哮喘患者吸入表面激素减量后哮喘症状变化与诱导痰嗜酸性粒细胞比例的关系

Relationship of symptom changes and induced sputum eosinophil proportion in asthmatic patients after inhaled corticosteroids-dose reduction

目的探讨吸入表面激素(ICS)减量后哮喘症状变化与诱导痰嗜酸性粒细胞(EOS)比例的关系。方法选择专科门诊已使用ICS治疗的39例缓解期哮喘患者,进行诱导痰检查。根据减量时间分为两组,一组16例为缓解1个月后ICS剂量减半(减量1组16例),另一组23例为缓解3个月后ICS剂量减半(减量2组),予诱导痰检查。分别予目前使用ICS剂量减半,并于ICS减量后1个月、2个月、3个月及6个月复诊,复查诱导痰,观察气道炎症变化,对所得数据应用SPSS15.0软件分析。结果两组患者ICS减量后3个月(43.8%vs.21.7%)及6个月(43.8%vs.43.5%)内哮喘症状复发率无显著差异(P>0.05);ICS减量后3个月复发组与未复发组患者减量前诱导痰EOS比例存在显著差异(10.3%vs.2.5%,P<0.05)。ICS减量后6个月复发组与未复发组患者减量前诱导痰EOS比例也存在显著差异(11.5%vs.2.5%,P<0.05)。结论诱导痰EOS比例对判断缓解期患者ICS减量后症状复发具有重要参考价值,临床症状缓解后,参考诱导痰EOS比例进行ICS减量,有可能减少哮喘的复发。

Objective To explore the relationship of symptom changes and induced sputum eosinophil （Eos） proportion in asmatic patients after inhaled corticosteroids （ICS）-dose reduction.Methods Induced sputum by hypertonic saline aerosol inhalation were performed in 39 patients with stable asthma after ICS treatment.All patients were divided into two groups according to the time of ICS-dose reduction.The patients got a 50％ ICS-dose reduction respectively 1 month（group 1,16 cases）,3 months（group 2,23 cases） after asthma symptom remission.The followed visits took place at 1,2,3 and 6months after ICS-dose reduction,differential cell counting in the induced sputum were carried out to evaluate airways inflammation.All of the data were analyzed by SPSS15.0.Results The asthma recurrence rate was similar in both groups during 3 months （43.8％ vs.21.7％） and 6 months （43.8％ vs.43.5％） after ICS-dose reduction（P ＞ 0.05） ; The percentage of induced before ICS reduced was significantly different between patients with asthma relapse and without asthma relapse 3 months after ICS-dose reduction （10.3％ vs.2.5％,P ＜ 0.05）,so did 6 months after ICS-dose reduction （11.5 ％ vs.2.5 ％,P ＜ 0.05）.Conclusions The putum Eos proportion may be an important predictor for the risk of relapse in stable asthmatics after the ICS-dose reduction.Asthma relapse would be reduced if ICS-dose was reducted according to the outcome of induced sputum,when asthma symptom was remissed.