哮喘和慢性阻塞性肺疾病患者糖皮质激素治疗前后痰液炎性标志物的变化

The significance of inflammatory markers in sputum of asthmatic and chronic obstructive pulmonary diseases patients before and after glucocorticoid treatment

目的探讨哮喘和慢性阻塞性肺疾病（ＣＯＰＤ）患者吸入糖皮质激素治疗前后痰液中细胞因子和嗜酸细胞阳离子蛋白（ＥＣＰ）浓度及糖皮质激素对其影响。方法采用荧光酶联免疫法检测糖皮质激素治疗前后痰液中白细胞介素（ＩＬ）５、ＩＬ８、ＥＣＰ浓度及嗜酸细胞和嗜中性粒细胞计数。结果哮喘患者经糖皮质激素治疗后ＥＣＰ浓度由（５００．３±４９．６）μｇ／Ｌ降至（５９．８±１０．９）μｇ／Ｌ，嗜酸细胞数由（１１．６±１．７）×１０－２降至（４．１±０．７）×１０－２，ＩＬ５浓度较治疗前差异有显著性（Ｐ＜０．０１）；ＣＯＰＤ患者ＩＬ５浓度下降不明显。结论哮喘气道炎症与嗜酸细胞激活、ＥＣＰ和ＩＬ５释放增多有关。ＣＯＰＤ气道炎症以嗜中性粒细胞数增高为主。哮喘病人吸入糖皮质激素治疗后可调节炎性细胞数量和功能，抑制细胞因子生成，从而抑制气道炎症，治疗效果优于ＣＯＰＤ患者。

Objective To study the change of cytokines and eosinophil cationic protein(ECP) level in the sputum before and after glucocorticoid(GC) inhalation treatment so as to comprehend their effect on asthmatic and chronic obstructive pulmonary diseases (COPD) patients. Methods A method to induce sputum with inhaled hypertonic saline was used. The level of interleukin (IL) 5, IL 8 and ECP was measured with enzyme linked immunosorbent assay method. Results The concentration of ECP decreased from (500.3±49.6) μg/L to (59.8±10.9) μg/L, the percentage of eosinophils (Eos) dropped from (11.6±1.7)×10 -2 to (4.1±0.7)×10 -2 and there is significant difference in the concentration of IL 5 in the group of asthmatic patients after GC treatment. However, the concentration of IL 5 in the COPD patients did not show significant change after the same therapy. Conclusion Respiratory tract inflammation in asthma is related to Eos activation and increase in ECP and IL 5 excretion, while respiratory tract inflammation in COPD is related to neutrophil increase. These changes can be considered as the indicator of airway inflammation in asthma or COPD. Through regulating the quantity and function of the inflammatory cells and inhibiting the formation of cytokines to control the asthmatic airway inflammation, GC inhalation treatment will have better effect in treating asthmatic patients than COPD patients.