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目的观察支气管哮喘(简称哮喘)患者不同气道炎症类型(嗜酸粒细胞炎症与非嗜酸粒细胞炎症)对吸入糖皮质激素(简称激素)治疗的反应性。方法选择近3个月内未接受激素治疗的慢性持续性哮喘患者42例,根据诱导痰嗜酸粒细胞百分比将患者分为嗜酸粒细胞增高组(嗜酸粒细胞>3%,23例)与非嗜酸粒细胞增高组(嗜酸粒细胞<3%,19例),进行哮喘症状评分、肺功能检查、诱导痰细胞分类计数。采用酶联免疫荧光法测定痰液嗜酸粒细胞阳离子蛋白(ECP)的浓度。吸入激素治疗1、3个月时进行随访,重复上述哮喘疗效的评价指标。结果嗜酸粒细胞增高组痰嗜酸粒细胞比值、ECP 水平基线值分别为0.080(0.063～0.178)、(324±149)μg/L,非嗜酸粒细胞增高组分别为0.017(0.006～0.021)、(152±68)μg/L,两组比较差异有统计学意义(t 值分别为4.40、3.33,P 均<0.01)。嗜酸粒细胞增高组第一秒用力呼气容积(FEV_1)、FEV_1占预计值百分比(FEV_1占预计值%)、症状评分的基线值分别为(1.98±0.67)L、(65±20)%、7.0(5.0～10.0)分,非嗜酸粒细胞增高组分别为(2.07±1.05)L、(66±27)%、5.0(2.0～9.0)分,两组比较差异无统计学意义(t 值分别为-0.62、-0.09、1.32,P 均>0.05)。吸入激素治疗1、3个月后嗜酸粒细胞增高组的嗜酸粒细胞比值、ECP 水平、症状评分、FEV_1和 FEV_1占预计值%分别为[0.019(0.010～0.060)、[0.036(0.006～0.070)、(173±153)μg/L、(173±122)μg/L、3.0(1.0～6.0)分、3.0(1.0～5.0)分、(2.42±0.64)L、(2.43±0.76)L、(77±13)%、(77±18)%,与基线值比较差异有统计学意义(F 值分别为6.73、6.71、5.93、7.38、5.78,P 均<0.05)。非嗜酸粒细胞增高组分别为0.013(0.000～0.025)、0.012(0.004～0.031)、(111±50)μg/L、(117±50)μg/L、3.0(0.0～6.0)分、3.0(1.0～7.3)分、(2.22±0.86)L、(2.21±0.24)L、(71±20)%、(65±21)%,与基线值比较,嗜酸粒细胞比值、FEV_1和FEV_1占预计值%均无统计学意义(F 值分别为1.98、0.80、1.37,P 均>0.05),而 ECP 水平和症状评分比较差异有统计学意义(F 值分别为3.78、3.59,P 均<0.05)。多元线性回归分析显示,病情严重度、基线 FEV_1和痰嗜酸粒细胞百分比与 FEV_1改善程度相关(r 值分别为-0.27、-0.02、0.03,P 均<0.05)。痰嗜酸粒细胞比值的基线值对激素治疗反应的阴性预测值最高(89.5%)。结论对于痰嗜酸粒细胞增高的哮喘患者,吸入激素治疗能够抑制嗜酸粒细胞炎症,改善肺功能和症状评分。非嗜酸粒细胞增高哮喘患者对激素治疗反应性差,FEV_1无改善。痰嗜酸粒细胞比值不高是激素治疗反应性差的最佳预测指标。
Objective To observe the responsiveness of different types of airway inflammation (eosinophilia and non-eosinophilic inflammation) to inhaled glucocorticoid (Hormone) treatment in patients with bronchial asthma (asthma). Methods Forty-two patients with chronic persistent asthma who did not receive hormone therapy in the recent 3 months were divided into eosinophilic group (eosinophils> 3%, 23 cases) according to the percentage of induced sputum eosinophils, And non-eosinophilia (eosinophils <3%, 19 cases), asthma symptom scores, lung function tests, the number of induced sputum cells were counted. The sputum eosinophil cationic protein (ECP) concentration was measured by enzyme-linked immunosorbent assay. Follow-up was performed at 1 and 3 months after inhaled corticosteroid treatment, and the above indicators of asthma efficacy were repeated. Results The baseline values of eosinophils and ECP in patients with eosinophilia were 0.080 (0.063 ~ 0.178) and (324 ± 149) μg / L, respectively, while those in non-eosinophils were 0.017 (0.006 ~ 0.021 ), (152 ± 68) μg / L respectively. The difference between the two groups was statistically significant (t = 4.40, 3.33, P <0.01). (FEV_1), FEV_1 (predicted FEV 1) and baseline values of symptom scores were (1.98 ± 0.67) L and (65 ± 20)%, respectively, in the first second forced expiratory volume (FEV_1) (2.07 ± 1.05) L, (66 ± 27)%, 5.0 (2.0-9.0) points in the non-eosinophilic group, respectively. There was no significant difference between the two groups (t Values were -0.62, -0.09,1.32, P> 0.05). The levels of eosinophils, ECP, symptom score, FEV_1 and FEV_1 in the group of eosinophilia after 1 and 3 months of inhaled steroid treatment were 0.019 (0.010 ~ 0.060) and 0.036 (0.006 ~ (1.0 ± 6.0), 3.0 (1.0 ~ 5.0), (2.42 ± 0.64) L, (2.43 ± 0.76) L , (77 ± 13)% and (77 ± 18)%, respectively. There were significant differences between the two groups (F = 6.73, 6.71, 5.93, 7.38 and 5.78 respectively, P <0.05). (111 ± 50) μg / L, (117 ± 50) μg / L and 3.0 (0.0-6.0) in the non-eosinophils group were 0.013 (0.000-0.025), 0.012 (2.22 ± 0.86) L, (2.21 ± 0.24) L, (71 ± 20)%, (65 ± 21)%, respectively. Compared with the baseline values, the ratio of eosinophils, FEV_1 and FEV_1 (F = 1.98, 0.80, 1.37 respectively, P> 0.05), while there was significant difference between ECP level and symptom score (F = 3.78, 3.59, P <0.05 respectively) ). Multivariate linear regression analysis showed that the severity of illness, baseline FEV_1 and sputum eosinophil percentage correlated with the improvement of FEV_1 (r = -0.27, -0.02,0.03, P <0.05, respectively). Baseline sputum eosinophils had the highest negative predictive value (89.5%) for response to hormone therapy. Conclusion In patients with sputum eosinophilia, inhaled corticosteroids can inhibit eosinophilic inflammation and improve lung function and symptom scores. Patients with non-eosinophilic asthma had poor responsiveness to hormone therapy and no improvement in FEV 1. Low sputum eosinophil ratio is the best predictor of poor response to hormone therapy.