CAJ | 학술논문

目的探讨哮喘患者吸入糖皮质激素对气道炎性反应、网状基底膜厚度以及气道高反应性之间关系的影响.方法 28例哮喘患者(哮喘组)吸入布地奈德200 μg,2次/d,持续12个月.治疗前后均行肺功能检查及电子支气管镜检查,取肺泡灌洗液及支气管黏膜行病理检查,并与10例非哮喘患者(对照组)进行比较.结果哮喘组治疗前肺泡灌洗液中嗜酸性粒细胞、上皮细胞、肥大细胞比例均较对照组明显升高[哮喘组:(1.60±0.11)％、(2.50±0.29)％、(0.1100±0.0100)％,对照组:(0.50±0.02)％、(1.20±0.08)％、(0.0200±0.0001)％,P＜0.01 ],支气管黏膜活检组织示网状基底膜厚度、平滑肌厚度较对照组增厚[哮喘组:(14.25±2.15)、(0.36±0.01)μm,对照组:(4.45±1.22)、(0.20±0.01)μm,P＜0.01].哮喘组治疗后肺泡灌洗液中嗜酸性粒细胞、上皮细胞、肥大细胞比例[(0.80±0.04)％、(1.60±0.07)％、(0.0500±0.0020)％]较治疗前下降(P＜0.01),网状基底膜厚度、平滑肌厚度[(6.18±1.30)、(0.26±0.02)μm]也较治疗前改善(P＜ 0.01).哮喘组治疗后气道高反应性下降(P＜0.01).网状基底膜厚度与支气管激发试验第1秒用力呼气容积下降20％所需乙酰甲胆碱激发剂量呈负相关(r=-0.672,P＜0.01).结论哮喘患者气道炎性反应、网状基底膜厚度、气道高反应性之间相互关联,吸人糖皮质激素可以改善气道炎性反应,降低网状基底膜厚度,降低气道高反应性.
목적 탐토효천환자흡입당피질격소대기도염성반응、망상기저막후도이급기도고반응성지간관계적영향.방법 28례효천환자(효천조)흡입포지내덕200 μg,2차/d,지속12개월.치료전후균행폐공능검사급전자지기관경검사,취폐포관세액급지기관점막행병리검사,병여10례비효천환자(대조조)진행비교.결과 효천조치료전폐포관세액중기산성립세포、상피세포、비대세포비례균교대조조명현승고[효천조:(1.60±0.11)％、(2.50±0.29)％、(0.1100±0.0100)％,대조조:(0.50±0.02)％、(1.20±0.08)％、(0.0200±0.0001)％,P＜0.01 ],지기관점막활검조직시망상기저막후도、평활기후도교대조조증후[효천조:(14.25±2.15)、(0.36±0.01)μm,대조조:(4.45±1.22)、(0.20±0.01)μm,P＜0.01].효천조치료후폐포관세액중기산성립세포、상피세포、비대세포비례[(0.80±0.04)％、(1.60±0.07)％、(0.0500±0.0020)％]교치료전하강(P＜0.01),망상기저막후도、평활기후도[(6.18±1.30)、(0.26±0.02)μm]야교치료전개선(P＜ 0.01).효천조치료후기도고반응성하강(P＜0.01).망상기저막후도여지기관격발시험제1초용력호기용적하강20％소수을선갑담감격발제량정부상관(r=-0.672,P＜0.01).결론 효천환자기도염성반응、망상기저막후도、기도고반응성지간상호관련,흡인당피질격소가이개선기도염성반응,강저망상기저막후도,강저기도고반응성.
Objective To study the relationships between airway inflammation,reticular basement membrane (RBM) thickness and bronchial hyperresponsiveness (BHR) before and after treatment with inhaled corticosteroids (ICS) in patients with asthma.Methods Twenty-eight patients with asthma (asthma group) were treated with inhaled budesonide (200 μg,twice a day for 12 months).Lung function,bronchoalveolar lavage (BAL) fluid and airway biopsy pathology were carried out before and after treatment.And 10 patients without asthma were acted as control group.Results BAL fluid eosinophils,epithelial cell and mast cell proportions before treatment in asthma group were significantly higher than those in control group [asthma group:(1.60 ±0.11)％,(2.50 ±0.29)％,(0.1100 ±0.0100)％ ;control group:(0.50 ±0.02)％,(1.20 ±0.08)％,(0.0200 ±0.0001)％,P ＜0.01].RBM and smooth muscle thickness were increased in asthma group than those in control group [ asthma group:( 14.25 ± 2.15 ),(0.36 ± 0.01 ) μ m;control group:(4.45 ± 1.22),(0.20 ± 0.01 ) μ m,P ＜ 0.01 ].BAL fluid eosinophils,epithelial cell and mast cell proportions,RBM and smooth muscle thickness decreased after treatment in asthma group [ (0.80 ±0.04)％,(1.60 ±0.07)％,(0.0500 ±0.0020)％,(6.18 ± 1.30) μm,(0.26 ±0.02) μm,P ＜0.01].RBM thickness was negative correlation with methacholine provoking dose which made forced expired volume in one second reduce by 20％ (r =-0.672,P ＜ 0.01 ).Conclusions Airway inflammation,RBM thickness and BHR in patients with asthma are interrelated and improved with ICS.The results of this study support the need for early and long treatment with ICS.