吸烟对成人哮喘控制及气道炎性反应的影响

Impact of Smoking on Asthma Control and Airway Inflammation in Adults

目的:探讨吸烟对成人哮喘控制和气道炎性反应的影响。方法:选取吸烟哮喘患者(吸烟组)20例及非吸烟哮喘患者(非吸烟组)17例,记录两组患者的临床资料。对两组进行哮喘控制测试(ACT),并行肺功能检查,检测呼出气一氧化氮(Fe-NO)、血常规、血总IgE、尿白三烯E4(leukotriene E4,LTE4)和可替宁,并行诱导痰检测,比较两组间各项指标的差异。结果:吸烟组每人平均1年内哮喘急性发作次数为(1.80±1.88)次,高于非吸烟组患者[(0.76±1.44)次],两组比较差异有统计学意义(P<0.05)。两组患者的ACT评分、1秒用力呼气容积(FEV1)和FeNO值差异无统计学意义。两组患者血和痰中嗜酸细胞百分比(Eos)、血IgE、诱导痰涂片中巨噬细胞百分比(Mac)、中性粒细胞百分比(Neu)、诱导痰上清液中白细胞介素-8(IL-8)和嗜酸性粒细胞阳离子蛋白(ECP)值差异均无统计学意义。吸烟组诱导痰上清液中肿瘤坏死因子-α(TNF-α)为(39.60±13.32)pg/mL,明显高于非吸烟组的(33.87±4.46)pg/mL,两组差异有统计学意义(P<0.05)。吸烟组尿LTE4为(203.25±136.3)pg/mgCr,较非吸烟组的(121.23±62.77)pg/mgCr明显升高,两组差异有统计学意义(P<0.05)。吸烟组的尿LTE4水平与吸烟量呈直线相关(r=0.521,P=0.032),FeNO与血IgE无直线相关性;非吸烟组FeNO水平与血IgE呈直线相关(r=0.612,P=0.009)。吸烟组FEV1、痰Neu、痰Eos、痰上清液中IL-8和吸烟量无直线相关性。结论:吸烟使哮喘更难以得到控制,使患者痰液中TNF-α分泌增多,导致白三烯代谢增加,且其增加的量与吸烟量正相关。

Objective：To investigate the impact of smoking on asthma control and airway inflammation in adults. Methods：A total of 20 asthmatic smokers and 17 asthmatic nonsmokers were included in this case-control study. Clinical data of patients was recorded. Asthma control test（ACT）, lung function, fractional excretion of nitric oxide （FENO）, blood routine examina tion, blood serum IgE, urine creatinine, urine leukotriene E4 （LTE4） and cotnine, as well as induced sputum were tested and compared between the two groups. Results： The frequency of acute exacerbation in last one year for smokers （1.80 ± 1.88） was significantly more than that for nonsmokers （0.76 ± 1.44）, P〈0.05. There were no significant differences in tests of ACT, forced expiratory volume in one second （FEV1）% and FeNO between the two groups. There were no significant differences in blood eosinophil percentage, serum IgE, as well as sputum percentages of eoslnophil, macrophage, neutrophil and IL-8, and ECP in supernatant of sputum between the two groups. The levels of TNF-α in supernatant of sputum[（39.60 ± 13.32） pg/mL ]and urine LTE4 [（203.25 ± 136.3） pg/mgCr] in smokers were significantly higher than those in the nonsmokers（P〈0.05）. And LTE4 in smokers was linearly correlated with the quantity and time of smoking（r = 0. 521, P = 0. 032）. In nonsmokers, there was a linear correlation between FENO and IgE（r= 0. 693, P = 0. 006）, which did not exist in smokers. There was no correlation among FEV1 %, percentages of eosinophil and neutrophil in sputurn. IL-8 and the quantity and time of smoking. Conclusions： Asthma is much more difficult to control in smoking patients. The levels of sputum TNF-α and urine LTE4 in asthmatic smokers were statistically much higher than those in asthmatic nonsmokers. LTE4 in smokers was positively correlated with the quantity and time of smoking.