鼻炎患者气道炎症和高反应性特征比较

Comparison on airway inflammation and hyperresponsiveness in subjects with rhinitis

目的比较变应性与非变应性鼻炎患者全身及上下气道炎症、气道高反应性的特征及差异,探求上下气道炎症及高反应性之间的内在联系。方法按是否具有鼻炎临床症状及变应原皮肤点刺试验结果将受试者分为三组:变应性鼻炎组184例、非变应性鼻炎组129例、健康正常组162例,均进行外周血嗜酸粒细胞(EOS)计数、鼻灌洗液炎症细胞分类、诱导痰炎症细胞分类、呼出气一氧化氮、肺通气功能检查和乙酰甲胆碱支气管激发试验。比较三组全身及上下气道炎症、气道高反应性的特征及差异。结果①非变应性鼻炎和变应性鼻炎组患者血EOS计数、鼻EOS计数、痰EOS比例阳性率与正常组的差异均具有统计学意义(P<0.01),变应性鼻炎组呼出气一氧化氮、支气管激发试验阳性率与正常组的差异具有统计学意义(P<0.01);②增加下气道EOS炎症发生的危险因素分别是:变应原皮肤点刺试验阳性(OR=4.096)、血EOS计数升高(OR=9.715)、气道高反应性(OR=3.107)和鼻灌洗液EOS计数升高(OR=16.398);③增加气道高反应性的危险因素分别是:变应原皮肤点刺试验阳性(OR=4.276)和诱导痰EOS比例升高(OR=4.890)。结论部分无下呼吸道症状的变应性鼻炎患者存在下气道炎症及高反应性;部分无下呼吸道症状的非变应性鼻炎患者存在下气道炎症;上气道炎症是导致下气道炎症的主要高危因素;特应性体质和气道炎症是气道高反应性的独立危险因素。因此,上气道炎症导致下气道炎症,甚至发展为下气道高反应性可能是部分非变应性鼻炎患者向变应性鼻炎甚至哮喘发生、发展的重要过程和机制。

Objective To compare the character and difference in systemic,upper and lower airway inflammation as well as airway hyperresponsiveness in subjects with allergic and non-allergic rhinitis.Methods All subjects enrolled the study were categorized into three groups,allergic rhinitis group（184 subjects）,non-allergic rhinitis group（129 subjects） and normal control group（162 subjects） according to the clinical symptoms of rhinitis and allergen skin prick test results.Peripheral five-classify blood examinations,induced sputum differential cytology tests,nasal lavage fluid differentiation cytology tests,measurements of exhaled nitric oxide concentration,spirometry tests and methacholine bronchial provocation tests were performed.The character and difference in systemic,upper and lower airway inflammation as well as airway hyperresponsiveness among three groups were compared.Results ①The positive rate of eosinophils count in peripheral blood,eosinophils count in nasal lavage fluid,eosinophils proportion in induced sputum of allergic rhinitis group and non-allergic rhinitis group both had significant statistical difference（P0.01） with normal control group.The positive rate of fractional exhaled nitric oxide and bronchial provocation test of allergic rhinitis group had significant statistical difference（P0.01） with normal control group.②The predisposing factors of eosinophils-associated inflammation were positive allergen skin prick test result（OR=4.096）,increased eosinophils count in peripheral blood（OR=9.715）,susceptible positive bronchial provocation test result（OR=3.107） and increased eosinophils count in nasal lavage fluid（OR=16.398）.③The predisposing factors of airway hyperresponsiveness were positive allergen skin prick test result（OR=4.276） and increased eosinophils proportion in induced sputum（OR=4.890）.Conclusions Lower airway eosinophilsic inflammation and airway hyperresponsiveness have developed despite the absence of lower airway symptoms in a proportion of individuals with allergic rhinitis.Lower airway eosinophilsic inflammatory changes have also developed despite absence of lower airway symptoms in part of subjects with non-allergic rhinitis.Lower airway inflammation and even hyperresponsiveness induced by upper airway inflammation might be the vital link and mechanism of development of allergic rhinitis and asthma in a proportion of individuals with non-allergic rhinitis.