[1]郭维丽,李敏超.冷刺激敏感哮喘患者的临床及炎症表型特点[J].南方医科大学学报,2019,(02):181.[doi:10.12122/j.issn.1673-4254.2019.02.09]
点击复制

冷刺激敏感哮喘患者的临床及炎症表型特点()
分享到:

《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2019年02期
页码:
181
栏目:
出版日期:
2019-02-28

文章信息/Info

Title:
Clinical and inflammatory phenotypic features of asthmatic patients sensitive to cold stimulation
作者:
郭维丽李敏超
关键词:
冷刺激支气管哮喘炎症表型
Keywords:
cold stimulation asthma inflammatory phenotype
DOI:
10.12122/j.issn.1673-4254.2019.02.09
摘要:
目的探讨对冷刺激敏感的哮喘患者的临床症状、肺功能及气道炎症表型特点。方法选取于我院呼吸内科就诊的初诊支 气管哮喘或诊断为支气管哮喘但未正规治疗的急性发作(轻度至中度)患者80例,根据冷空气刺激能否诱发咳嗽、喘息等呼吸道 症状将其分为冷刺激不敏感组(45例)和冷刺激敏感组(35例),均予以糖皮质激素(ICS)+长效β2受体激动剂(LABA)(沙美特罗 替卡松粉吸入剂50 μg/250 μg,2 次/d)及孟鲁斯特钠(10 mg 口服,1 次/d)治疗3 月,必要时加用短效β2 受体激动剂(SABA)或 (和)全身用糖皮质激素(泼尼松10 mg 1次/d或甲强龙40 mg静脉推注),分别于治疗前及治疗3月后行哮喘控制问卷(ACT)了 解咳嗽、喘息等临床症状控制情况,肺功能检查明确治疗前肺功能减损及治疗后肺功能恢复情况,血及诱导痰细胞计数以明确 气道炎症特点,并进行统计学分析。结果两组患者治疗前年龄、性别、体质量指数、吸烟者所占比例、过敏性鼻炎情况无统计 学差异。冷刺激敏感组在就诊前1年内急性发作次数较冷刺激不敏感组多(P<0.05),但治疗期间(3月)为控制症状冷刺激敏感 组使用SABA及激素较冷刺激不敏感组并无显著性差异(P>0.05)。冷刺激敏感组ACT评分在治疗前后均低于冷刺激不敏感 组(P<0.01),且其治疗前FEV1/FVC%、FEV1%pred减损较不敏感组明显(P<0.01),治疗后FEV1/FVC%、FEV1%pred恢复程度 较不敏感组差(P<0.05)。冷刺激敏感组在治疗前后血及诱导痰嗜酸性粒细胞百分比与不敏感组无显著差异;但中性粒细胞百 分比明显高于不敏感组(P<0.01)。根据治疗前诱导痰细胞分类结果,冷刺激不敏感组以嗜酸性粒细胞型为主,所占比例为 60%,中性粒细胞型为20%,而冷刺激敏感组以中性粒细胞型为主,其所占比例为42.86%,显著高于冷刺激不敏感组(P=0.03), 嗜酸性粒细胞型仅为31.43%,显著低于冷刺激不敏感组(P=0.01)。结论冷刺激敏感哮喘患者症状常反复发作和(或)加重,其 肺功能受损明显,气道内炎症表型也不同于经典哮喘,以中性粒细胞型为主。
Abstract:
Objective To explore the clinical symptoms, lung function and airway inflammation phenotype characteristics of asthmatic patients who are sensitive to cold stimulation. Methods Eighty patients with newly diagnosed bronchial asthma or with mild to moderate acute exacerbation of previously diagnosed bronchial asthma but without regular treatment were selected. According to whether cold air stimulation could induce respiratory symptoms such as cough and wheeze, the patients were divided into cold-insensitive group (45 cases) and cold-sensitive group (35 cases). All the patients were treated with inhaled corticosteroid (ICS), long-acting β2 receptor agonist (LABA; salmeterol xinafoate and fluticasone propionate powder for inhalation, 50 μg/250 μg, twice daily) and montelukast sodium tablets (10 mg, once daily); short-acting β2 receptor agonist (SABA) and/or systemic glucocorticoid (prednisone acetate tablets, 10 mg, once daily; or injection of methylprednisolone sodium succinate, 40 mg) were given if necessary. Asthma Control Test (ACT) score before treatment and at 3 months of treatment was used to assess the clinical symptoms such as cough and wheeze; spirometry was performed to determine lung function impairment and recovery. Blood and induced sputum cell counts were examined to determine the characteristics of airway inflammation. Results The two groups were comparable for age, gender, BMI, proportion of smokers and allergic rhinitis before treatment. The cold-sensitive patients experienced significantly more frequent acute exacerbations than the cold-insensitive patient within 1 year before the visit (P<0.05), but the use of SABA and glucocorticoid for symptom control during the treatment did not differ significantly between the two groups (P>0.05). The ACT scores of the cold-sensitive group were significantly lower than those of the cold-insensitive group both before and after the treatment (P<0.01). Compared with the cold-insensitive patients, the cold-sensitive patients had more obvious impairment of FEV1/FVC% and FEV1%pred before treatment (P<0.01), and also showed poorer recovery after treatment (P<0.05). The percentages of eosinophils in blood and induced sputum samples did not differ significantly between the two groups either before and after the treatment, but the percentage of neutrophils was significantly higher in the cold-sensitive group (P<0.01). In the induced sputum samples collected before treatment, the cell populations consisted mainly of eosinophilic subtype (60% ) and neutrophilic subtype (20% ) in the cold-insensitive group; in the cold-sensitive patients, the sputum neutrophilic subtype cells increased significantly to 42.86% (P=0.03) and the eosinophilic subtype cells were lowered to 31.43% (P=0.01). Conclusion The cold-sensitive asthmatic patients experience frequent recurrent and/or aggravated symptoms and have obvious lung function impairment. Different from that in patients with classic asthma, the airway inflammatory phenotype in these patients is characterized by the domination by neutrophilic subtype.

