哮喘患者诱导痰白细胞介素-17A与基质金属蛋白酶-9水平测定及其意义

目的测定不同严重程度支气管哮喘患者诱导痰上清液白细胞介素17A（IL-17A）、基质金属蛋白酶-9（MMP-9）、白细胞介素-8（IL-8）的水平，探讨气道慢性炎症的特点及可能机制。方法按标准纳入慢性持续哮喘患者41例：健康对照者15例，采用诱导痰技术对痰炎性细胞进行分类并采用酶联免疫吸附测定（ELISA）法检测痰上清液IL-17A、IL-8、MMP-9水平，并进行相关性分析。结果重度组患者诱导痰中性粒细胞比值（62．6±15．7）％]与正常对照组（26．3±10．3）％]、轻度组（42．3±18．7）％]及中度组（46．1±14．3）％]比较差异均有统计学意义（P〈0．01或0．05）；重度哮喘患者嗜酸性粒细胞比值（8．2±3．9）％]与轻度组（4．9±3．4）％]及对照组（1．0±0．8）％]比较增高（P〈0．01或0．05），与中度组（5．4±3．3）％]比较差异无统计学意义（P〉0．05）；诱导痰上清液IL～17A水平轻度组（154±91）pg／ml]和对照组（55±23）pg／ml]与重度组（262±162）pg／ml]比较差异有统计学意义（P〈0．05），且各组哮喘患者与正常对照组比较均增高（P〈0．01）；重度组MMP-9水平（451±251）ng／ml]与轻度、中度组患者（166±99）ng／ml，（189±110）ng／ml]及对照组（158±109）ng／ml]比较差异均有统计学意义（P〈0．01）；轻度、中度和重度哮喘患者诱导痰IL-8水平（387±227）pg／ml，（390±194）pg／ml，（480±217）pg／ml]与健康对照者（203±104）pg／ml]比较差异有统计学意义（P〈0．01）。诱导痰中性粒细胞比值与IL-17A、IL-8、MMP-9呈正相关（r=0．323，P〈0．05；r=0．493，P〈0．01；r=0．344，P〈0．01）。结论中性粒细胞浸润性气道炎症是重度持续性哮喘的重要特征，IL-17A、IL-8、MMP-9构成的复杂炎症介质网络可能是气道损伤的关键机制之-。

Levels of IL - 17A and MMP - 9 in induced sputum from patients with asthma and the relationship to the airway inflammation

Objective To explore the characteristics and the possible mechanisms of the airway inflammation and airway remodeling. Methods Airway ceils were obtained by sputum induction from 15 healthy and 41 asthmatic individuals to processed for cell differentiation, and the supernatant was assayed for the levels of IL - 17A, IL - 8, MMP - 9. Results The percentage of sputum neutrophils and eosinophils were significantly elevated in patients with severe asthma （62.6 ± 15.7） %, （8.2 ± 3.9）% ] compared to patients with mild asthma （42.3 ± 18.7）%, （4.9 ±3.4）% ] and healthy controls （26.3 ± 10.3）%, （ 1.0 ± 0.8） % ] （ P 〈 0. 05 ）, and the percentage of sputum eosinophils had no significant difference in patients with severe asthma compared to patients with moderate asthma （5.4 ±3.3） % ] （ P 〈0.05）. The levels of sputum IL- 17A were significantly elevated in patients with severe asthma （26 ± 162 ）pg/ml] compared to patients with mild asthma （15 ± 91 ）pg/ml] and healthy controls（5 ± 23 ）pg/ml] （P 〈 0.05）, moreover, those in mild, moderate （196 ± 103）pg/ml] and severe group were significantly increased compared to patients with healthy controls（ P 〈0.01 ）. As compared to patients with mild and moderate asthma （ 166 ± 99 ）ng/ml, （ 189 ± 110 ）ng/ml ] and the normal controls （ 158 ± 109 ）ng/ml ], the levels of MMP - 9 in severe asthma （451 ±251 ）ng/ml] was significantly increased（ P 〈 0.01 ）. The sputum level of IL- 8 in mild, moderate and severe asthma （387 ±227）pg/ml, （390 ± 194）pg/ml, （480 ±217）pg/ml]was significantly higher than those in normal controls （203 ± 104）pg/ml] （ P 〈 0.01 ）. The percentage of sputum neutrophils positively correlated with the levels of IL - 17A, IL - 8, MMP - 9 （ γ = 0.323, P 〈 0.01 ; γ =0.493, P 〈0. 01; γ =0. 344, P 〈0. 05）. Conclusions Neutrophilic infiltration in the airways is prominent in severe asthma exacerbations and may contribute to sever