雾化吸入灭活草分枝杆菌对支气管哮喘患者γδT细胞功能的影响

THE EFFECTS OF INACTIVATED-MYCOBACTERIUM PHLEI NEBULIZATION BY SPRAYING INHALATION ONγδT CELLS IN ASTHMATIC PATIENTS WITH BRONCHIAL ASTHMA

目的:探讨雾化吸入灭活草分枝杆菌对支气管哮喘患者γδT细胞功能的影响。方法:将44例轻、中度持续期支气管哮喘患者随机分为A、B两组,每组22例。A组按GINA方案常规吸入沙美特罗替卡松粉吸入剂治疗;B组予3mL生理盐水+灭活草分枝杆菌1.72mg/L×2支雾化吸入,连续5d。两组在治疗前和治疗后观察患者临床症状的改变,治疗前和治疗后第6天查肺功能和气道反应性,记录1秒用力呼气容积(forced expiratory volume in one second,FEV1)、最大呼气流量(peak expiratory flow,PEF)、支气管激发试验转阴率,同时行流式细胞术检测外周血中γδT细胞占淋巴细胞百分数及IFN-γ+γδT/IL-4+γδT细胞比值。结果:治疗后两组患者哮喘症状得到控制;治疗后B组支气管激发试验转阴率较A组高(81.82%vs13.64%,P<0.01);治疗后B组FEV1较治疗前增高(82.99±16.42vs 73.93±11.45,P<0.05);治疗后A、B两组患者PEF均较治疗前增高(80.66±24.94vs 63.15±25.22,P<0.05;83.88±26.60vs 76.35±20.77,P<0.05)。治疗前后两组外周血γδT细胞占淋巴细胞百分数均无明显差异(P>0.05);两组IFN-γ+/IL4+γδT细胞比值均较治疗前明显增高(1.53±0.31vs 0.73±0.43,P<0.05;2.95±0.41vs 0.74±0.46,P<0.05)。结论:雾化吸入灭活草分枝杆菌F.U.36可改变γδT细胞分泌功能,恢复其Th1/Th2平衡,同时显著降低轻、中度持续期支气管哮喘患者的气道高反应性及改善肺功能。

Objective：To explore the effects of Inactivated-Mycohacterium phlei nebulizationhy spraying inhalation on γδT cells in bronchial asthma. Methods： 44 patients with mild and moderate persistent bronchial asthma were randomly divided into 2 groups. According the GINA program, group A were treated with salmeterol xinafoate and fluticasoneand, and group B were treated with 3ml normal saline plus 1.72 mg/L × 2 piece of inactivated Mycobacterium phlei by spraying inhalation for five days. The clinical symptoms and adverse drug reaction of the 2 groups were observed and evaluated before and after treatment. The pulmonary function and determination of airway responsiveness in the sixth clay before and after treatment were detected. Meantime,FEVl ,PEF and the negative rate of bronchial provocation test, the percentage of γδT cells and the ratio of IFN-γ^＋γδT cells/IL-4^＋γδT cells were detected by flow cytometry before and after therapy. Results： The symptoms of asthma were controlled in two groups after treatment. And after treatment, the negative rate of bronchial excitation test in group B was higher than that in group A （81.82% vs 13. 64%, P 〈0. 01）,and the FEV1 of B group was higher than ever（82.99±16.42 vs 73.93± 11.45, P〈0.05）. For PEF, the value of PEF in A and B groups were increase after treatment（80.66± 24.94 vs 63.15±25.22, P 〈0. 05 ; 83. 88 ± 26. 60 vs 76.35±20.77, P 〈0.05）. But there was no statistical changes in the percentage of γδT cells in peripheral blood between the two groups（ P 〉0.05）. The ratio of IFN-γ＋/IL-4^＋ γδT cells in both two groups were significantly increased after treatment（1.53±0.31 vs 0. 73±0. 43 , P 〉0. 05;2. 95±0. 41 vs 0. 74±0.46, P 〈0.05）. Conclusion： Nebulization with inactivatedMycobacterium phlei F. U. 36 can change the function of γδT cells and balance the ratio of Th1/Th2 , meanwhile can reduce the airway hyperresponsiveness and improve lung function in light and moderat broehial asthma patients.