CAJ | 학술논문

目的通过测定支气管哮喘(以下简称哮喘)患者呼出气冷凝液(EBC)和诱导痰中炎性指标的浓度,分析其与临床指标的关系,探讨炎性指标用于病情和疗效评估的价值.方法选四川大学华西医院呼吸内科门诊接受吸入糖皮质激素联合长效β2受体激动剂治疗的中重度慢性持续期哮喘患者,记录治疗前和治疗1个月后哮喘症状积分,测定第1秒钟用力呼气容积(FEV1)占预计值百分比,采集诱导痰和EBC标本,测定标本中过氧化氧(H2O2)、硝酸盐/哑硝酸盐(NO3-/N2-)和半胱氨酰白三烯E4(LTE4)浓度.结果共有25例中重度哮喘患者按研究方案完成治疗和随访.哮喘患者经联合治疗1个月后临床症状积分和FEV1占预计值百分比明显改善(P<0.01);EBC和诱导痰中H2O2、NO3-/NO2-和LTE4浓度均降低,但仍高于健康对照者;H2O2和NO3-/NO2-的下降比LTE4明显;哮喘患者EBC中的H2O2和NO3-/NO2-;浓度与FEV1呈负相关(P<0.01),与症状积分呈正相关(P<0.01),LTE4与症状积分和FEV1均无相关性.诱导痰中H2O2浓度与FEV1占预计值百分比呈负相关(P<0.01),与症状积分呈正相关(P<0.01);NO3-/NO2-浓度与FEV1占预计值百分比呈负相关(P<0.01),与症状积分无相关性;LTE4浓度与症状积分和FEV1占预计值百分比均无相关性.治疗后FEV1占预计值百分比增高程度与EBC和诱导痰中H2O3、NO3-/NO2-浓度降低水平呈正相关(P<0.01).诱导痰和EBC对应的炎性指标之间有相关性(P值均小于0.01).EBC和诱导痰中H2O2浓度与NO3-/NO2-浓度呈正相关(P<0.01),与LIE4之间无相关性.结论中重度哮喘患者联合治疗后在临床症状和肺功能改善的同时,气道炎症显著减轻.EBC的安全性和可重复性优于诱导痰,H2O2和NO3-/NO2-的敏感性优于LTE4.
목적 통과측정지기관효천(이하간칭효천)환자호출기냉응액(EBC)화유도담중염성지표적농도,분석기여림상지표적관계,탐토염성지표용우병정화료효평고적개치.방법 선사천대학화서의원호흡내과문진접수흡입당피질격소연합장효β2수체격동제치료적중중도만성지속기효천환자,기록치료전화치료1개월후효천증상적분,측정제1초종용력호기용적(FEV1)점예계치백분비,채집유도담화EBC표본,측정표본중과양화양(H2O2)、초산염/아초산염(NO3-/N2-)화반광안선백삼희E4(LTE4)농도.결과 공유25례중중도효천환자안연구방안완성치료화수방.효천환자경연합치료1개월후림상증상적분화FEV1점예계치백분비명현개선(P<0.01);EBC화유도담중H2O2、NO3-/NO2-화LTE4농도균강저,단잉고우건강대조자;H2O2화NO3-/NO2-적하강비LTE4명현;효천환자EBC중적H2O2화NO3-/NO2-;농도여FEV1정부상관(P<0.01),여증상적분정정상관(P<0.01),LTE4여증상적분화FEV1균무상관성.유도담중H2O2농도여FEV1점예계치백분비정부상관(P<0.01),여증상적분정정상관(P<0.01);NO3-/NO2-농도여FEV1점예계치백분비정부상관(P<0.01),여증상적분무상관성;LTE4농도여증상적분화FEV1점예계치백분비균무상관성.치료후FEV1점예계치백분비증고정도여EBC화유도담중H2O3、NO3-/NO2-농도강저수평정정상관(P<0.01).유도담화EBC대응적염성지표지간유상관성(P치균소우0.01).EBC화유도담중H2O2농도여NO3-/NO2-농도정정상관(P<0.01),여LIE4지간무상관성.결론 중중도효천환자연합치료후재림상증상화폐공능개선적동시,기도염증현저감경.EBC적안전성화가중복성우우유도담,H2O2화NO3-/NO2-적민감성우우LTE4.
Objective To assess the clinical significance of three different noninvasive airway inflammatory indices in induced sputum and exhaled breath condensate ( EBC ) from persistent asthmatic patients.Methods Moderate and severe asthmatic patients were prescribed inhaled corticosteroids combined with long-acting β2 agonists for a month.The symptom scores and percentage of predicted value of forced expiratory volume in one second ( FEV1 ) ( FEV1% pred) were measured while the concentrations of H2O2,NO3-/NO2-,and cysteinyl-leukotriene E4(LTE4) in induced sputum and EBC were detected before and after therapy.Results A total of twenty-five subjects with moderate and severe asthma were enrolled.By combined therapy for one month the asthma aymptoms relieved and FEV1% pred improved significantly (P<0.01).The concentrations of H2O2,NO3-/NO2- arid LTE4in induced sputum and EBC declined significantly(P<0.01) although the concentrations were still higher than those at normal baseline.More marked reduction of H2O2 and NO3-/NO2- compared to LTE4was observed.It was revealed that the concentrations of H2O2 and NO3-/NO2- but not of LTE4in EBC were negatively correlated with FEV1% pred (P <0.01) and positively with symptom scores.Such correlations were also found in H2O2 in induced sputum with FEV1 % pred and symptom scores as well as NO3-/NO2- in induced sputum with FEV1 % pred.The improvement of FEV1 % pred after treatment was positively correlated with the reduction of H2O2 and NO3-/NO2- both in induced sputum and EBC.Correlation analysis also demonstrated three inflammatory indices were equivalent in induced sputum and EBC( correlation coefficient of H2O2,NO3-/NO2- and LTE4,0.759,0.826 and 0.653,respectively.P < 0.01 ).Conclusions (1) Combined therapy with inhaled corticosteroid plus long-acting β2 agonist significantly improves the clinical symptoms and lung function of patients with moderate and severe asthma companied with marked suppression of airway inflammation.(2) Both of EBC and induced sputum sampling are valuable noninvasive procedures for detecting asthma airway inflammation,however,EBC technique is superior in safety and reproducibility.(3) H2O2 and NO3-/NO2- seem to be more sensitive indices in diagnosis and monitoring asthma compared to LTE4.