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目的检测缓解期老年晚发哮喘(LOA)患者气道反应性和诱导痰嗜酸细胞、嗜酸细胞阳离子蛋白(ECP)和白介素-5(IL-5)水平,探讨其临床意义。方法选择58例缓解期 LOA 患者,测定其气道反应性,并分别采用瑞氏染色、荧光免疫法和酶联免疫吸附试验检测诱导痰中嗜酸细胞数量、ECP 和 IL-5水平;选择25例急性发作期 LOA 患者和15例健康老年人作为对照。结果 58例缓解期 LOA 患者中,49例(84.5%)支气管激发试验阳性,9例(15.5%)阴性。缓解期 LOA 组诱导痰中嗜酸细胞数量[(9.3±3.1)%]、ECP[(144.2±68.1)μg/L]和 IL-5水平[(20.3±6.3)μg/L]显著低于急性发作期 LOA 组[(21.1±9.8)%、(399.3±172.5)μg/L 和(50.6±10.7)μg/L,P<0.01],但显著高于健康老年组[(1.3±0.7)%、(48.7±21.9)μg/L 和(10.3±3.2)μg/L,P<0.01]。气道反应性增高组患者诱导痰中嗜酸细胞数量[(12.7±3.6)%]、ECP[(171.3±69.8)μg/L]和 IL-5水平[(23.6±8.5)μg/L]显著高于气道反应性正常组[(3.1±1.3)%、(52.7±21.1)μg/L 和(13.7±4.1)μg/L,P<0.01]。结论缓解期 LOA 患者多数存在气道高反应性且气道炎症持续存在,测定患者气道反应性和诱导痰中炎性标志物有助于指导缓解期治疗。
Objective To investigate the airway responsiveness, eosinophil eosinophilic protein (ECP) and interleukin-5 (IL-5) levels in induced sputum in senile patients with late-onset asthma (LOA) and their clinical significance. Methods Fifty-eight patients with LOA during remission stage were selected and their airway reactivity was measured. The number of eosinophils, ECP and IL-5 in induced sputum were measured by Wright staining, immunofluorescence assay and enzyme-linked immunosorbent assay respectively. Cases of acute exacerbation of LOA patients and 15 healthy elderly as a control. Results Of 58 patients with LOA during remission, 49 (84.5%) had bronchial provocation test positive and 9 (15.5%) were negative. ECP [(144.2 ± 68.1) μg / L] and IL-5 levels [(20.3 ± 6.3) μg / L] in induced sputum LOA group were significantly lower than those in acute leukemia group [(9.3 ± 3.1) (21.1 ± 9.8)%, (399.3 ± 172.5) μg / L and (50.6 ± 10.7) μg / L, respectively, P <0.01] in the onset LOA group compared with those in the healthy control group [(1.3 ± 0.7) (48.7 ± 21.9) μg / L and (10.3 ± 3.2) μg / L respectively, P <0.01]. The number of induced eosinophils in sputum was significantly higher in patients with increased airway reactivity (12.7 ± 3.6%), ECP (171.3 ± 69.8) μg / L, and IL-5 levels (23.6 ± 8.5) μg / L (3.1 ± 1.3)%, (52.7 ± 21.1) μg / L and (13.7 ± 4.1) μg / L respectively, P <0.01]. Conclusions Most patients with LOA during remission have airway hyperresponsiveness and airway inflammation persists. Measuring airway responsiveness and inducing inflammatory markers in sputum may be helpful to guide remission therapy.