无创方法评价喘可治雾化吸入对支气管哮喘气道重塑的影响  

Noninvasive evaluation of the effect of chuankezhi atomizing inhalation in airway remodeling of asthma

作　　者：叶飒[1] 严建平[1] 王宏[1] 蔡学祥[2] 

机构地区：[1]浙江省人民医院呼吸内科,杭州310014 [2]浙江省人民医院放射科,杭州310014

出　　处：《浙江医学》2012年第21期1728-1731,1738,共5页Zhejiang Medical Journal

基　　金：浙江省卫生厅医药卫生科学研究基金资助课题（2012KYA011）

摘　　要：目的使用无创方法评价喘可治雾化吸入对支气管哮喘气道重塑的影响及探讨可能的干预机制.方法选择临床缓解期的哮喘患者共40例,随机分为两组（每组各20例）,分为哮喘组,喘可治雾化吸入组,另设正常对照组20例.通过3%高渗盐水诱导痰液,利用酶联免疫吸附实验（ELISA 法）测定3组诱导痰中基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶抑制剂1（TIMP-1）浓度.运用高分辨率 CT（HRCT）测量横截面内径为1~6mm 支气管气道壁的外径（D）、内径（L）,采用气道壁厚度/气道外径的2倍（2T/D）,气道壁面积占气道总横截面积百分比（WA%）为量化指标评价气道重塑程度,分析其与 MMP-9、TIMP-1的相关关系.结果哮喘组诱导痰 MMP-9、TIMP-1水平明显高于对照组,MMP-9/TIMP-1比值明显低于对照组（均 P〈0.01）;喘可治雾化吸入组 MMP-9、TIMP-1水平低于哮喘组（P〈0.05、0.01）,MMP-9/TIMP-1比值显著高于哮喘组（P〈0.01）.哮喘组2T/D 和WA%显著高于对照组,喘可治雾化吸入组2T/D 和 WA%显著低于哮喘组（均 P〈0.01）.MMP-9与2T/D、WA%呈正相关（r =0.412、0.391,均 P〈0.01）;TIMP-1与2T/D、WA%呈正相关（r=0.5、0.494,均 P〈0.01）;MMP-9/TIMP-1与2T/D、WA%呈负相关（r =0.386、0.387,均 P〈0.01）.结论运用诱导痰 MMP-9、TIMP-1检测和 HRCT 可无创评估哮喘气道重塑;喘可治雾化吸入对气道重塑的干预作用可能通过调整 MMP-9/TIMP-1比值来实现.Objective To evaluate the effect of chuankezhi atomizing inhalation in airway remodeling of asthma with non-invasive methods. Methods Forty asthma patients in clinical remission were divided into two groups： asthma group and chuankezhi group with 20 patients in each group, 20 healthy subjects served as control group. The sputum was induced with 3% hypertonic saline solution, and the levels of the MMP-9 and TIMP-1 in sputum were determined with ELISA. High resolution CT （HRCT） scanning was performed, total airway and lumen diameter of the airways visualized with a transverse diameter of 1-6 mm were measured, the percentage of airway wall area to total airway cross sectional area （WA%） and two-fold of the wall thickness to airway diameter ratio （2T/D） were calculated for evaluating the degree of airway remodeling, and the relationship of WA%, 2T/D and MMP-9, TIMP-1 were analyzed. Results The levels of MMP-9 and TIMP-1 in induced sputum of asthma group were higher than those in control group （P〈0.01）, the MMP-9/TIMP-1 ratio was lower than that in the control group （P〈0.01）. The levels of MMP-9 and TIMP-1 of chuankezhi group were lower than those of asthma group （P〈0.05, P〈0.01）, the MMP-9/TIMP-1 ratio was higher than that of asthma group （P〈0.01）. 2T/D and WA% in the asthma group were higher than those in the control group, 2T/D and WA% in chuankezhi group were lower than those in the asthma group （P〈0.01）. The MMP-9 level in sputum was positively correlated with 2T/D and WA% （r =0.412, 0.391,P〈0.01）; the TIMP-1 level was positively correlated with 2T/D and WA% （r =0.5, 0.494, P〈0.01）; the MMP-9/TIMP-1 ratio was negatively correlated with 2T/D and WA% （r =0.386, 0.387,P〈0.01）. Conclusion The airway remodeling of asthma can be evaluated by the detection of MMP-9 and TIMP-1 in the induced sputum and HRCT. Atomizing inhalation of chuankezhi can affect the airway remodeling of asthma, which may be associated with adjusting the MMP-9/TIMP-1 ratio.

关 键 词：支气管哮喘 气道重塑 喘可治雾化吸入 诱导痰 基质金属蛋白酶-9 基质金属蛋白酶抑制剂1 高分辨率CT 

分 类 号：R562.25[医药卫生—呼吸系统]