支气管哮喘患者血浆中硫化氢的变化及其意义

Plasma level of endogenous hydrogen sulfide in patients with acute asthma

目的:研究内源性硫化氢(hydrogen sulfide,H2S)在支气管哮喘发病中的作用。方法:哮喘急性发作期患者44例,其中经过临床治疗进入缓解期的患者33例,失访11例,33例中有3例回访时雾化留痰失败,健康对照12例。采用敏感硫电极的方法测定血浆H2S水平,检测肺功能,测定诱导痰细胞的计数和分类。结果:健康对照组(12例)的血浆H2S水平为(75.2±13.1)μmol/L,哮喘临床缓解组(33例)为(55.8±13.6)μmol/L,急性发作期轻度组(9例)为(57.8±6.3)μmmol/L,急性发作期中度组(13例)为(40.8±5.1)μmol/L,急性发作期重度组(22例)为(31.3±2.9)μmol/L,各组之间比较差异均有统计学意义(F=44.592,P<0.01)。协方差分析结果显示,研究对象中吸烟者与非吸烟者血浆H2S水平分别为(45.4±19.5)μmol/L与(52.7±16.0)μmol/L,二者比较差异有统计学意义(F=4.804,P<0.05)。研究对象所处的状态(健康、哮喘缓解期及哮喘发作期)与血浆硫化氢水平明显相关(r=0.712,P<0.01)。急性发作期血浆H2S水平与第一秒用力呼气容积(force expiration volumn inone second,FEV1.0)占预计值的百分比呈正相关(r=0.877,P<0.01),与诱导痰中巨噬细胞的百分比也呈正相关(r=0.791,P<0.01);而与诱导痰中的细胞总数呈负相关(r=-0.348,P<0.01),与诱导痰中的中性粒细胞百分比也呈负相关(r=-0.906,P<0.01)。结论:内源性H2S可能参与哮喘的发病,内源性H2S作为一种无创性指标监测疾病的严重程度和活动度具有一定意义。

Objective：To investigate the role of endogenous hydrogen sulfide （H2S） in patients with asthma. Methods： Levels of serum H2S, lung function and cell differential count in induced sputum were studied in 44 patients with acute exacerbation of asthma, 33 patients with stable asthma and 12 health subjects. Of the 33 patients with stable asthma, 3 failed to achieve induced sputum. Results： The serum HzS level was （75.2±13.0）μmol/L in controls （ 12 cases）, （55.8±13.6）μmol/L in patients with stable asthma （33 eases）, （57.8±6.3 ） μmol/L in patients with mild of acute exacerbation asthma （9 eases）, （40.8±5.1） μmol/L in that with moderate of acute exacerbation asthma （13 eases）, and （31.3±2.9） μmol/L in that with severe of acute exacerbation asthma （22 cases, F=44.592,P〈0.01）. The level of serum HzS was significantly lower in smokers （45.4±19.5）μmol/L as compared with nonsmokers （52.7＋16.0） μmol/L （F=4.804,P〈0.05）. Status of the subjects （ in good health, stable asthma, and exacerbation of asthma） was positively correlated with H2S in serum （r=0.712,P〈0.01）. HzS in serum was positively correlated with FEV1.0% （r=0.877, P〈0.01） and the percentage of sputum macophages （r=0.791,P〈0.01） ; and it was negatively correlated with count of sputum cells （r=-0.348,P〈0.01） and the percentage of sputumneutrophils （r=-0.906,P〈0.01）. Conclusion： Endogenous H2S may be involved in the pathogenesis of airway obstruction in asthma and may be a noninvasive marker of disease activity and severity.