急性哮喘气道炎症表型与激素治疗反应性的关系

目的研究急性哮喘气道炎症表型与激素治疗反应性的关系。方法采用回顾性的方法对85例急性哮喘患者的诱导痰炎症细胞进行分类,并研究了不同气道细胞炎症表型与患者使用全身激素剂量、时间等的关系。结果根据患者诱导痰炎症细胞分类的不同,将患者分为4组:嗜酸性细胞组(31.8%,27/85)和中性粒细胞组(30.6%,26/85)、混合细胞组(16.4%,14/85)和寡细胞组(21.2%,18/85)。各组患者在性别和是否吸烟方面无统计学差异,但嗜酸性细胞组患者严重程度与混合细胞组有统计学差异(P<0.05)。嗜酸性细胞组全身激素使用剂量及时间显著少于寡细胞和混合细胞组(P<0.05)。同期患者使用吸入激素剂量使用吸入激素时间方面,混合细胞组显著多于嗜酸性细胞组(P<0.05)。中性粒细胞组吸入激素剂量显著少于混合细胞组(P<0.05),而嗜酸性细胞组患者住院时间显著少于混合性细胞组(P<0.05)。其余各组间在全身激素使用剂量及时间、吸入激素使用剂量及时间、住院时间比较无统计学差异(P>0.05)。结论不同炎症表型对激素的治疗反应性可能存在差异。不同炎症表型对治疗的反应性差异可能给临床带来重要的指导意义。

Relationship between phenotypes of airway inflammation and responses to corticosteroid treatment in acute asthma

Objective To investigate the relationship between the phenotypes of airway inflammation and the responses to corticosteroid treatment in acute asthma.Methods The inflammatory cells of the induced sputum obtained from 85 patients with acute asthma were classified,and the relationship between the phenotypes of airway inflammation and the dose of systemic corticosteroid and the treatment time of corticosteroid treatment was retrospectively analyzed in these patients.Results According to the classification of the sputum cells,the 85 acute asthmatic patients were divided into four groups including an eosinophil group(31.8%,27/85),a neutrophil group(30.6%,26/85),a mixed cell group(16.4%,14/85) and a pauci-granulocyte group(21.2%,18/85).There was no significant difference of sex and smoking among the four groups(P>0.05),but the severity of acute asthma of the eosinophil group was significantly different from that of the mixed cell group(P<0.05).The total dose of systemic corticosteroid and the treatment time were significantly less in the eosinophil group than in the mixed cell group and the pauci-granulocyte group(P<0.05),while the total dose of inhaled corticosteroid and the treatment time were significantly more in the mixed cell group than in the eosinophil group(P<0.05).The total dose of inhaled corticosteroid in the mixed cell group was significantly higher than that of the neutrophil group,while the hospitalization time of the mixed cell group was significantly longer than that of the eosinophil group(P<0.05).There was no significant difference of the dose and treatment time of systemic and inhaled corticosteroid and the hospitalization time among the rest of the groups(P>0.05).Conclusion Different phenotypes of airway inflammation may have different responses to corticosteroid treatment in acute asthma,which may provide important clinical implications for the treatment of acute asthma.