支气管哮喘患者痰中白三烯和组胺浓度变化及其临床意义

Changes of Concentrations of Sulfidopeptide-Leukotrienes and Histamine in Sputum from Patients with Asthma and their Clinical Significance

目的 利用诱导痰观测半胱氨酰白三烯 (s L T)及组胺在痰中浓度的变化 ,探讨它们在支气管哮喘发病机制中的意义及激素和抗白三烯受体拮抗剂等临床治疗因素的影响。 方法 以吸入 3%高渗食盐水诱导、采集痰液标本。制作痰液涂沫玻片用梅 -杰染色法染色后进行细胞学分析 ,同时通过高效流体色谱仪 (HPL C)处理后测定s L T浓度。另用生理盐水稀释、离心后 ,收集痰标本稀释液 ,测定组胺浓度。s L T和组胺均以 EIA检测箱测定。 结果 哮喘患者痰中嗜酸性粒细胞百分比显著高于对照组 (P<0 .0 1) ,哮喘组痰中 s L T浓度水平比对照组增高 (P>0 .0 5 ) ,嗜酸性粒细胞百分比与 s L T水平之间存在显著相关关系 (r=0 .6 1,P<0 .0 5 )。变应性哮喘痰中组胺水平显著高于非变应性者 (P<0 .0 1)。痰中 s L T水平在哮喘发作期间增高并受激素治疗影响而降低 ,但激素治疗不能将这种较高的浓度水平在症状完全消失以前调低至稳定时的水平。组胺浓度无类似表现。 结论 在哮喘发作期间 ,s L T而非组胺被大量分泌进入炎症气道 ,参与发作机制作用 ,此期间 L T受体拮抗剂会更有效。组胺受体拮抗剂可能在哮喘尤其是变应性哮喘无症状期更为有效。皮质激素可以与抗 L T药物产生协同作用 ,与抗组胺药之间没有同样的作用。

Objective\ To study the changes of sulfidopeptide\|leukotrienes(sLT) and histamine concentrations in induced sputum from asthma patients, and their clinical effecting factors such as steroid and sLT receptor antagonist therapies.\ Methods\ The sputum was induced with inhaled 3% hypertonic saline.\ A small amount of sputum was smeared in glass\|slide and stained with May\|Grünwald\|Giemsa for cellularity analysis.\ One milli\|liter of them was treated with HPLC for sLT measurement, another one was diluted with isotonic saline for histamine measurement.\ sLT and histamine were measured with EIA kits.\ Results\ The percentage of eosinophil in asthmatics' sputum was significantly higher than that in control subjects(23 82%±11 71% vs 0 28%±0 49%, P<0 001), sLT concentration did not increase significantly in sputum from asymptomatic asthmatics(1 35±1 64 ng/ml) when compared to that of normal control subjects(0 43±0 30 ng/ml), but there was positive correlation between the sputum eosinophils and sLT level in induced sputum(r=0 61, P<0 05).\ The level of histamine in sputum from patients with atopy type asthma was higher than that in non\|atopy type(118 33±19 44 nmol/ml vs 47 26±25 35 nmol/ml, P<0 01).\ sLT concentration level correlated to steroid therapy especially during asthma exacerbation, but histamine did not show similar trend.\ There was an increase of sLT level in period of asthma attack, it was down\|regulated by steroid therapy, and this higher level kept until symptoms disappeared.\ Conclusion\ During asthma exacerbation, sLT is secreted into inflammatory airway, LT receptor antagonists may be more effective than anti\|histamine drug.\ However, histamine\|receptor antagonists may have more effective action in asthma stable status, particularly in atopic asthma.\ Steroid therapies may cooperate with LT antagonists, but not anti\|histamine therapy. \;