尘螨变应性鼻炎全血细胞IL-4、IL-13的表达及临床意义

目的探讨IL-4、IL-13在变应性鼻炎发病机制中的作用及IL-4、IL-13拮抗剂治疗变应性鼻炎的临床意义。方法取52例变应性鼻炎（实验组）及25例无过敏性疾病（对照组）患者的外周血，用PMA（phorbol 12-myristate 13-acetate佛波酯）＋inomycin（离子霉素）及标准化尘螨抗原刺激后经细胞内染色，流式细胞仪检测IL-4、IL-13、IFN-γ的表达细胞百分数，ELISA检测血清IL-4、IL-13含量。结果对照组经标准化尘螨变应原刺激后细胞内测出IFN-γ为0．3％-0．4％，但检测不到IL-4与IL-13，经PMA＋inomycin刺激后IFN-γ为5．0％-12．4％、IL-4为0．5％-0．8％、IL-13为0％-0．2％；实验组经标准化尘螨变应原刺激后IFN-γ为0．3％-0．5％、IL-4为0．9％-1．3％、IL-13为0．5％-0．9％，经PMA＋inomycin刺激后IFN-γ为17.3％-24．0％、IL-4为2．1％-3．5％、IL-13为0．8％-2．0％。实验组血清中IL-4含量为（1．768±0．485）pg／ml、IL-13为（5．427±1．263）pg／ml，对照组IL-4与IL-13含量均低于敏感度。结论IL-4、IL-13在变应性鼻炎患者中表达升高，参与了变态反应过程，为临床应用IL-4、IL-13拮抗剂治疗变应性鼻炎提供了依据。     

老年变应性鼻炎患者血清TNF-α和IL-2的表达水平及临床意义

变应性鼻炎(AR)是特应性机体接触致敏原后由IgE介导的由多种细胞因子参与的鼻黏膜非感染性慢性炎性疾病,临床症状表现为鼻痒、打喷嚏、鼻塞、流鼻涕、头痛、嗅觉减退等〔1〕。AR在我国老年人群中患病率高达3%～12%〔2〕。研究表     

变应性鼻炎患者血清Th细胞亚群及相关细胞因子水平变化

目的 观察变应性鼻炎患者血清辅助性T细胞(Th细胞)亚群及其相关因子(IL-12、IL-2、INF-γ)水平变化。方法 选取40例变应性鼻炎患者(观察组)、36例健康体检者(对照组),检测两组血清IL-4、IL-27、INF-γ、CRP、ESR、TNF-α水平,计算Th1/Th2。结果 与对照组比较,观察组IL-27、INF-γ水平及Th1/Th2降低,而IL-4、CRP、TNF-α水平及ESR升高,两组比较差异有统计学意义(P均<0.05)。结论 变应性鼻炎患者IL-27、INF-γ水平降低,IL-4水平上升,Th1/Th2值下降,此变化可能与变应性鼻炎发病有关。     

过敏性鼻炎口服液对变应性鼻炎动物模型骨髓IL-5的影响

目的观察过敏性鼻炎口服液对变应性鼻炎大鼠骨髓中白细胞介素-5(IL-5)表达的影响,以探讨该药治疗变应性鼻炎的作用机理。方法 40只大鼠随机分为过敏性鼻炎口服液实验组、扑尔敏对照组、盐水对照组、正常对照组;造模完成后第2天,前3组分别予过敏性鼻炎口服液、扑尔敏、生理盐水灌胃7d;最后处死动物,取骨干髓腔将骨髓细胞冲洗出,离心沉渣涂片。采用免疫组化方法检测骨髓中IL-5的表达。结果过敏性鼻炎口服液实验组的骨髓IL-5与扑尔敏对照组、盐水对照组相比差异均有统计学意义(P0.01),与正常对照组比较差异无统计学意义(P0.05)。结论过敏性鼻炎口服液能降低骨髓IL-5,抑制AR的发生,这可能是过敏性鼻炎口服液治疗变应性鼻炎患者的作用机理之一。     

