吸烟对支气管哮喘患者糖皮质激素治疗前后诱导痰中炎性因子的影响

Influence of cigarette smoking on inflammatory factor in sputum after inhaled corticosteroid treatmentin asthma

目的探讨吸烟对支气管哮喘患者糖皮质激素治疗前后诱导痰中细胞成分、白细胞介素-8及嗜酸粒细胞趋化因子的影响，了解吸烟哮喘患者对激素治疗的敏感性。方法选取2009年1月至2010年2月就诊的38例慢性持续期哮喘患者，根据是否吸烟，分为吸烟组15例和非吸烟组23例。所有患者给予吸入糖皮质激素（ICS）治疗，必要时可吸入βν2受体激动剂。分别记录治疗前后诱导痰中嗜酸粒细胞及中性粒细胞百分比，并测定痰液中自细胞介素-8（IL-8）及嗜酸粒细胞趋化因子（eotaxin）。结果2组患者ICS治疗前嗜酸性粒细胞百分比为吸烟组（2．0±0．4）％，非吸烟组（4．6±2．5）％，治疗后吸烟组（1．14-0．5）％，非吸烟组（1．8±1．6）％，组内比较差异有统计学意义（F=15．271，P〈0．05）。eotaxin治疗前吸烟组（3．5±2．1）×10^-3mg／L，非吸烟组（8．6±2．3）×10^-3mg／L，治疗后吸烟组（3．1±1．5）x10^-3mg／L，非吸烟组（3．6±1．3）×10^-3mg／L，组内比较差异均有统计学意义（F=24．172，P〈0．05）。中性粒细胞百分比（F=1．563，P〉0．05），IL-8浓度（F=1．793，P〉0．05），治疗前、后差异无统计学意义。2组间比较中性粒细胞（F=9．632，P〈0．05）及IL-8浓度（F=5．720，P〈0．05），吸烟组明显高于非吸烟组，而吸烟组嗜酸性粒细胞百分比（F=15．879，P．〈0．05）及eotaxin（F=12．365，P〈0．05）远低于非吸烟组。结论2组患者ICS治疗28d后，痰中炎性细胞及递质均有所改善，但吸烟组改善程度较非吸烟组差。吸烟组哮喘患者诱导痰中中性粒细胞及IL-8浓度高于非吸烟组哮喘患者，而嗜酸性粒细胞及eotaxin水平低于后者。

Objective To investigate the impact of cigarette smoking on inllammatary factors in sputum including cell component, IL-8 and eotaxin,and the effect on responses to treatment with inhaled corticosteroids （ICS） in patients with asthma. Methods Thirty-eight outpatients with chronic stable asthma who visited from January 2009 to February 2010 were enrolled in the study. Twenty-three cases were nonsmokers and 15 cases were smokers. All of them were treated by daily inhaled budesonide, and 132 agonist when necessary. Induced sputum eosinophil and neutrophil proportion were measured, and the levels of interleukin （IL-8） and eotaxin in induced-sputum by enzymatic immunoassay （ELISA） were compared between non-smoking and smoking asthmatic patients. Results The eosinophil proportion was （ 2.0 ＋0. 4 ） % in smokers and （4. 6 ±2. 5 ） % in nonsmokers before therapy, and （ 1, 1± 0. 5 ） % in smokers and （ 1.8 ± 0. 6） % in nonsmokers after therapy. The difference was statistical significant （ F = 15.271, P 〈 0. 05 ）. The eotaxin was （3.5 ± 2. 1 ） X 10 -3 mg/L in smokers and （8. 6 ±2. 3 ）10^-3 mg/L in nonsmokers before therapy, and （3.1 ±1.5 ） x 10^-3 mg/L in smokers） and （3.6 ±1. 3） x 10^-3mg/L in nonsmokers after therapy. There was statistical significant （F = 24. 172,P 〈0.05）. There were no significant difference on neutrophil proportion and IL-8 before and after treatment （ F = 1. 563 and 1. 793, respectively, Ps 〉 0. 05 ）. Neutrophil proportion （ F = 9. 632, P 〈 0. 05 ） and IL-8 （ F = 5.720, P 〈 0. 05 ） in smokers were significantly higher than non-smokers, whereas eosinophil proportion （F = 15. 879,P 〈0. 05） and eotaxin（F = 12. 365,P 〈0. 05） in smokers were significantly lower than nonsmokers. Conclusion There was a significantly increase in inilammatary cells andfactors in induced-sputum in two groups after ICS treatment, but the effect in smokers was lower than in non-smokers. Neutrophil proportion and IL-8 were higher in induced sputum in smokers, whereas eosinophil proportion and eotaxin were higher in non-smokers.