哮喘诱导痰中弹性蛋白酶和α_1-抗胰蛋白酶水平与气道炎症气流受限的关系

目的:探讨中重度支气管哮喘(哮喘)患者诱导痰中弹性蛋白酶和α1-抗胰蛋白酶水平及其与气道炎症和气流受限的关系。方法:测定12例慢性持续期中重度哮喘患者(哮喘组),12例稳定期中度慢性阻塞性肺疾病(COPD)患者和10例健康对照者的(健康对照组)肺功能。并对其诱导痰进行炎性细胞分类计数,测定诱导痰上清液中IL-8、弹性蛋白酶浓度和α1-抗胰蛋白酶的活性。结果:哮喘和COPD患者诱导痰中弹性蛋白酶浓度和α1-抗胰蛋白酶活性与健康对照组比较差异有统计学意义,且与中性粒细胞数、IL-8浓度呈正相关,但与FEV1/FVC百分比值呈负相关。哮喘和COPD患者诱导痰中弹性蛋白酶浓度/α1-抗胰蛋白酶活性比值与健康对照组比较差异有统计学意义,且与FEV1/FVC百分比值呈正相关。结论:中重度哮喘患者诱导痰中存在弹性蛋白酶与α1-抗胰蛋白酶间失平衡,增高的弹性蛋白酶与其气道炎症和气流受限有关(与COPD患者相类似),这在其气道重塑的发病机制中可能发挥重要作用。IL-8参与了中重度哮喘患者气道炎症和气道重塑的过程。

Levels of elastase and α1-antitrypsin in induced sputum in patients with middle-severe asthna and their relationship to airway inflammation and airflow limitation

Objective：To investigate the Levels of elastase and α1-antitrypsin in induced sputum in patients with moderate-severe asthma and the relationship to the number of inflammation cells, interleukin-8 （IL-8） and FEV1 values（ %predicted）. Method： 12 patients with moderate-severe asthma during chronic persistence, 12 patients with stable moderate chronic obstructive pulmonary disease（COPD） and 10 normal control subjects were included in this study. Lung function was measured. Induced sputum was obtained and processed for celldifferential and the supernatant was assayed for the concentrations of IL-8 and elastase by enzyme-linked immunoserbent assay （ELISA）. The activity of α1-antitrypsin was also measured by Dietz method. Result： The levels of elastase and α1-antitrypsin in induced sputum in patients with asthma（respectively, 108.79 ± 26.54 ng/mL, 8.9 ±2.5 × 10^-2 u/mL） and COPD （respectively, 153.84 ± 33.37 ng/mL, 11.9± 3.1× 10^ - 2 u/mL） were significantly higher than those in normal control subjects （respectively,25.36 ± 5.62 ng/mL, 0. 8 ± 0.6 × 10^- 2 u/ml, F = 3.52,3.24, all P 〈 0.05 ） ）. Both of the levels of elastase in induced sputum in patients with asthma and COPD correlated positively with the percentage of neutrophil（respectively, r = 0.58,r = 0.63, P 〈 0.05）and the level of IL-8（respectively, r = 0.60, r = 0.65, P 〈 0. 05）, but correlated inversely with FEV1% （ respectively, r = - 0. 55, r = - 0. 71, P 〈 0. 05 ）. The ratio between elastase and α1-antitrypsin in induced sputum in patients with asthma and COPD（ respectively, 12.9 ± 8.5,13.54 ± 7.5） were significantly lower than that in normal control subjects（32.8 ± 8.6, F = 3.14, P 〈 0.05）, and correlated positively with FEV1% （ respectively, r = 0. 63, r = 0. 52, P 〈 0. 05 ）. Conclusion： There is an imbalance between elastase and α1-antitrypsin in induced sputum in patients with moderate-severe asthma. Increased levels of elastase in induced sputum in patients with s