支气管哮喘患者诱导痰IL-9及PEF变化的临床意义

分别用酶联免疫吸附试验测定支气管哮喘患者治疗前后及对照组诱导痰中白细胞介素9(IL-9)水平,微型呼气流速峰值(PEF)仪测定PEF.结果与治疗后及对照组比较,哮喘治疗前诱导痰中IL-9水平显著升高,PEF降低(P均<0.01),治疗后IL-9水平高于对照组(P<0.01);诱导痰中IL-9水平与PEF呈显著负相关(r=-0.691,P＜0.01).提示哮喘患者诱导痰中IL-9水平及PEF在一定程度上反映支气管哮喘严重程度,可用于监测哮喘活动、评价疗效.     

血清IFN-γ、IL-4、IL-5及IL-17对儿童哮喘影响及相关性研究

目的探究血清IFN-γ、IL-4、IL-5及IL-17对儿童哮喘影响及相关性。方法分析2013年1月~2014年6月在我院收治的39例哮喘急性期儿童的临床资料,并列为观察组,选取37例在我院进行健康检查的健康儿童作为对照组。结果观察组患者血清IFN-γ、IL-4、IL-5及IL-17水平显著高于对照组,差异具有统计学意义(P0.05);观察组患者VC%、FEV1/FVC%、MMER水平明显低于对照组,差异具有统计学意义(P0.05);观察组患者IFN-γ、IL-4、IL-5、IL-17水平与FEV1/FVC(%)水平呈现显著负相关。结论儿童哮喘发病与Th1、Th2及Th17细胞分泌的IFN-γ、IL-4、IL-5及IL-17有关,其表达水平升高与哮喘的严重程度呈正比。     

新生儿脐血IL-5、IL-18检测诊断哮喘的临床意义

目的探讨新生儿脐血IL-18、IL-5检测诊断哮喘的临床意义。方法采集哮喘产妇（哮喘组）及正常对照组新生儿脐血,用ELISA法测定血清IL-18、IL-5,并对哮喘组脐血IL-5与IL-18水平进行相关性分析。结果哮喘组新生儿脐血IL-18、IL-5明显升高,与正常对照组比较,IL-18有统计学差异（P〈0.01）,IL-5无统计学差异（P〉0.05）。相关性分析显示,哮喘组新生儿脐血IL-18与IL-5无明显相关性（P〉0.05）。结论检测哮喘高危新生儿脐血IL-5、IL-18,对其早期哮喘诊断及预防具有指导意义。     

老年支气管哮喘患者IL-18、IL-12水平的变化及临床意义

目的 探讨老年支气管哮喘患者外周血白细胞介素18(IL-18)和IL-12的变化及其在哮喘发病机制中的作用.方法 采用ELISA法检测42例老年支气管哮喘患者及26例正常对照组检测血清中IL-18及IL-12水平.结果 支气管哮喘发作期患者的血浆IL-12明显高于正常对照组(P<0.01),IL-18明显高于正常对照组(P<0.01).结论 IL-18、IL-12参与了老年支气管哮喘发作期的发病机制,IL-18、IL-12在Th1/Th2细胞因子网络失衡的发病机制中起重要的调节作用.     

哮喘患者诱导痰IL-8、MMP-9水平检测及其临床意义

目的探讨哮喘患者发病及治疗后诱导痰中炎症因子的变化及意义。方法随机选取哮喘患者135例、慢性阻塞性肺疾病（COPD）患者20例、健康对照者20例,治疗前后行诱导痰炎性细胞分类并计数,检测痰上清液IL-8、基质金属蛋白酶9（MMP-9）、嗜酸性粒细胞趋化因子Eotaxin-1水平。结果哮喘患者诱导痰中嗜酸性粒细胞比例及Eotaxin-1水平高于对照组及COPD组,中性粒细胞比例及IL-8、MMP-9水平高于对照组但低于COPD组,且重度哮喘患者上述指标均高于轻中度哮喘患者;哮喘患者中性粒细胞比例及IL-8、MMP-9水平均随治疗后好转有所降低。结论中性粒细胞及炎症介质IL-8与MMP-9对于评价哮喘患者病情及控制水平有一定意义。     

