嗜酸粒细胞在慢性鼻炎患者上下气道炎症相关性中的意义

The significance of eosinophils in the correlation of upper and lower airway inflammation in patients with chronic rhinitis

目的通过研究嗜酸粒细胞(eosinophils, EOS)在慢性鼻炎患者上下气道及全身的表达和关联,探讨预测下气道炎症的鼻部炎性指标。方法收集2010年6月至2013年12月,就诊于解放军东部战区总医院的变应性鼻炎(allergic rhinitis, AR)患者162例和非变应性鼻炎(non-allergicrhinitis, NAR) 117例,AR组和N AR组统称为鼻炎组;另有门诊无气道疾病患者及本院职工104例作为对照组。全部研究对象均行详细病史采集、鼻阻力测量、皮肤点刺实验(skin prick test,SPT)、血清总IgE (total immunoglobin E, tlgE)、血 EOS、鼻灌洗及诱导痰 EOS、鼻激发实验(nasal provocation test,NPT)及支气管激发实验(bronchial provocation test, BPT)、鼻一氧化氮(nasal nitric oxide, NNO)及呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)检测:多组间比较米用单因素方差分析,两组间比较采用LSD I检验或Mann-Whitney U检验,相关性分析采用Pearson或Spearman相关参数测试法。结果 AR组患者的鼻EOS、NNO、痰EOS、FeNO、血EOS及血tlgE均高于NAR组,差异有统计学意义[3.70[1.20,14.23](M[P25,P75],下同)个/200 HP比1.40[0.20,3.40]个/200 HP,673.50[466.80,936.00]ppb 比 455.80 [248.10, 705.60] ppb, 2.97 [0.00, 10.63]%比 1.00 [0.23,2.00]%,(49.28 + 26.37) ppb 比(34.07± 19.11 ) ppb, 4.00 [ 2.00,7.00 ]%比 2.00 [ 1.00, 5.00 ]%, 208.01 [61.70, 387.50] IU/ml 比43.30 [19.00,122.00] IU/ml,F值或X^2值分别为 11.442、19.440、70.727、69.449、47.453 、46.525,P值均<0.05],而两组间的鼻阻力、NPT及BPT差异无统计学意义。无论AR组还是NAR组,鼻EOS与痰EOS、FeNO、血清tlgE及血EOS均呈正相关(AR组r值分别为0.448、0.202、0.159、0.321,NAR组r值分别为0.442、0.268、0.268、0.334,P值均<0.05),而与BPT无关。控制性别、年龄、身高及体重4个因素后,鼻EOS与痰EOS仍呈正相关。多元线性回归分析显示,鼻EOS、血EOS及SPT结果与痰EOS水平存在统计学关联。经受试者工作特征曲线分析,鼻EOS对痰EOS阴阳判断的最佳临界值为3.30个/200 HPO结论鼻EOS与下气道及全身多个炎性指标相关,且是痰EOS增高的相关因素,可作为预测下气道EOS炎症的生物学指标。

Objective To explore the predictor of lower airway inflammation among the index of nasal in flanimation by investigating the expression and association of eosinophils (EOS) in the upper-lower ainxays and blood of patients with chronic rhinitis. Methods A total of 162 patients with allergic rhinitis (AR), 117 patients with non-allergic rhinitis (NAR) and 104 controls were enrolled from June 2010 to December 2013 from General Hospital of Eastern Theater Command, People's Liberation Army. All subjects were required detailed medical history collection and nasal resistance measurement. Skin prick test (SPT), blood total immunoglobin E (tlgE) and blood EOS, nasal lavage and induced sputum EOS, nasal provocation and bronchial provocation test (NPT, BPT), nasal and forced exhaled nitric oxide (NNO, FeNO) were performed in all patients. One-way analysis of variance was used for comparison between groups. LSD t test or Mann-Whitney U test was used for comparison between the two groups. Pearson or Spearman related parameter test was used for conelation analysis. Results The nasal lavage EOS, NNO, induced sputum EOS, FeNO, blood EOS and tlgE were higher in the AR group than that in the NAR group (3.70[1.20, 14.23]/ 200 HP vs 1.40[0.20, 3.40]/200 HP, 673.50[466.80. 936.00] ppb vs 455.80[248.10, 705.60] ppb, 2.97(0.00. 10.63]% vs 1.00[0.23, 2.00]%,(49.28±26.37)ppb vs (34.07± 19.11)ppb, 4.00[2.00, 7.00]% vs 2.00[1.00, 5.00]%, 208.01161.70, 387.50] IU/ml vs 43.30[ 19.00, 122.00) IU/ml, F or x^2 value was 11.442, 19.440, 70.727. 69.449. 47.453, 46.525, respectively, all P<0.05). But there was no significant difference in nasal resistance, NPT and BPT between the two groups. Nasal lavage EOS in AR group and NAR group was correlated with induced sputum EOS, FeNO, tlgE and blood EOS (r value of AR group was 0.448, 0.202, 0.159. 0.321, r value of NAR group was 0.442, 0.268,0.268,0.334, respectively, all P<0.05), but not with BPT. After adjustment for gender, age, height and weight, nasal EOS was positively correlated with sputum EOS. Multiple linear regression analysis showed that nasal EOS, blood EOS and SPT were factors affecting sputum EOS levels. The optimal threshold for nasal EOS to determine induced sputum EOS was 3.30/ 200 HP by (receiver operating characteristic,ROC) analysis. Conclusion The nasal EOS is correlated with multiple lower airway and systemic inflammatory markers, and is a risk factor for the induced sputum EOS, which can be used as an inflammation biomarker to predict the lower air inflammation.