中国延边地区与日本东北地区重症哮喘患者肺功能和血清中IL-4IL-5INF-γ水平的对比研究

Comparative study of lung function, clinical characters and serum IL - 4, IL - 5, INF - γ level in two different areas patients with severe asthma from China Yanbian and Japan Northeast

目的阐明中国延边地区重症哮喘患者病情反复、肺功能差的主要原因，为进一步开展本地区的重症哮喘防治工作提供参考依据。方法对2007—04—2008—03到延边大学医院就诊的50例重症哮喘患者和同一期间内到日本岩手医科大学附属医院就诊的50例重症哮喘患者进行血清中总IgE、特异性IgE及肺功能检查，了解用药情况，测定血清中白细胞介素-4（IL-4）、白细胞介素-5（IL-5）、干扰素-1（INF-γ）水平并进行对比研究。结果①两个地区70％以上的重症哮喘患者血清中总IgE高于200IU／mL，对户内、户外花粉、尘螨的特异性IgE阳性反应者占50％以上；②肺功能改变：中国延边地区重症哮喘患者用力肺活量（FVC）为（64．8±4．66）％、一秒量（FEV1）（48．9±3．78）％，与日本东北地区重症哮喘患者比较差异有统计学意义。③合并COPD者中国延边地区重症哮喘患者50％，日本东北地区重症哮喘患者13％。④用药情况：中国延边地区重症哮喘患者用吸入糖皮质激素甚少，而日本东北地区重症哮喘患者用吸入糖皮质激素100％。⑤血清中IL-4、IL-5和IFN-1水平：中国延边地区重症哮喘患者血清中IL-4、IL-5水平明显高于日本东北地区重症哮喘患者（P〈0．01），而IFN-γ两组比较差异无统计学意义。结论中国延边地区重症支气管哮喘患者病情反复、肺功能差的主要原因可能是气道慢性炎症的持续存在，应积极推广以吸入糖皮质激素为主的规范化治疗。

Objective To compare the pulmonary function, clinical character and serum IL -4, IL - 5, INF -γ level in two different areas patients with severe asthma from China Yanbian and Japan Northeast in order to find out the possible reason why the asthmatic patients from China Yanbian area with more recurrent asthma attacks and more poor lung function, and to provide the basis for drawing up a work plan for China Yanbian Asthma Alliance. Methods 50 cases of severe asthmatic patients respectively from Yanbian area and Japan Northeast area at the same duration were included in this study The lung function, serum IgE, specific IgE and the serum IL- 4, IL- 5, INF-γ level were measured, the treatment conditions were also questioned. Results Serum IgE was more than 200 IU/mL in 70% severe asthmatic patients of two different areas. FVC was （64.8 ±4.66）% and FEV1 was （48.9±3.78）% in severe asthmatic patients of China Yanbian and there were significant differences in FVC and FEV1 between two different areas. 50% severe asthmatic patients in China Yanbian area had COPD,but only 13% in Japan Northeast. The serum IL -4 IL -5 level in China Yanbian area patients with severe asthma were much higher than those in Japan Northeast area patients with severe asthma （ P 〈0.01 ）. There was no significant difference in INF -γ level between two areas. The rate of accepting inhaled corticosteroid treatment in China Yanbian area under guidance of GINA was less than 5%, while the most of patients with severe asthma in Japan Northeast were treated under guidance of GINA . Conclusion The possible reason of more recurrent severe asthma attacks and more poor lung function in severe asthmatic patients from China Yanbian area was persistent chronic airway inflammation, which shows regular inhaled corticosteroid treatment is very important in the asthma treatment.