哮喘合并过敏性鼻炎患者TH2类细胞因子水平研究

目的 探讨哮喘合并过敏性鼻炎患者血清中TH2类细胞因子水平同单纯哮喘患者是否存在差异.方法 采用双抗体夹心酶联免疫吸附法检测哮喘、过敏性鼻炎合并哮喘患者及健康查体者血清中IL-4、IL-5、IL-10水平.结果 哮喘、哮喘合并过敏性鼻炎患者患者血清IL-4、IL-5、IL-10水平均较健康查体者高,以哮喘合并过敏性鼻炎患者升高为著(P<0.05、<0.01).结论 哮喘合并过敏性鼻炎患者与单纯哮喘患者TH2类细胞因子水平存在差异.     

支气管哮喘患者合并变应性鼻炎的临床调查

目的调查支气管哮喘患者中变应性鼻炎的发生率,并对其临床诊治现状作初步分析。方法连续调查98例确诊的哮喘患者,详细了解其临床表现及诊治现状,并对所得数据进行统计学分析。结果 98例哮喘患者中63例（64.3%）并发变应性鼻炎,其中54例（85.7%）被误认为系反复感冒者。哮喘合并变应性鼻炎组（63例）和单纯哮喘组（35例）在年龄、病程等方面差异无显著性（P〉0.05）。仅在9例变应性鼻炎患者中有6例间断使用过鼻喷皮质类固醇激素治疗。结论较多的哮喘患者合并变应性鼻炎,及反复误诊提示应关注哮喘合并变应性鼻炎的诊治。当前对哮喘合并变应性鼻炎的诊治关注不足。     

The correlation between FeNO and nNO in allergic rhinitis and bronchial asthma

This study aimed to evaluate the correlation between fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in allergic rhinitis (AR) and patients with or without bronchial asthma (BA).A total of 90 patients who were diagnosed with persistent AR (AR group, n = 30), BA (BA group, n = 30), or allergic rhinitis with bronchial asthma (AR-BA) (AR-BA group, n = 30), were enrolled in this study, along with 30 healthy adult volunteers (control group, n = 30). The participants were further divided into 2 groups based on the results of a skin-prick test (SPT): a highly atopic group (SPT = 3+ and above) and a moderately atopic group (SPT = 2+ and below). All participants underwent FeNO and nNO measurement, an absolute blood eosinophil count, total serum immunoglobulin measurement, and horizontal baseline lung capacity determination.The results showed that the FeNO levels in the 3 observation groups were significantly higher than those in the control group (P < .01), and in the BA group they were significantly higher than in the AR-BA group (P < .01). The levels of nNO in both the AR group and the AR-BA group were higher than those in the control group and the BA group (P < .01), but there was no significant difference between the AR group and the AR-BA group (P > .05). The levels of nNO in the BA group were also significantly different from those in the control group (P < .01).FeNO and nNO are positively correlated with the degree of AR in patients with BA; therefore, nNO levels can be used as an inflammatory marker of AR in patients with BA. FeNO can also be used as an inflammatory marker of AR in patients complicated with BA as a warning indicator of asthma.     

