变应性鼻炎患者鼻分泌物中嗜酸粒细胞计数与鼻用糖皮质激素治疗反应的关系

Relationship between nasal discharge eosinophils and responses to treatment of inhaled giucocorticosteroid in patients with allergic rhinitis

目的观察常年性持续性变应性鼻炎（allergic rhinitis，AR）患者不同炎症类型（嗜酸粒细胞炎症型与非嗜酸粒细胞炎症型）对鼻用糖皮质激素治疗的反应性。方法选择近3个月内未接受糖皮质激素治疗的常年性持续性AR患者42例，根据鼻分泌物嗜酸粒细胞计数将患者分为嗜酸粒细胞组（A组，嗜酸粒细胞数≥0．03，23例）与非嗜酸粒细胞组（B组，嗜酸粒细胞数〈0．03，19例）进行AR症状、体征评分和鼻分泌物细胞分类计数。采用酶联免疫荧光法测定鼻分泌物嗜酸粒细胞阳离子蛋白浓度。糖皮质激素治疗2、4、6个月时进行随访，并进行疗效评价。结果A组鼻分泌物中嗜酸粒细胞数[中位数肘（25分位数；75分位数），下同]、嗜酸粒细胞阳离子蛋白水平（x^-±s，下同）基线值分别为0．086[0．065；0．176]、（3264±145）μg/L，B组分别为0．016[0．005；0．022]、（154±58）μg∥L，两组比较差异有统计学意义（t值分别为4．40、3．33，P值均〈0．01）。鼻用糖皮质激素治疗2、6个月后，A组嗜酸粒细胞数，嗜酸粒细胞阳离子蛋白水平分别为0．038[0．006；0．070]、0．019[0．010；0．060]、（175±122）μg／L、（175±153）μg／L，与基线值比较差异均有统计学意义（F值分别为6．73、7．38，P值均〈0．05）；B组分别为0．014[0．004；0．032]、0．015[0．000；0．026]、（118±60）μg／L、（112±60）μg／L，与基线值比较，嗜酸粒细胞数差异无统计学意义（F=0．82，P〉0．05），而嗜酸粒细胞阳离子蛋白水平差异有统计学意义（F=3．78，P〈0．05）。A组平均症状、体征评分与B组在基线及2、4、6个月时不同时间点比较差异均无统计学意义。鼻用糖皮质激素用量，两组各时间点比较差异均无统计学意义（P值均〉0．05）。结论对于鼻分泌物嗜酸粒细胞数增高的AR患者，鼻用糖皮质激素能够抑制嗜酸粒细胞性炎症，改善AR患者的症状和体征。非嗜酸粒细胞数增高的AR患者对糖皮质激素治疗反应性差。

Objective To evaluate the treatment responses of persistent allergic rhinitis with and without nasal discharge eosinophilia （EOS） to inhaled glucocorticosteroid （CS）, and therefore to verify whether low nasal discharge eosinophils predict poor response to treatment with CS. Methods Forty-two symptomatic allergic rhinitis patients, who had not received CS therapy in three months preceding the study, were examined before and 2 month, 4 months and 6 months after treatment with CS. At each visit, all patients underwent symptom scoring and physical sign scoring. The level of eosinophil cationic protein （ECP） in the nasal discharge supernatants was measured by radioimmunoassay. The patients were divided into 2 groups according to nasal discharge EOS percentages, an EOS group（ group A , EOS≥0. 03） and a non-EOS group （ group B, EOS 〈 0. 03）. The response to CS therapy （ as measured by symptom and physical sign scores） and the changes of nasal discharge measurements were compared between the 2 groups. Results In the group A, the baseline EOS [ 0. 086 （0. 065 ; 0. 176 ） ] and ECP level [ （ 326 ± 145 ） μg/L ] were significantly higher than those of the group B [0. 016（0. 005 ;0. 022） ] and ECP level （ 154 ± 58 ） μg/L] , respectively, t = 4.40, 3.33, both, all P 〈 0. 01. After 2 month and 6 months CS therapy, the nasal discharge EOS, ECP pred were 0. 038（0. 006;0. 070）, 0. 019（0. 010;0. 060）, （ 175 ± 122） μg/L, （ 175 ± 153） μg/L, respectively in the EOS group, which were significantly different as compared to baseline values （ F = 6. 73, 7.38, respectively, all P 〈 0. 05 ）. But in the non- EOS group, the nasal discharge EOS ECP pred were 0. 014 （ 0. 004 ; 0. 032 ）, 0. 015 （ 0. 000 ; 0. 026 ）, （ 118 ± 60 ） μg/L, （ 112 ± 60 ） μg/L, respectively at 2 and 6 months, which showed that the the nasal discharge EOS pred and the symptom and physical sign scores improved did not change （ F = 0. 82, P 〉 0. 05 ）, but the ECP level improved （ F = 3.78, P 〈 0. 05 ）. and the average daily dose of CS wear not different between the two groups at any visits. Conclusions In persistent allergic rhinitis with low nasal discharge EOS, CS therapy for 6 months failed to improve symptom and physical sign.