相似文献/References:

[1]张丹,罗显荣,叶小群,等.支气管哮喘与慢性阻塞性肺疾病患者痰液细胞因子对比研究[J].南方医科大学学报,2006,(08):1217.
[2]徐劲松,蔡绍曦,邹飞,等.应用抑制消减杂交克隆支气管哮喘病人嗜酸细胞差异表达基因[J].南方医科大学学报,2004,(05):509.
 XU Jin-song,CAI Shao-xi,ZOU Fei,et al.Cloning of differentially expressed genes of eosinophils from asthmatic patients by suppression subtractive hybridization[J].Journal of Southern Medical University,2004,(02):509.
[3]张丹,罗显荣,叶小群,等.慢性阻塞性肺疾病和支气管哮喘患者血浆及痰液P物质的测定[J].南方医科大学学报,2005,(10):1314.
 ZHANG Dan,LUO Xian-rong,YE Xiao-qun,et al.Determination of plasma and sputum substance P content in patients with chronic obstructive pulmonary disease or asthma[J].Journal of Southern Medical University,2005,(02):1314.
[4]吴媛媛,孙秀珍,李满祥,等.重组葎草花粉主要变应原免疫特性研究[J].南方医科大学学报,2012,(10):1431.
[5]肖敏,朱涛,汪涛,等.甘草酸二铵抑制慢性哮喘模型小鼠气道平滑肌增生[J].南方医科大学学报,2013,(10):1416.
[6]时光,赵俊伟,明亮.哮喘患者外周血血小板-淋巴细胞比值和中性粒细胞-淋巴细胞比值的临床意义[J].南方医科大学学报,2017,(01):84.

更新日期/Last Update: 1900-01-01