支气管哮喘患者诱导痰炎性指标与气道反应性的关系

目的分析诱导痰中硝酸盐/亚硝酸盐(NO_3~-/NO_2~-)浓度和嗜酸粒细胞(EOS)计数与气道反应性的相关性,探讨上述指标对评估病情、调整支气管哮喘(简称哮喘)治疗方案的指导意义。方法 2003年2月至2004年6月华西医院哮喘门诊收集轻至中度非急性发作期哮喘患者35例,其中轻度9例,中度26例;经吸入糖皮质激素(ICS)和长效β_2受体激动剂(LABA)联合治疗1年,随访期间记录哮喘症状积分,测定气道反应性[以比气道传导率下降35%所需的激发剂浓度(PC_(35)sGaw)表示]、诱导痰中 EOS 计数和 NO_3~-/NO_2~-浓度。15名健康志愿者作为对照组,测定其诱导痰 EOS,NO_3~-/NO_2~-浓度。结果 35例患者中26例完成1年或以上的治疗和随访。26例患者 PC_(35)sGaw 治疗前为0.08g/L,治疗3个月为1.40g/L,随后7个月维持在2.64 g/L 水平。在治疗第3个月时,诱导痰NO_3~-/NO_2~-水平从治疗前的(734±72)×10~(-3)g/L 下降至(230±41)×10~(-3)g/L,差异有统计学意义(q=6.26,P<0.05),治疗7个月时 NO_3~-/NO_2~-水平降至(137±27)×10~(-3)g/L,与健康对照[(136±20)×10~(-3)g/L]比较差异无统计学意义(q=3.77,P>0.05)。治疗3个月后 EOS 计数为0.014±0.007,与健康对照(0.016±0.008)比较差异无统计学意义(q=2.94,P>0.05);随访期间任一时点PC_(35)sGaw 与 EOS 计数无相关(r_1=0.237,r_2=0.536,r_3=0.675,P 均>0.05)。5个月内 PC_(35)sGaw 与NO_3~-/NO_2~-水平呈负相关(r_1=-0.872,r_2=-0.653,r_3=-0.639,r_4=-0.656,P 均<0.05)。结论 PC_(35)sGaw 与诱导痰 NO_3~-/NO_2~-是反映哮喘气道炎症较为敏感的指标,可作为评价疗效及调整治疗方案的指标。

A study on the relevance of airway inflammatory indices in induced sputum and airway hyperresponsiveness in asthmatics

OBJECTIVE: To analyze the correlations between NO(3)(-)/NO(2)(-), eosinophil counts in induced sputum and airway hyperresponsiveness (AHR) and therefore to explore the clinical significance of these parameters in severity assessment and medication adjustment in patients with mild to moderate asthma. METHODS: From February 2003 to June 2004, 35 outpatients with mild to moderate persistent asthma (mild: 9, moderate: 26) from Huaxi Hospital asthma clinic were treated with combined medications of inhaled corticosteroids (ICS) plus long-acting beta(2) agonist (LABA) for one year. The symptom scores were recorded, and AHR (represented by PC(35)sGaw), eosinophil counts and NO(3)(-)/NO(2)(-) concentrations in induced sputum were measured at regular intervals. Fifteen healthy volunteers served as control and eosinophil counts and NO(3)(-)/NO(2)(-) concentrations in induced sputum were measured. RESULTS: A total of 35 subjects were enrolled, of whom 26 completed one-year or longer follow-up. PC(35)sGaw of 26 subjects before treatment was 0.08 g/L, which became 1.40 g/L at the third months, and then maintained at a very low level (2.64 g/L) after the seventh month. NO(3)(-)/NO(2)(-) decreased from [(734 +/- 72) x 10(-3) g/L] to [(230 +/- 41) x 10(-3) g/L] by the third month (q = 6.26, P < 0.05), and [(137 +/- 27) x 10(-3) g/L] by the seventh month, which showed no significant difference with normal control (136 +/- 20) x 10(-3) g/L, q = 3.77, P > 0.05). Eosinophil counts decreased from (0.016 +/- 0.008) to (0.014 +/- 0.007) by the third month, which was not significantly different from normal control (q = 2.94, P > 0.05). In the first fifth months the concentration of NO(3)(-)/NO(2)(-) in induced sputum exhibited a significant negative correlation with PC(35)sGaw (r(1) = -0.872, r(2) = -0.653, r(3) = -0.639, r(4) = -0.656, all P < 0.05). But eosinophil counts had no correlation with PC(35)sGaw in the first three months (r(1) = 0.237, r(2) = 0.536, r(3) = 0.675, all P > 0.05). CONCLUSION: The parameters related to airway inflammation including PC(35)sGaw and sputum NO(3)(-)/NO(2)(-) may be useful in assessing asthma severity, evaluating the efficacy of treatment and adjusting medication regimens.