients. （3）We could monitor and treat asthma by the index of airway inflammation.