胃食管反流和支气管哮喘的关系的研究  

A study on the relationship between gastroesophageal reflux and bronchial asthma

作　　者：鲍永波[1] 姜向春[2] 元熙哲[3] 刘晓娜[2] Bao Yongbo

机构地区：[1]枣庄市立医院,山东枣庄277100 [2]中国人民解放军第32183部队医院,吉林白城137000 [3]延边大学附属医院,吉林延吉133000

出　　处：《中医临床研究》2020年第16期1-5,共5页Clinical Journal Of Chinese Medicine

摘　　要：目的:探讨胃食管反流与支气管哮喘关系以及可能的发生机制。方法:选择60只雄性小鼠,随机分为A组(正常对照组)、B组(生理盐水对照组)、C组(哮喘组)、D组(胃食管反流合并哮喘组)。以卵清蛋白致敏及激发制备哮喘模型,用盐酸胃蛋白酶溶液制备胃食管反流模型,结束末次灌胃的24 h内对小鼠进行支气管激发,监测不同小组小鼠的气道阻力比值,观察气道高反应性的改变;在肺泡灌洗液涂片结束后,计数嗜酸性粒细胞和中性粒细胞的数,并算出其所占的百分比;根据流式细胞学的方法检测脾细胞中γ-干扰素(Interferon-γ,IFN-γ)、白细胞介素(Interleukin,IL)-4以及Th1/Th2的改变;对肺组织进行苏木精-伊红染色法(Hematoxylin-eosin Staining,HE),观察病理切片来判定病理形态的改变。结果:C、D组呼吸道阻力与A组比较,差异有统计学意义(P<0.05),而D组呼吸道阻力更高于C组,差异有统计学意义(P<0.05);C组、D组小鼠IL-4、IFN-γ较A组明显升高,差异有统计学差异(P<0.05),且D组较C组增高,差异有统计学意义(P<0.05)。C组、D组小鼠Th1/Th2较A组降低,差异有统计学意义,D组较C组比值明显下降,差异有统计学意义(P<0.05);肺泡灌洗液中C组、D组可见大量的嗜酸性粒细胞,与A组比较,C组、D组中百分比明显增多,差异有统计学意义(P<0.05),D组与C组相比较,D组百分比明显升高,差异有统计学意义(P<0.05);肺组织病理示C组、D组见支气管上皮细胞有不同程度的脱落,局部伴增生,基底膜增厚,黏膜下间质可见充血水肿,以嗜酸性粒细胞为主的慢性炎性细胞的浸润,局灶的肺泡腔变大,肺泡壁变薄。A组、B组支气管管壁以假复层纤毛柱状的上皮细胞为主,间质未见炎性细胞浸润,管腔规则。结论:胃食管反流可以加重哮喘小鼠的气道高反应性,IL-4水平明显升高,而IFN-γ水平则明显降低,Th1/Th2比值降低明显,肺泡灌洗液中的嗜酸性粒细胞�Objective:To investigate the relationship between gastroesophageal reflux and bronchial asthma as well as the possible pathogenetic mechanism.Methods:60 mice were randomly divided into A(normal control group),B(NS control group),C(asthma control group)and D(gastroesophageal reflux and bronchial asthma control group).The asthmatic models were replicated with ovalbumin and aluminum hydroxide,and gastroesophageal reflux models were replicated with hydrochloric acid solution pepsin.After the last inhaling ovalbumin and slow perfusion,the airway pressure was detected,and EOS and neutrophil granulocyte in bronchial lavage fluid were counted.The flow cytometer was used to determinate IL-4,IFN-γ,and Thl/Th2 ratio changes of spleen cells.Lung tissue and esophagus sections were stained by HE,and pathological changes of lung tissue and esophagus were observed.Results:In group C and group D,the airway hyperresponsiveness was significantly more increased than group A(all P﹤0.05).The respiratory resistance in group D was higher than group C(all P﹤0.05).In group C and group D,IL-4,IFN-γwere more increased than the group A(all P﹤0.05).And those in group D were higher than group C(all P﹤0.05).While in group C and group D,Th1/Th2 were significantly more decreased than the group A(all P﹤0.05).EOS in group C and group D in BALF accounted for a high percentage of total cells and they were significantly higher than that in group A(all P﹤0.05).That in group D was higher than group C(all P﹤0.05).Through lung tissue biopsy,in group C and group D,the bronchial epithelial cells were dropped,hyperplasia was found in parts,basement membrane was thickened,submucosal stroma showed hyperaemia oedema,mainly eosinophils of chronic inflammatory cells were infiltrated,alveolar space in focal lesion was bigger,and alveolar wall was thin.Bronchial wall in group A and B was priority pseudostratified ciliated columnar epithelium,lumen was regular,with no interstitial inflammatory cell infiltration.Conclusion:Gastroesophageal reflux can

关 键 词：胃食管反流 哮喘 胃食管反流合并哮喘 气道高反应 白细胞介素-4 Γ-干扰素 TH1/TH2 

分 类 号：R562.25[医药卫生—呼吸系统]