过敏性鼻炎与支气管哮喘患者的Fe NO比较研究

目的探讨呼出气一氧化氮(Fe NO)在支气管哮喘(BA)和过敏性鼻炎(AR)患者中的应用,比较Fe NO和外周血嗜酸粒细胞分类(EOS%)在健康对照组(A组)、AR(B组)、BA/AR(C组)及BA(D组)之间的不同,寻找两种疾病Fe NO、EOS%改变的意义,以及两种疾病之间的关系。方法采用按国际技术标准设计的尚沃纳库仑一氧化氮分析仪对A、B、C、D组患者检测Fe NO,同时测定各组患者血常规。结果三组病例ROC曲线下面积均大于0.5;AR、BA/AR、BA三组Fe NO、EOS%水平均高于对照组(P0.05),三组组间无明显差异(P0.05);Fe NO与EOS%间存在显著相关性(r=0.505,P0.0 5)。结论Fe NO诊断支气管哮喘和过敏性鼻炎有临床意义。Fe NO可以反映患者气道嗜酸性炎症水平。过敏性鼻炎与支气管哮喘这两种疾病存在密切的关系。     

Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response

Background and Aims: Seasonal allergy is an interesting model to study the pathophysiological mechanisms involved in allergic inflammation. However, experimental allergen exposure is easier to perform and standardise. The primary aim of this study was to compare the inflammatory responses to high‐dose bronchial challenge and natural exposure during birch pollen season. The second aim was to compare the responses of patients with allergic rhinitis and allergic asthma, respectively to both types of allergen exposure. Methods: Fifteen birch pollen‐allergic patients (seven with asthma and eight with rhinitis) and five healthy individuals were studied during pollen season and after challenge with birch allergen. Symptoms, medication and peak expiratory flow rate (PEFR) were recorded, and blood samples, spirometry and induced sputum were analysed during season and after challenge. Results: Patients with allergic asthma demonstrated a greater bronchial responsiveness to bronchial provocation with birch allergen than patients with rhinitis (P = 0.04) whereas no difference was found regarding nasal challenge. No significant association was found between the level of responsiveness and the inflammatory response after seasonal exposure. Seasonal exposure was related to a more marked systemic inflammatory blood–eosinophil increase than bronchial challenge [(median) (0.25 vs 0.11 × 109/L, P = 0.03)] and after nasal challenge, respectively [(median) (0.25 vs 0.04 × 109/L, P = 0.003)]. A significant correlation in eosinophil cationic protein in induced sputum was found between the experimental and seasonal exposure (rho = 0.62, P = 0.02). Conclusions: Bronchial allergen challenge with inhalation of birch pollen gives a similar inflammatory response in the airway but less systemic inflammation than seasonal exposure in birch pollen allergic patients with asthma and rhinitis. Please cite this paper as: Kämpe M, Janson C, Stålenheim G, Stolt I and Carlson M. Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752‐699X.2009.00140.x.     

Early bronchial airflow impairment in patients with persistent allergic rhinitis and bronchial hyperreactivity

BACKGROUND: Allergic rhinitis and its impact on asthma (ARIA) document underlines the link between upper and lower airways. Patients suffering from allergic rhinitis frequently (up to 80%) show bronchial hyperreactivity (BHR). OBJECTIVES: This study aimed at evaluating a group of subjects suffering from persistent allergic rhinitis, with BHR but with nasal symptoms only, to investigate the type and intensity of nasal symptoms, nasal and bronchial airflow, and BHR grade during the pollen season. METHODS: One hundred and twenty one polysensitized rhinitics were investigated. Total symptom score (TSS) was assessed in all patients. Rhinomanometry, spirometry and methacholine bronchial challenge were performed in all patients. RESULTS: 65 (53.7%) patients had impaired FEF 25-75 values. TSS correlated with nasal airflow (P<0.001) and BHR grade (P<0.001). Nasal airflow correlated with FEF 25-75 values (P<0.05) and BHR (P<0.001). FEF 25-75 values correlated with FEV(1) levels (P<0.003), BHR grade (P<0.001), and nasal obstruction symptom (P<0.05). Severe BHR correlated with FEV(1) (P<0.05) and FEF 25-75 (P<0.03) values, nasal airflow (P<0.05) and nasal symptoms (P<0.001). CONCLUSIONS: This study evidences that early bronchial impairment is frequently detectable in patients with persistent allergic rhinitis and BHR. Moreover, nasal function is strictly related with bronchial calibre and BHR grade. Therefore, careful evaluation of lower airways should be investigated in all rhinitics as suggested by the ARIA document.     

