口服糖皮质激素对哮喘患者全身及局部气道炎症反应的影响

Effects of oral glucocorticoids on systemic and local airway inflammation in patients with asthma

目的 分析口服糖皮质激素对哮喘患者全身及局部气道炎症反应的影响。方法 选取2020年1月至2022年1月在山西白求恩医院就诊的50例呼出气一氧化氮(FeNO)升高(≥40 ppb)和外周血嗜酸性粒细胞增多(≥3%)的严重哮喘患者50例,给予口服糖皮质激素治疗后,根据治疗前后FeNO和外周血嗜酸性粒细胞的变化将患者分为糖皮质激素反应组(治疗后FeNO水平和外周血嗜酸性粒细胞均降低≥20%,21例)和不良反应组(治疗后FeNO水平降低<20%和/或外周血嗜酸性粒细胞降低<20%,29例)。比较治疗前后2组FeNO、外周血嗜酸性粒细胞计数、血清总免疫球蛋白E(IgE)、哮喘控制问卷(ACQ)评分以及肺功能指标水平,并分析FeNO水平变化与其他指标变化之间的相关性。结果 治疗后,糖皮质激素反应组外周血嗜酸性粒细胞计数、血清总IgE、ACQ评分均低于而第1秒用力呼气容积(FEV)、用力肺活量(FVC)以及FEV/FVC比值均高于不良反应组,差异均有统计学意义(均P<0.05),而2组患者FeNO水平比较差异无统计学意义(P>0.05)。糖皮质激素治疗前后,患者FeNO水平降低与外周血嗜酸性粒细胞计数减少(r=0.341、P=0.016)以及ACQ评分降低(r=0.340、P=0.016)存在弱相关性,而与血清总IgE减少和FEV、FVC、FEV/FVC比值升高无相关性(均P>0.05)。结论 口服糖皮质激素可改善严重哮喘患者全身及局部气道炎症反应,但患者局部气道炎症反应标志物FeNO水平和全身炎症反应标志物外周血嗜酸性粒细胞对糖皮质激素治疗的反应存在差异。同时抑制FeNO和外周血嗜酸性粒细胞对改善哮喘控制至关重要。

Objective To analyze the effect of oral glucocorticoids on systemic and local airway inflammatory in patients with asthma. Methods From January 2020 to January 2022, 50 patients with severe asthma complicated with elevated fractional exhaled nitric oxide(FeNO)(≥40 ppb) and increased peripheral blood eosinophils(≥3%) were enrolled in Shanxi Bethune Hospital. Patients were treated with oral glucocorticoids. According to the changes of FeNO and peripheral blood eosinophils before and after treatment, the patients were divided into glucocorticoids reaction group(FeNO level and peripheral blood eosinophils decreased by ≥20% in 21 cases) and weak reaction group(FeNO level decreased by <20% and/or peripheral blood eosinophils decreased by <20% in 29 cases). The levels of FeNO, peripheral blood eosinophils count, serum total immunoglobulin E(IgE), asthma control questionnaire(ACQ) score and pulmonary function indexes were compared between the two groups before and after treatment, and the correlation between FeNO level and other indexes was analyzed. Results After treatment, the peripheral blood eosinophils count, total serum IgE level and ACQ score in glucocorticoids reaction group were lower than those in weak reaction group. The first second forced expiratory volume(FEV_(1)), forced vital capacity(FVC) and FEV_(1)/FVC ratio were higher than those in weak reaction group(all P<0.05), while there was no significant difference in FeNO level between the two groups(P>0.05). Before and after glucocorticoids treatment, the decrease of FeNO level was weakly correlated with the decrease of peripheral blood eosinophils count(r=0.341, P=0.016) and ACQ score(r=0.340, P=0.016), however, it was not correlated with the decrease of serum total IgE and the rise of FEV_(1), FVC and FEV_(1)/FVC ratio(all P>0.05). Conclusions Oral glucocorticoids can improve systemic and local airway inflammation in patients with asthma. There are differences in the reaction of airway inflammatory marker FeNO level and systemic inflammatory marker peripheral blood eosinophils to glucocorticoids therapy in patients with severe asthma. Simultaneous inhibition of FeNO and peripheral blood eosinophils is essential to improve asthma control.