M胆碱能受体阻断剂和β受体激动剂治疗哮喘疗效分析

The changes of receptor and lung function of asthma patients treated with receptor agonist and antimucarinics

目的研究M胆碱能受体阻断剂和β受体激动剂治疗哮喘时β受体的变化以及相关细胞因子和肺功能的变化。方法选取稳定期哮喘患者和健康志愿者为研究对象,对哮喘患者分别应用噻托溴铵、溴化异丙托品、沙丁胺醇。用放射性配基结合分析法测定外周血淋巴细胞β受体的变化,测定血清白介素5(interleukin-4,IL-4)、白介素12(interleukin-12,IL-12)含量,测定治疗前后的肺功能。结果健康对照组外周血淋巴细胞β受体密度比哮喘各组显著升高(P<0.01)。沙丁胺醇组治疗后β受体密度较治疗前下降显著(P<0.01)。噻托溴铵和溴化异丙托品组治疗前后β受体密度变化不显著。哮喘各组治疗后IL-4均比治疗前显著降低(P<0.01),沙丁胺醇组降低IL-4作用更显著(P<0.01)。哮喘各组治疗后IL-12均比治疗前显著升高(P<0.01)。治疗后,噻托溴铵组较溴化异丙托品组第一秒用力呼气容积(FEV1)、呼气峰流速(PEF)升高更显著(P<0.01)。结论长期应用β受体激动剂会导致β受体下调,长期应用噻托溴铵和溴化异丙托品对β受体无影响。M胆碱能受体阻断剂和β受体激动剂都能调节Th细胞亚群功能失衡。噻托溴铵较溴化异丙托品改善肺功能疗效好。

Objective To investigate changes of receptor,cytokine and lung function in asthma patients by using antimucarinics and agonist.Methods Thirty stable asthma patients and ten health volunteers were involved into our study.The asthma patients were treated with tiotropium bromide,ipratropium bromide and agonist randomly.The adrenoreceptor density of peripheral lymphocytes were measured by radio ligand binding assay,and the content of interleukin-4（IL-4） and interleukin-12（IL-12） were measured by enzyme-linked immunosorbnent assay.The variation of lung function before and after treatment was also observed.Results The adrenoreceptor density of those in health group were significantly higher than that of asthma group（P〈0.01）.The adrenoreceptor density was significantly lower after agonist therapy than that before reatment（P〈0.01）.There were no significant change of adrenoreceptor density after treated with tiotropium bromide and ipratropium bromide.The content of IL-4 of the health group were significantly lower than that of asthma group（P〈0.01）.The content of IL-12 of the health group was significantly higher than that of asthma group（P〈0.01）.After therapy,the content of IL-4 of all the groups was significantly lower than that before treatment（P〈0.01） and the content of IL-12 of all the groups was significantly higher than before（P〈0.01）.The parameters of FEV1 and PEF of tiotropium bromide group were enhance after treatment than that of ipratropium bromide group（P〈0.01）.Conclusion The level of adrenoreceptor will be down-regulated after treated with agonist in long period of time.There were no changes of adrenoreceptor after tiotropium bromide and ipratropium bromide therapy.Antimucarinics and agonist can correct disbalance of function existing in Th1/Th2.The effect of tiotropium bromide is better than that of ipratropium bromide in improvement of lung function.