支气管哮喘合并过敏性鼻炎的临床治疗观察

目的了解布地奈德鼻喷剂联合舒利迭吸入剂对过敏性鼻炎-哮喘综合症患者的治疗效果。方法60例过敏性鼻炎-哮喘综合症患者,随机分为两组,对照组30例,给予吸入舒利迭50/100μg或50/250μg,1吸/次,2次/日。试验组30例,在吸入舒利迭治疗基础上,同时给予布地奈德鼻喷剂治疗,每个鼻孔各1喷,64μg/喷,2次/日。治疗时间为8周。结果试验组比对照组能显著提高患者的生存质量,对照组不能有效改善患者的鼻炎症状。结论联合治疗过敏性鼻炎和支气管哮喘比单纯治疗支气管哮喘更能有效地提高患者的生存质量。     

Simultaneous treatment of asthma and allergic rhinitis

Asthma and allergic rhinitis (AR) form a well-recognized comorbidity. This study aims at assessing the efficacy of nasally inhaled beclomethasone dipropionate (BDP) in their simultaneous treatment. A randomized controlled trial was conducted with 78 allergic rhinitis and asthma patients aged 5-17 years. Seventy-five individuals completed the study. During 8 weeks, 38 subjects received BDP-CFC aerosol (>or= 500 mcg/day) exclusively via nasal inhalation through a facemask attached to a plastic valved spacer. The control group (37 patients) received 200 mcg/day of aqueous intranasal beclomethasone plus oral inhalation of BDP-CFC (>or= 500 mcg/day) through a mouthpiece connected to the same spacer. Primary outcomes analyzed in order to assess the response to treatment were clinical scoring for allergic rhinitis and measurements of nasal inspiratory peak flow (NIPF). AR clinical scoring and NIPF did not differ in the two groups at admission or at nearly all follow-up visits. Nasal inhalation of beclomethasone dipropionate provides AR symptom relief while maintaining control of asthma by delivering it to the lungs. Therefore, this therapeutic strategy might be considered for patients suffering from this comorbidity, especially in low-resource countries, since it is less expensive than the conventional treatment.     

变应性鼻炎、哮喘患者T细胞亚群、白介素水平及肺功能测定

目的评价变应性鼻炎、哮喘患者血清中白细胞介素IL-4、IL-5、IL-6检测指标的方法。方法变应性鼻炎、哮喘及鼻炎并哮喘患者外周血CD3、CD4、CD8较正常对照组均有明显下降,经t检验有显著性差异(P<0.01),鼻炎组、哮喘组及鼻炎并哮喘组血清IL-4、IL-5、IL-6水平明显高于对照组。其气道反应性明显高于对照组。结论IL-4、IL-5、IL-6参与了变应性鼻炎、哮喘的发生和促进了变态反应性疾病的发展,有必要开展更广泛研究和更深层的原因探索。     

变应性鼻炎与支气管哮喘患者的肺功能改变

目的 通过对变应性鼻炎(A组)与支气管哮喘患者(B组)及健康对照组(C组)进行肺功能检测,寻找两种疾病肺功能改变的意义.方法 采用美国Sensor-Medics6200体描箱对A、B、C组患者检测肺功能有关指标.结果 A、B两组V25％ 、V50％明显降低,与C组比较,差异显著(P＜0.01);A组V50％与B组比较,有意义地增高(P＜0.05);B组RV明显增高,与A、C组比较,差异显著(P＜0.01);A、B两组Raw与C组比较,有意义地增高(P ＜0.05);FVE1％:B组低于C组(P＜0.05),而A组与C组及A组与B组对照均无明显差异(P＞0.05);DLCO％:B组高于A及C两组(P＜0.05).结论 两组患者对肺功能影响相似,主要是小气道阻塞,只是哮喘组影响强.