吸入性糖皮质激素(ICS)对咳嗽变异性哮喘(CVA)的气道高反应性和诱导痰中炎性介质的影响

 目的 探讨吸入糖皮质激素(inhaled corticosteroid, ICS)对咳嗽变异性哮喘(cough variant asthma, CVA)患者的气道高反应性和诱导痰中炎性介质的影响。方法 本实验纳入28例CVA患者作为实验CVA组及22例健康体检者作为对照组。所有研究对象治疗前均进行基础肺功能、支气管激发试验(bronchial provocating test, BPT)和诱导痰检查,入组后所有CVA患者接受正规糖皮质激素,治疗方案为布地奈德粉吸入剂400 μg/d,随访观察12个月。评估治疗前后0、3、6、9、12月PD20 FEV1值,通过酶联免疫吸附试验(enzyme linked immunosorbent assay, ELISA)法检测CVA组治疗前和治疗后3、6、9、12个月诱导痰IL 5、IL-10的含量,用瑞氏吉姆萨染色法计数诱导痰中的嗜酸性粒细胞(eosinophils, EOS)百分比(%)。结果 治疗前CVA患者的诱导痰中IL 5含量和EOS(%)明显高于健康对照组,IL 10含量低于健康组(P<0.05)。短期(3个月)ICS即可有效提高CVA患者PD20 FEV1, ICS干预12个月后,CVA组气道高反应性达极轻度水平。CVA组诱导痰IL-5、 IL-10及EOS水平分别在ICS干预3个月、6个月后较基线水平出现明显变化(P＜0.05),干预12个月后CVA组各炎症观察指标皆有不同程度的恢复,但与健康对照组比较差异仍有统计学意义(P＜0.05)。结论 ICS治疗可以显著降低CVA患者的AHR和气道炎症,但CVA治疗12个月也仅有50%(14例)的AHR转阴率,且气道炎症未完全消退,因此CVA的ICS疗程大多数需要12个月以上,提示ICS对CVA的疗程也需要坚持长期的原则。

The effect of inhaled corticosteroid (ICS) on airway hyperresponsiveness and inflammatory mediators in induced sputum in cough variant asthma (CVA)

Objective To investigate the effect of inhaled corticosteroid on inflammatory mediators in induced sputum and airway hyperresponsiveness in cough variant asthma.Methods Patients with CVA (n=28) and healthy subjects (n=22) were recruited into this study. All patients were treated with budesonide (400 μg/day). Measurement of inflammatory mediators in induced sputum and PD20 FEV1 (the accumulated provocative dose resulting in a 20% decrease in FEV1) in histamine challenged subjects was performed every three months after the start of medication. Interleukin (IL)-5 and IL-10 were assayed by ELISA and the percentage of eosinophils was detected with Giemsa stain. Trends during the follow up period were analyzed using a general linear model.Results The basic level of IL 5 and the percentage of eosinophils in CVA group were higher than those in healthy group,while the basic level of IL-10 in CVA group was lower than that in healthy group(P<0.05). Short time (3 months) ICS may significantly improve the value of PD20 FEV1,and airway hyperresponsiveness in CVA can be ameliorated to the lightest level after ICS treatment for 12 months.The levels of induced sputum IL-5 and IL-10 as well as the percentage of eosinophils were altered after ICS treatment for 3 and 6 months respectively.Conclusions Short term ICS considerably reduces AHR whilst the result of BPT turns to be negative among only 50% of CVA patients, indicating that longer treatment is required for CVA patients.