胃食管反流源性"哮喘"诱导痰中细胞及细胞因子分析

目的 观察胃食管反流源性"哮喘"的气道炎症特点.方法 筛选34例胃食管反流(GERD)伴"类哮喘"症状患者,并以12例哮喘无GERD患者和11例健康正常人为对照组,结合诱导痰方法,刘氏染色分析痰液中细胞分类,应用酶联免疫吸附法(ELISA)测定痰上清液中的IL-5,6和8的浓度.结果 GERDa组与哮喘组比较,中性粒细胞百分率明显增高(P＜0.05),嗜酸性细胞百分率减低(P＜0.05);GERD组及哮喘组IL-5(52.86±20.25,55.69±17.72,70.56±12.63),IL-6水平(22.14±9.18,18.62±9.94,15.63±13.61)较健康正常组均升高(P＜0.05),其中哮喘组IL-5水平明显高于GERD a组(P＜0.05).相较于正常组(143.26±32.71),GERD组IL-8水平(308.33±178.60,234.28±130.98)升高(P＜0.05),而哮喘组(179.78±51.08)与正常组比较,IL-8水平差异无统计学意义(P＞0.05).结论 GERD源性"哮喘"气道炎症是以中性粒细胞浸润和IL-8升高为主要特点,不同于哮喘以嗜酸性细胞浸润、IL-5升高为主的气道炎症状态,当合并哮喘时,GERD可通过上述细胞因子的作用促进哮喘既有的气道炎症,进而加重其病程.

Characteristics of airway inflammatory cells and cytokines in patients with gastroesophageal refluxinduced "asthma"

Objective To observe the feature of airway inflammation in patients troubled by gastro-oesophageal reflux (GER) with asthma-like symptoms. Methods Thirty-four cases of GER with asthma symptoms, 12 with asthma and 11 healthy subjects were enrolled in this study. Sputum was induced by hypertonic saline aerosol inhalation in all patients and healthy subjects, and the sputum differential cell counts were determined. The concentration of IL-8, -6, and -5 in the supernatant of induced sputum was measured by using enzyme linked immunosorbert assay (ELISA) respectively. Results The sputum eosinophilic percentage in GERDa patients was significantly decreased (P ＜0. 05 ) and the sputum neutrophil percentage was increased as compared with those in asthmatic patients ( P ＜ 0. 05 ). The concentrations of IL-5 (52.86 ±20.25, 55.69 ± 17.72, 70.56 ± 12.63), IL-6 (22. 14 ±9. 18, 18.62 ±9.94, 15.63 ±13.61 ) in the sputum supernatant in all patients were significantly increased as compared with healthy controls (P ＜ 0. 05), and the concentration of IL-5 in asthmatic patients were higher than in GERDa patients (P ＜0. 05). The concentration of IL-8 in GERD patients (308. 33 ± 178.60, 234. 28 ± 130. 98) was significantly increase as compared with healthy controls ( 143.26 ± 32.71, P ＜ 0. 05 ). There was no significant difference in the concentration of IL-8 between asthmatic patients and healthy controls ( P ＞ 0. 05 ).Conclusion Asthma and gastroesophageal reflux are both characterized by airway inflammation. Differed with asthma obtained by airway eosinophilic inflammation and mainly elevated IL-5, the GER-triggered airway inflammation is characterized by a neutrophilic airway inflammation and mainly enhanced levels of IL-8. GER does aggravate pre-existing airway inflammation in asthmatic patients through related cytokines which is the linkage between them.