根据变应性鼻炎患者鼻分泌物嗜酸粒细胞计数调整类固醇治疗的临床意义

目的:探讨根据常年性持续性变应性鼻炎(AR)患者鼻分泌物嗜酸粒细胞(EOS)相对计数调整类固醇治疗的临床意义。方法:选择近3个月内未接受类固醇治疗的常年性持续性AR患者42例,采用酶联免疫荧光法测定鼻分泌物EOS阳离子蛋白浓度,根据鼻分泌物EOS计数将患者分为EOS组23例(EOS≥3%)与非EOS组19例(EOS<3%),均进行AR症状、体征评分、鼻分泌物细胞分类计数。治疗2、4、6个月时进行随访和疗效评价。结果:EOS组鼻分泌物中EOS比值[中位数M(25分位数;75分位数),下同]、EOS阳离子蛋白水平(x珋±s,下同)基线值分别为0.086(0.065;0.176)、(326±145)μg/L,非EOS组分别为0.016(0.005;0.022)、(154±58)μg/L,2组比较差异有统计学意义(t值分别为4.40、3.32,均P<0.01)。治疗2、6个月后,EOS组的EOS比值、EOS阳离子蛋白水平分别为0.038(0.006;0.070)、0.019(0.010;0.060);(175±122)μg/L、(175±153)μg/L,与基线值比较差异均有统计学意义(F值分别为6.73、7.38,均P<0.05);非EOS组分别为0.014(0.004;0.032)、0.015(0.010;0.026);(118±60)μg/L、(112±60)μg/L,与基线值比较,EOS比值差异无统计学意义(F=0.82,P>0.05),而EOS阳离子蛋白水平差异有统计学意义(F=3.78,P<0.05)。平均症状、体征评分EOS组和非EOS组在基线及2、4、6个月时不同时间点比较,差异均无统计学意义。2组鼻用类固醇用量各时间点比较差异均无统计学意义(均P>0.05)。结论:对于鼻分泌物EOS增高的AR患者,采用类固醇治疗能够抑制EOS炎症,改善AR患者的症状和体征。非EOS增高的AR患者对类固醇治疗反应性差,症状、体征无改善。临床上可以根据EOS的相对计数决定是否采用类固醇治疗。

Relationship between eosinophils in nasal discharge and responses to treatment of inhaled glucocorticosteroid in patients with persistent allergic rhinitis

Objective:To evaluate the treatment responses of persistent allergic rhinitis with and without eosinophils(EOS) in nasal discharge to inhaled glucocorticosteroid(CS),and therefore to verify whether low eosinophil level in nasal discharge can predict poor response to treatment with CS.Method:Forty-two symptomatic allergic rhinitis patients,who had not received CS therapy in three months preceding the study,were examined before and 2 month,4 months and 6 months after treatment with CS.At each visit,all patients underwent symptom scoring and physical sign scoring.The level of eosinophil cationic protein(ECP) in the nasal discharge supernatants was measured by radioimmunoassay.The patients were divided into 2 groups according to nasal discharge EOS percentages,an EOS group(EOS≥3%) and a non-EOS group(EOS <3%).The response to CS therapy(as measured by symptom and physical sign scores) and the changes of nasal discharge measurements were compared between the 2 groups.Result:In the EOS group,the baseline EOS [0.086(0.065;0.176)] and ECP level [(326±145) μg/L] were significantly higher than EOS [0.016(0.005;0.022)] and ECP level [(154±58)μg/L] of the non-EOS group,t=4.40,3.32,respectively,all P<0.01.After 2 months and 6 months of CS therapy,the nasal discharge EOS,ECP level were 0.038(0.006;0.070),0.019(0.010;0.060),(175±122)μg/L,(175±153)μg/L,respectively in the EOS group,which were significantly different as compared to baseline values(F=6.73,7.38, respectively,allP<0.05).But in the non-EOS group,the nasal discharge EOS and ECP level were 0.014(0.004;0.032),0.015(0.010;0.026),(118±60)μg/L,(112±60)μg/L,respectively at 2 and 6 months,which showed that the nasal discharge EOS level and the symptom and physical sign scores did not improve significantly(F=0.82,P>0.05),but the ECP level did improve(F=3.78,P<0.05).The average daily dose of CS was not different between the two groups at any visits.Conclusion:In persistent allergic rhinitis with low EOS in nasal discharge,CS therapy for 6 months failed to improve symptoms and physical signs.