吸入性糖皮质激素对咳嗽变异性哮喘气道炎症和高反应性的影响

目的探讨吸入性糖皮质激素对咳嗽变异性哮喘（CVA）患者气道炎症和高反应性的影响。方法选取2011年7月至2012年7月收治的CVA患者30例作为观察组，以同时间段我院体检健康者30例作为对照组。治疗前对所有入选对象进行肺功能检查、支气管激发试验及诱导痰检查。观察组患者给予布地奈德吸入剂治疗，随访观察1年。评估观察组患者治疗前及治疗3、6、9、12个月后的PD20-FEV。值，诱导痰中IL-5、IL-10含量和嗜酸性粒细胞比例。结果治疗前观察组患者诱导痰中的IL-5含量和嗜酸粒细胞比例明显高于对照组，IL-10含量明显低于对照组，差异均具有统计学意义（P〈0．05）；治疗3个月后观察组患者PD20-FEV。较治疗前明显提高，治疗12个月后观察组患者的气道高反应性达到极轻度水平，但仅有53．3％（16／30）的气道高发应性转阴率；治疗后各时间节点观察组患者诱导痰中IL-5、IL-10含量和嗜酸性粒细胞比例较治疗前明显变化，但与对照组比较差异仍存在统计学意义（P〈0．05）。结论1年的吸入性糖皮质激素治疗可以显著缓解咳嗽变异性哮喘患者的气道炎症和高反应性，但是气道炎症的完全消退和气道高反应性的转阴需要更长时间的维持治疗。

Influence of the airway inflammation and hyperresponsiveness in cough variant asthma treated by the inhaled corticosteroids

Objective To evaluate the influence of the airway inflammation and hyperresponsiveness in cough variant asthma treated by the inhaled corticosteroids. Methods Thirty patients with cough variant asthma were selected as the observation group, seen in our hospital from July 2011 to July 2012, and 30 cases of physical healthy people as control group in the same period. Before treatment, the two groups underwent lung function, bronchial provocation tests, and the induced sputum examination. Then the patients in observation group were given budesonide inhalation therapy and followed for 1 year. PD20-FEV~ values, levels of IL-5 and IL-10 and the eosinophils ratio of induced sputum in observation group were assessed before treatment and 3, 6, 9 and 12 months after treatment. Results Before treatment, IL-5 level and eosinophils ratio of induced sputum in the observation group was significantly higher than those in the control group, while IL-10 level was significantly lower than that in the control group. All the differences had statistically significance （P〈0.05）. The PD20-FEV1 was obviously improved 3 months after treatment. The airway hyperresponsiveness was very mild 12 months after treatment, but the negative conversion ratio is only 53.3% （16/30）. Compared with the control group, levels of IL-5 and IL-10 and the eosinophils ratio of induced sputum in the observation group were significantly changed at all the time nodes after treatment （P〈0.05）. Conclusion Inhaled glucocorticoid treatment for 1 year could significantly reduce airway inflammation and hyperresponsiveness in patients with cough variant asthma, but longer maintenance treatment was needed for complete subside of airway inflammation and negative conversion of airway hyperrcsponsiveness.