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目的探讨气道嗜酸性粒细胞性炎症和运动诱发的支气管痉挛(EIB)之间的关系,及其对吸入糖皮质激素(ICS)治疗的反应。方法本研究为随机、双盲、二阶段交叉试验,将26例有运动诱发性支气管痉挛发作史且从未接受过激素治疗的哮喘患者随机分为两组,每组分别给予两个剂量水平的布地奈德吸入:①100μg/d与400μg/d对比;②200μg/d与800μg/d对比。每一阶段为3周,洗脱期3～8周。治疗前及开始治疗后每隔1周进行1次运动激发试验并留取痰液标本行嗜酸性粒细胞计数。结果高剂量ICS治疗(400μg/d和800μg/d)可显著减少痰嗜酸性粒细胞比例。痰嗜酸性粒细胞百分比与运动诱发性支气管痉挛严重程度相关,且对EIB的严重程度有预测作用;高剂量ICS治疗时,尚可预测EIB对激素治疗有效,而对低剂量ICS组(100μg/d和200μg/d)则无预测作用。低剂量ICS治疗,不管基线痰嗜酸性粒细胞计数是否增多,EIB在第1周末发作显著减轻,尔后几无改善。而高剂量ICS治疗对EIB的改善作用在痰嗜酸性粒细胞增多的患者中显著优于嗜酸性粒细胞计数小于5%者,这种明显的差异在开始治疗1周后即显现,且随时间的推移而继续加大。结论气道嗜酸性粒细胞性炎症可能在EIB的发生及其对ICS治疗有效的调节机制中起重要的作用。测定痰嗜酸性粒细胞计数在预测EIB的严重程度及其对不同剂量ICS治疗的反应具有一定的临床应用价值。
Objective To investigate the relationship between airway eosinophilic inflammation and exercise-induced bronchospasm (EIB) and its response to inhaled glucocorticoid (ICS) therapy. METHODS: This randomized, double-blind, two-phase crossover study randomized 26 patients with history of exercise-induced bronchospasm who had never received hormonal therapy into two groups, each with two dose levels Budesonide inhalation: ① 100μg / d compared with 400μg / d; ② 200μg / d compared with 800μg / d. Each stage is 3 weeks, the elution period of 3 to 8 weeks. Before treatment and after the start of treatment every 1 week for 1 exercise challenge test and sputum specimens were taken for eosinophil count. Results High dose ICS treatment (400 μg / d and 800 μg / d) significantly reduced sputum eosinophil ratio. The percentage of sputum eosinophils was related to the severity of exercise-induced bronchospasm and predicted the severity of EIB. EIB was predicted to be effective in hormone therapy in high-dose ICS treatment, but not in low-dose ICS group (100μg / d and 200 μg / d) have no predictive effect. Low-dose ICS treatment, regardless of baseline sputum eosinophil count increased, EIB significantly reduced in the first weekend attack, and after few no improvement. The improvement of EIB by high-dose ICS treatment in patients with sputum eosinophilia was significantly better than those with eosinophil counts less than 5%. This apparent difference appeared immediately after 1 week of treatment, and over time And continue to increase. Conclusions Airway eosinophilic inflammation may play an important role in the pathogenesis of EIB and its regulatory mechanism for the treatment of ICS. Determination of sputum eosinophil count in predicting the severity of EIB and its response to different doses of ICS has some clinical value.