生物标志物、CT评价咳嗽变异性哮喘气道重塑的研究

目的探讨诱导痰神经生长因子（NGF）、基质金属蛋白酶-9（MMP-9）及高分辨CT在评价咳嗽变异性哮喘（CVA）患者气道重塑中的作用。方法将50例确诊为CVA的患者设为CVA组,20例健康体检者设为正常对照组（N组）,受试者行肺通气功能、诱导痰及胸部高分辨CT（HRCT）检查,应用酶联免疫吸附法（ELISA）检测诱导痰中NGF、MMP-9浓度,计算气道壁的厚度（T）、气道壁面积（WA）、气道壁面积占气道总截面积的百分比（WA%）,并应用体表面积（BSA）对T、WA进行校正。结果与N组比较,CVA组诱导痰NGF、MMP-9浓度升高,差异有统计学意义（P〈0.05）。CVA组与N组相比,肺通气功能（FEV1、FVC、MMEF）差异无统计学意义（P〉0.05）。CVA组T/BSA、WA/BSA、WA%测定值与N组相比,差异有统计学意（P〈0.05）。CVA咳嗽患者诱导痰NGF浓度与WA/BSA、WA%和T/√BSA呈正相关（r=1.103、0.846、0.917,均P〈0.05）;诱导痰MMP-9浓度与WA/BSA、WA%和T/√BSA呈正相关（r=0.742、1.020、0.694,均P〈0.05）。结论诱导痰NGF、MMP-9可作为评价CVA气道重塑的生物标志物,HRCT检查可作为无创手段更广泛用于气道重塑的评估。联合生物标志物及高分辨CT可更全面评价CVA患者气道重塑情况,从而更好地指导临床治疗。

Research on the assessment of airway remodeling in cough variant asthma by use of biological markers and CT

Objective To explore the roles of biological markers of nerve growth factor （NGF）, matrix metalloproteinase- 9（MMP-9） in induced sputum and high-resolution CT （HRCT） in assessing airway remodelillg in cough variant asthma （CVA）. Methods Fifty cases of CVA patients were recruited as CVA group, and control group （N group） included 20 healthy persons in this study. Lung function test, induced sputum and HRCT check were performed on these subjects. The concentrations of NGF, MMP-9 in induced sputum were measured by ELISA. The wall thickness （T）, the airway wall area （WA） and the percentage of airway wall area to total airway cross sectional area（WA%） were calculated on HRCT. T and WA were adjusted by body surface area （BSA）. Results The concentration of NGF, MMP-9 in induced sputum of CVA group were higher than those of N group （P 〈 0.05）. The lung function parameters （FEVI, FVC, MMEF） of CVA group and N group had no difference （P 〉 0.05）. WA/BSA, WA% and T/√BSA of CVA group were higher than N group （P 〈 0.05）. The concentration of NGF in induced sputum of CVA group showed positive correlation with WA/BSA, WA% and T/√BSA （r = 1.103, 0.846, 0.917, P 〈 0.05）. The concentration of MMP-9 in induced spu- tum of CVA group showed positive correlation with WA/BSA, WA% and T/√BSA（r = 0.742, 1.020, 0.694, P 〈 0.05）. Conclusion NGF and MMP-9 in induced sputum can be used as the biological makers in assessing airway remodelillg in CVA. The airway remodeling could be assessed by HRCT which is noninvasive and can be used more generally. It will be better to assess the airway remodeling of CVA patients by the combination of biological makers and HRCT, thus guided the clinical treatment.