| 引用本文： |
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李馨,余莉,魏为利,等.支气管扩张剂治疗有效和无效咳嗽变异性哮喘的比较研究[J].同济大学学报（医学版）,2011,32(1):95-100. [点击复制]
- LI Xin,YU Li,WEI Wei-li,et al.Comparative study of cough variant asthma responsive and unresponsive to bronchodilator treatment[J].同济大学学报（医学版）,2011,32(1):95-100. [点击复制]
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| 摘要: |
| 目的 探讨支气管扩张剂治疗有效的咳嗽变异性哮喘（cough variant asthma,CVA）和支气管扩张剂治疗无效但糖皮质激素治疗有效CVA在临床表现、气道炎症和炎性介质水平的差异。方法 选择CVA患者72例,根据口服支气管扩张剂治疗反应的差异分为支气管扩张剂有效者55例（A组）和支气管扩张剂无效者17例（B组）,支气管哮喘组（C组）和正常对照组（D组）均为26例。比较相应各组间一般临床资料、辣椒素咳嗽敏感性、肺通气功能指标、气道反应性、诱导痰炎症细胞数和分类计数,以及诱导痰上清液中组胺、前列腺素D2（PGD2）、白细胞介素-5（IL-5）及嗜酸粒细胞阳离子蛋白（ECP）含量的差异。结果 A组占所有CVA的76%,B组为24%。A组的咳嗽阈值logC5低于B组（P＜0.05）,肺通气功能指标如FEV1、FVC、FEV1/FVC和MMEF及PD20FEV1与B组相比有下降趋势,但差别无统计学意义。A组诱导痰中嗜酸性粒细胞比例明显高于B组（P＜0.05）,上清液中PGD2和ECP水平也较高（P＜0.01）。A组治疗1周后咳嗽症状积分改善分值与诱导痰嗜酸性粒细胞比例、PGD2、组胺、ECP水平间存在正相关（嗜酸性粒细胞比例：r=0.254,P=0.036;PGD2：r=0.422,P=0.007;组胺：r=0.365,P=0.020;ECP：r=0.371,P=0.020）,与logC5间存在负相关（r=-2.064,P=0.025）。结论 CVA可能存在支气管扩张剂治疗有效和无效两种亚型。两者咳嗽的发生机制可能有所不同,不同气道炎症介质水平导致的支气管收缩程度可能是决定支气管扩张剂疗效的重要因素。 |
| 关键词: 咳嗽变异性哮喘 支气管扩张剂 气道炎症 |
| DOI：10.3969/j.issn1008-0392.2011.01.095 |
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| 基金项目:上海市科委科技发展基金资助项目(074119628) |
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| Comparative study of cough variant asthma responsive and unresponsive to bronchodilator treatment |
| LI Xin,YU Li,WEI Wei-li,LV Han-jing,QIU Zhong-min |
| (Dept.of Respiratory Medicine,Tongji Hospital,Tongji University,Shanghai 200065,China) |
| Abstract: |
| Objective To compare the differences in clinical manifestations,airway inflammation and airway inflammatory mediators between CVA responsive and unresponsive to bronchodilator therapy.Methods Seventy-two patients with CVA were divided into two subgroups according to their different responses to the treatment of bronchodilators,CVA responsive group(55 cases) and unresponsive group(17 cases).Control groups included 26 classic asthmatic patients and 26 healthy volunteers respectively.Differences in clinical manifestation, cough reflex sensitivity to inhaled capsaicin, lung function parameters, airway hyperresponsiveness, total cell number or differentials in induced sputum, and levels of histamine, prostaglandin D2, interleukin-5 and eosinophil cationic protein in supernatants of induced sputum were compared among all the groups. Results CVA responsive to bronchodilator therapy accounted for 76% and unresponsive accounted for 24%. Cough threshold logC5 was lower in the former than that in the latter (P＜0.05) . Lung function parameters such as FEVh FVC, FEV1 /FVC, MMEF and PD20 FEV1 tended to be decrease in CVA responsive to bronchodilator therapy when compared with the unresponders, even though the difference was not significant. CVA responsive to bronchodilator therapy presented with a higher percentage of eosinophils in induced sputum (P＜0.05) , higher levels of prostaglandin D2 (P＜0.01 ) and eosinophil cationic protein (P＜0.01 ) in the supernatant of induced sputum than the unresponders did. Moreover, there was an apparent positive correlation between changes in cough symptom score and the percentage of eosinophils (r=0.254,P=0.036) in induced sputum, prostaglandin D2 (r=0.422, P=0.007 ) , histamine (r=0.365,P=0.020) or eosinophil cationic protein (r=0.371, P=0.020) in the supernatant of induced sputum after one week treatment with bronchodilators in the responders. A negative correlation was also found between changes in cough symptom score and cough threshold logC5，in these patients (r=-2.064, P=0.025) . Conclusions CVA may be divided into two subgroups according to the response to bronchodilator therapy, which possibly has different underlying mechanisms for cough. The varied bronchoconstriction caused by inflammatory mediators in airway may be crucial in determining the efficacy of bronchodilator therapy. |
| Key words: CVA bronchodilator airway inflammation |
