痰骨膜蛋白在重度哮喘患者不同表型中的表达水平

Sputum periostin in patients with different severe asthma phenotypes

目的观察重度哮喘患者不同的临床、炎症表型特征,比较痰骨膜蛋白(periostin)在重度哮喘患者不同表型中的表达水平。方法选择江汉大学附属医院呼吸内科2015年10月至2017年4月经临床证实的重度哮喘患者62例,检测肺功能、呼出气一氧化氮(Fe NO)浓度、外周血嗜酸性粒细胞(EOS)数量和血清总Ig E水平,诱导痰并行细胞分类计数,检测痰上层清液periostin水平。结果据临床表现、肺功能、炎症类型将哮喘分为肥胖型与非肥胖型,迟发型与早发型,伴固定气流受限型与不伴固定气流受限型,高Th2型与低Th2型。本组重度哮喘患者中,59.26%为肥胖型(BMI≥30 kg/m2),79.63%为迟发型(≥12岁),50.00%为伴固定气流受限型(吸入沙丁胺醇后FEV1/FVC≤70%),64.81%为高Th2型(血EOS≥140 cells/mm3,Ig E≥100 IU/m L);据诱导痰嗜酸性粒细胞和中性粒细胞比例,将哮喘分为嗜酸粒细胞型与混合粒细胞型。本组重度哮喘患者中,68.52%为嗜酸粒细胞型(嗜酸粒细胞>2%、中性粒细胞<40%),24.07%为混合粒细胞型(嗜酸粒细胞>2%,中性粒细胞>40%)。与可逆性气流受限型哮喘相比,伴固定气流受限型哮喘患者痰periostin水平[(61.58±4.75)pg/m L vs(37.31±3.66)pg/m L]明显升高,差异有统计学意义(P<0.05);与混合粒细胞型哮喘相比,嗜酸粒细胞型哮喘患者痰periostin水平[(69.76±6.19)pg/m L vs(43.84±5.81)pg/m L]明显升高,差异有统计学意义(P<0.05)。结论痰periostin水平与重度嗜酸粒细胞型哮喘固定气流受限密切相关。

Objective To identify the different clinical, inflammatory phenotypes in patients with severe asthma and to compare sputum periostin expression in different phenotype with severe asthma. Methods A total of 62 patients with severe asthma confirmed by clinical examination from October 2015 to April 2017 were selected in Department of Respiratory Medicine, the Affiliated Hospital of Jianghan University. Lung function, exhaled nitric oxide, blood eosinophil, and total IgE were detected. Sputum was induced, and the phlegm cell is counted. Periostin was measured in sputum supernatants. Results According to clinical, pulmonary function and inflammatory characteristics, the patients with asthma were classified into different phenotypes： obesity-related asthma vs non-obesity-related asthma, late-onset asthma vs early-onset asthma, persistent vs variable airflow limitation, and high Th2 vs low Th2 asthma. Among all the patients selected, 59.26% were obesity-related asthma（body mass index [BMI] ≥30 kg/m^2）, and 79.63% were late-onset asthma（≥12 years）, with 50.00% of persistent airflow limitation asthma（FEV1/FVC postbronchodilator ≤70%） and64.81% of high Th2 asthma（peripheral blood eosinophil≥140 cells/mm3, IgE≥100 IU/mL）. As for the inflammatory phenotypes, they were defined by differential sputum cell counts according to the cutoff values for eosinophils（2%） and neutrophils（40%）. 68.52% of the patients were eosinophilic asthma（eosinophils〉2%, neutrophils〈40%）, and 24.07% were mixed granulocytic asthma（eosinophils〉2%, neutrophils 〉40%）. Compared to patients with variable airflow limitation,higher periostin release were detected in patients with persistent airflow limitation,（61.58±4.75） pg/mL vs（37.31±3.66）pg/mL, P〈0.05. Compared with mixed granulocytic phenotype, patients with eosinophilic phenotype had significantly increased periostin expression,（69.76±6.19） pg/mL vs（43.84±5.81） pg/mL, P〈0.05. Conclusion Periostin levels in sputum are associated with persistent airflow limitation in asthma patients with airway eosinophilia.