白三烯受体拮抗剂(LTRA)对哮喘-慢阻肺重叠(ACO)患者气道炎症的影响及相关机制  

Effect of leukotriene receptor antagonists(LTRAs) on airway inflammation in patients with asthma-COPD overlap(ACO) and its mechanism

作　　者：刘美璇 张倩 黄建浩[1] 王凯玲[1] 陶梦非[1] 徐圣葆 郭忠良[1] LIU Mei-xuan;ZHANG Qian;HUANG Jian-hao;WANG Kai-ling;TAO Meng-fei;XU Sheng-bao;GUO Zhong-liang(Department of Respiratory Medicine,Shanghai East Hospital,Shanghai 200123,China)

机构地区：[1]上海市东方医院呼吸内科,上海200123

出　　处：《复旦学报（医学版）》2018年第6期852-857,共6页Fudan University Journal of Medical Sciences

基　　金：上海市重症医学重中之重临床重点学科项目(2017ZZ02017)~~

摘　　要：目的观察白三烯受体拮抗剂(leukotriene receptor antagonists,LTRAs)对哮喘-慢阻肺重叠(asthmaCOPD overlap,ACO)患者的临床症状、气道炎症及肺功能等方面的影响并探讨其可能作用机制。方法纳入符合诊断标准的ACO患者83例,随机分为试验组(A组)44例,及治疗对照组(B组)39例,选取同期本院体检中心年龄、性别匹配的健康志愿者30例作为健康对照组(C组)。试验组给予孟鲁斯特(10 mg,qn,po)联合布地奈德/福莫特罗粉吸入剂(160μg/4.5μg,bid)治疗,治疗对照组仅给予布地奈德/福莫特罗粉吸入剂(160μg/4.5μg,bid)。治疗6个月,对比治疗前后呼出气一氧化氮(FeNO)、诱导痰嗜酸粒细胞(E%)、中性粒细胞(N%)、CAT评分、ACT评分、肺功能参数FEV1占预计值的百分比(FEV1%pred)、FEV1/FVC等相关指标的变化。结果 ACO患者的FeNO、痰E%及N%明显高于健康组,FEV1%pred、FEV1/FVC明显低于健康组。治疗前,试验组与治疗对照组的FeNO、ACT评分、CAT评分及肺功能FEV1%pred、FEV1/FVC差异无统计学意义,其基线水平一致。经6个月治疗后,两组各项炎症指标、症状评分、肺功能参数均有不同程度改善,且试验组的临床症状与气道炎症改善程度明显优于治疗对照组(P<0.05),但治疗后两组间的肺功能差异无统计学意义。结论LTRAs短期治疗6个月可明显减轻ACO的气道炎症,改善呼吸道症状,但对患者的肺功能影响不大。Objective To observe the effect of leukotriene receptor antagonists(LTRAs)on clinical symptoms,airway inflammation as well as pulmonary function in asthma-COPD overlap(ACO)patients and investigate its mechanism.Methods Eighty-three patients with ACO were recruited in this study.They were randomly divided into two groups.The treatment control group(group A,n=39)received inhaled corticosteroid(ICS)and long-actingβ2 agonist(LABA)(budesonide/formoterol:160μg/4.5μg,bid),while the experimental group(group B,n=44)received montelukast(10 mg,qn,po)and ICS/LABA.Thirty healthy subjects with no difference in age and gender were included as healthy controls(group C,n=30).The treatment time was 6 months for ACO patients.All patients’ CAT score,ACT score,percentages of eosinophils(E%)and neutrophils(N%)in induced sputum were evaluated before and after the treatment.The fractionated exhaled nitric oxide(FeNO)and pulmonary function were also measured. Results Compared with healthy group,the levels of FeNO,E% and N%in induced sputum in ACO patients were strongly higher yet the values of FEV1%pred and FEV1/FVC were significantly lower.The baseline levels of clinical features had no significant difference between the two ACO groups.After 6-months’ treatment,respiratory symptoms and airway inflammation were improved in the experimental group,which were notably better than those in control group.However,no significant difference was found in pulmonary function between group A and B.Conclusions Short-time LTRAs may considerably ameliorate eosinophilic and neutrophilic inflammation rather than pulmonary function.

关 键 词：哮喘 慢性阻塞性肺疾病(COPD) 白三烯受体拮抗剂(LTRA) 气道炎症 肺功能 

分 类 号：R563.5[医药卫生—呼吸系统] R562.25[医药卫生—内科学]