摘要
目的探讨吸入性糖皮质激素对支气管哮喘(简称哮喘)患儿气道重塑的影响。方法对年龄在5～15岁的30例中重度持续哮喘的住院患儿(哮喘组)、30例健康儿童(对照组)、15例经规范化糖皮质激素吸入治疗6个月以上的哮喘缓解期(缓解组)患儿用5%高渗盐水进行超声雾化诱导痰液,以酶联免疫吸附试验(ELISA)测定诱导痰中IL-5水平,免疫细胞化学方法测定诱导痰中转化生长因子β1(TGF-β1)表达,同时进行诱导痰中嗜酸粒细胞(EOS)计数,测定第1秒用力呼气容积占预计值百分比(FEV1%pred),进行肺部高分辨CT(HRCT)检查,测定肺CT的段及亚段支气管壁厚度/气道外径(T/D)和气道壁面积占气道总面积百分比(WA%)。结果①哮喘组EOS计数为(17.24±12.11)%、IL-5为(25.45±18.05)pg/L;缓解组EOS计数为(3.66±2.13)%、IL-5为(7.33±4.39)pg/L;对照组EOS计数为(1.40±1.27)%、IL-5为(6.49±5.31)pg/L,哮喘组与对照组、哮喘组与缓解组比较差异有统计学意义,P值均<0.01。②30例哮喘患儿有27例痰液中出现TGF-β1阳性表达,缓解组有2例TGF-β1阳性表达,而对照组中未见有TGF-β1阳性表达。③哮喘组T/D(18.16±2.42)%、WA%(59.25±6.54)%、FEV1%pred(71.82±23.08)%;缓解组T/D(17.17±1.9)%、WA%(56.01±3.91)%、FEV1%pred(96.18±12.8)%;对照组T/D(16.45±2.30)%、WA%(53.91±7.72)%、FEV1%pred(107.46±17.11)%,哮喘组与对照组、哮喘组与缓解组比较差异有统计学意义,P值均<0.05。结论气道重塑在儿童哮喘中已经形成;吸入糖皮质激素可有效地调控气道炎症的发生、发展,经较长疗程的吸入糖皮质激素治疗后气道重塑部分可以逆转。
Objective To investigate the effect of inhaled glueocorticosteroid treatment in airway remodeling in children with bronchial asthma（asthma）. Methods Thirty hospitalized children（aged 5 to 15 years） with moderate-severe persistent asthma（asthma group）, 30 healthy children （control group）, 15 asthmatic eases regularly inhaled glueocorticosteroid for more than six months （remission group） were studied. Ultrasonically nebulized 5 % hypertonic saline was used to induce sputum. The 165 level in induced sputum was determined using ELISA. Immunocytochemistry assay was used to determine TGF-β1 expression of inflammatory cells. The forced expiratory volume in first second percent （FEV1%） predicted （FEV1% pred） and the eosinophils（EOS） counting in the sputum were measured. The percentage of airway wall area to total airway cross sectional area（WA%） and wall thickness to airway diameter ratio（T/D） were calculated at the segmental and subsegmental on HRCT. Results （1）The EOS counting and IL-5 level in induced sputum of astham group were （ 17.24 ± 12.11 ） %, （ 25.45 ± 18.05 ） pg/L, remission group were （3.66±2.13）%,（7.33±4.39） pg/L,control group were （1.4± 1.27）%,（6.49±5.31） pg/L,there are statistical significant differences between asthma group and control group, and the remission group（ P 〈 0.01）. （2）Twenty-seven of 30 asthma cases showed positive expression of TGF-β1 in inflammatory cells in induced sputum, 2 cases in the remission group, there is no positive expression of TGF-β1 in control group. （3） Asthma groupT/D （18.16±2.42）G,WA% （59.25±6.54）% ,FEV1% pred （71. 82±23.08）,remission group T/D （17.17±1.9） %,WA% （56. 01±3.91）G,FEV1% pred （96.18± 12.8）% . Control group T/D （16.45±2.30） %, WAG （53.91±7.72） %,FEV1 % pred （107.46 ± 17.11） %. Asthma and control group,and the remission group had a significant difference（ P 〈0.05）. Conclusions Airway remodeling had formed in children with asthma. Inhaled glucocorticosteroid could regulate genesis and development of airway inflammation effectually. After a longer-term glucocorticosteroid inhalation reversed airway remodeling partly can be observed.
出处
《中华哮喘杂志（电子版）》
CAS
2009年第2期12-16,共5页
Chinese Journal of Asthma(Electronic Version)
基金
江西省科技厅社会发展攻关项目(200405)
