无创性检测支气管哮喘患者气道炎性指标的临床意义  

A comparative study on the clinical significance of noninvasive airway inflammatory markers in persistent asthmatic patients

作　　者：谭成戊[1] 刘春涛[1] 吴永红[1] 

机构地区：[1]四川大学华西医院呼吸内科,成都610041

出　　处：《中华哮喘杂志（电子版）》2008年第2期118-123,共6页Chinese Journal of Asthma(Electronic Version)

摘　　要：目的测定支气管哮喘(简称哮喘)患者呼出气冷凝液(exhaled breath condensate,EBC)和诱导痰中炎性指标的浓度及其在治疗前后的变化,分析两种不同方法采集炎性指标的相关性以及与临床指标的关系,探讨炎性指标用于病情和疗效评估的价值。方法中、重度慢性持续期哮喘患者于门诊接受吸入糖皮质激素联合长效β2受体激动剂治疗,于治疗前和治疗1个月后记录哮喘症状积分,测定第一秒用力呼气容积(FEV1)占预计值%,采集诱导痰和EBC标本,测定标本中过氧化氢(H2O2)、硝酸盐/亚硝酸盐(NO3-/NO2-)和半胱氨酰白三烯E4(LTE4)浓度。结果共有25例中、重度哮喘患者按研究方案完成治疗和随访。哮喘患者经联合治疗1个月后临床症状积分和FEV1占预计值%明显改善,与治疗前比较差异有统计学意义(P<0.01);EBC和诱导痰中炎性指标浓度均降低,但仍高于正常对照组;H2O2和NO3-/NO2-的下降比LTE4明显;哮喘患者EBC中的H2O2和NO3-/NO2-浓度与FEV1呈负相关(P<0.01),与症状积分呈正相关(P<0.01),LTE4与症状积分和FEV1均无相关性。诱导痰中H2O2的浓度与FEV1占预计值%呈负相关,与症状积分呈正相关;NO3-/NO2-的浓度与FEV1占预计值%呈负相关,与症状积分无相关性;LTE4的浓度与症状积分和FEV1占预计值%均无相关性。治疗后FEV1占预计值%增高程度与EBC和诱导痰中H2O2和NO3-/NO2-的浓度降低水平呈正相关。诱导痰和EBC对应的炎性指标之间有相关性。EBC和诱导痰中H2O2浓度与NO3-/NO2-浓度呈正相关,与LTE4之间无相关性。结论中、重度哮喘患者联合治疗后在临床症状和肺功能改善的同时,气道炎症显著减轻。EBC和诱导痰均为无创检测气道炎症的良好方法,但EBC的安全性和可重复性优于诱导痰。无创炎性指标首选H2O2和NO3-/NO2-,而白三烯的价值不大。Objective To assess the clinical significance of three different noninvasive airway inflammatory indices in induced sputum and exhaled breath condensate(EBC) from persistent asthmatic patients.Methods Moderate and severe asthmatic patients were prescribed inhaled corticosteroids combined with long-acting (2 agonists for a month.The symptom scores and forced expired volume in one second(FEV1)predicted were measured while the concentrations of H2O2,NO-3/NO-2,and cysteinyl-leukotriene E4(LTE4) in induced sputum and EBC were detected before and after therapy.Results A total of twenty-five subjects with moderate and severe asthma were enrolled.By combined therapy for one month the asthma symptoms relieved and FEV1% improved significantly (P<0.01).The concentrations of H2O2,NO-3/NO-2 and LTE4 in induced sputum and EBC declined significantly (P<0.01) although the concentrations were still higher than those at baseline.More marked reduction of H2O2 and NO-3 /NO-2 compared to LTE4 was observed.It was revealed that the concentrations of H2O2 and NO-3/NO-2 but not of LTE4 in EBC were negatively correlated with FEV1(P<0.01) and positively with symptom scores.Such correlations were also found in H2O2 in induced sputum with FEV1% and symptom scores as well as NO-3/NO-2 in induced sputum with FEV1%.The improvement of FEV1% after treatment was positively correlated with the reduction of H2O2 and NO-3/NO-2 both in induced sputum and EBC.Correlation analysis also demonstrated three inflammatory indices were equivalent in induced sputum and EBC(correlation coefficient of H2O2,NO-3/NO-2 and LTE4,0.759,0.826 and 0.653,respectively (P<0.01).Conclusions Combined therapy with ICS plus LABA significantly improves the clinical symptoms and lung function of patients with moderate and severe asthma companied with marked suppression of airway inflammation.Both of EBC and induced sputum sampling are valuable noninvasive procedures for detecting asthma airway inflammation,however,EBC technique is superior in safety and reproducibility.H2O2 and

关 键 词：支气管哮喘 气道炎症 呼出气冷凝液 诱导痰 

分 类 号：R562.25[医药卫生—呼吸系统]