咳嗽变异性哮喘患者诱导痰中神经生长因子和白细胞介素－4水平及气道炎症特征初探  

The levels of nerve growth factor and IL-4 in induced sputum and characteristics of airway inflammation in cough variant asthma

作　　者：彭秋风[1] 孔灵菲[1] 

机构地区：[1]中国医科大学附属第一医院呼吸疾病研究所,沈阳110001

出　　处：《中华内科杂志》2011年第3期221-224,共4页Chinese Journal of Internal Medicine

摘　　要：目的 通过观察咳嗽变异性哮喘（CVA）患者诱导巾神经牛长闪予（NGF）和1L-4水甲，初步探讨咳嗽变异性哮喘的气道炎症特征。方法选咳嗽变异性哮喘患者36例及键康体检者23例，对受试者进行痰诱导，查诱导痰中细胞分类计数，酶联免疫吸附法检测诱导痰中NGF和IL－4水平．结果 （1）咳嗽变异性哮喘患者诱导痰中嗜酸性粒细胞百分数为8％，显并高于健康体检者（1％），差异有统计学意义（P〈0．001）．．其中13例患者应用糖皮质激素联合长效β2，受体激动剂（布地奈德／福莫特罗，每吸160μg／4．5／μg，2吸／d）治疗1个月后，咳嗽症状明显好转，诱导痰中嗜酸性粒细胞百分数为2％，硅著低于治疗前（5％），差异有统计学意义（P〈0．05）；但仍高于健康体俭者（2）咳嗽变异性哮喘患者诱导痰中NCF和IL－4浓度高于健康体检者，差异有统计学意义（P〈0．05）其中13例患背经上述治疗后诱导痰巾NGF和IL-4浓度下降，差异有统计学意义（P〈0．05）；但仍高于健康体检者．（3）相关性分析：诱导痰中嗜酸性粒细胞汁数与诱导痰上清中NGF、IL－4浓度早正相关（r分别为0．397、0．332，P〈0．01）。诱导痰上清中NGF与IL－4浓度呈正相关（r=0．728，P〈0．01）结论神经一免疫机制吁咳嗽变异性哮喘嗜酸性粒细胞性炎症密切相关，NGF和IL-4参与并介导了这一炎症。糖皮质激素联合长效β2受体激动剂吸人治疗，能显著降低诱导痰中NGF、IL-4和嗜酸性粒细胞水平，减轻嗜酸性粒细胞性炎症。Objective To observe sputum cytology counts, the levels of nerve growth factor （NGF） and II,-4 in cough variant asthma （CVA） patients and the change of their levels ＇after using glucocorticoids combined with β2-adrenergic agonists one month, and to investigate CVA＇s characteristics of airway inflammation. Methods Totally 36 patients with untreated CVA were selected, as well as 23 healthy controls. Coughed up sputum cells were obtained and HE strained for differential cell counting in each enrolled patient. In induced sputum＇s supernatant, the levels of NGF and IL-4 were determine（t by ELISA. Results Beh）re treatment, CVA patients had a median eosinophils （EOS） percentage of 8% , which was significantly higher than that after treatment （2% , P 〈 O. 05） and in healthy control group （ 1% , P 〈 0. 001 ）. The levels of NGF and IL-4 in induced sputum of CVA group were （9.50 ± 1.69 ） ng/L and （ 257.37± 53.57 ） ng/L. After treatment, they were （ 8.78 ± 1.02 ） ng/L and （ 228.60 ± 52. 93 ） ng/L in CVA group, （6.98 ± 0. 69 ） ng/L and （ 166. 44 ± 24.75 ） ng/L in healthy control group. The levels of NGF and IL-4 before and after treatment in the CVA group , as compared with the healthy control group, had statistically significant differences （ all P 〈 O. 001 ）. In CVA group before and after treatment, the level of NGF and IL-4 paired difference was significant （ P 〈 0. 001 ）. The percentage of induced sputum EOS correlated with sputum supernatant concentrations of NGF and IL-4 （P 〈 0. 01 ）. In induced sputum supernatant, the concentrations of NGF and II,4 were significant correlated （ P 〈 0. 01 ）. Conclusions Glucocortieoid joint long-term 132 agonist inhaled treatment significantly reduced NGF, IL-4 and EOS levels and reduced eosinophilic inflammation, which are closely related with the nerve-immune mechanism, NGF as well as IL-4 participated the inflammation. Induced sputum examination is non-invasive, economical,simple, easily accepted

关 键 词：咳嗽变异性哮喘 诱导痰 神经牛长因子 白细胞介素4 

分 类 号：R725.622.5[医药卫生—儿科]