Vitamin D reduces eosinophilic airway inflammation in nonatopic asthma
Vitamin D reduces eosinophilic airway inflammation in nonatopic asthma
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DOI：
10.1016/j.jaci.2014.11.033
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发表时间：
2015-03-01
影响因子：
14.2
通讯作者：
ten Brinke, Anneke
中科院分区：
文献类型：
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作者：
de Groot, Jantina C.;van Roon, Eric N. H.;ten Brinke, Anneke
背景资料：低水平的维生素D与哮喘的严重程度、气道重塑和加重率增加相关，尤其是在非特应性哮喘中。类固醇反应性降低或抗微生物防御受损可能是潜在机制。目的：我们试图评估补充维生素D对非特应性哮喘患者嗜酸性粒细胞和嗜酸性粒细胞气道炎症的影响。方法：在一项双盲、随机、安慰剂对照试验中，我们调查了长效维生素D-3的作用（400，000 IU）对44例非特应性哮喘伴嗜中性粒细胞（>= 53%）和/或嗜酸性粒细胞（>= 3%）气道炎症患者痰中性粒细胞和嗜酸性粒细胞的影响。在基线和9周后进行痰诱导。其他测量包括问卷调查，血液样本，和肺功能。结果：治疗与维生素D没有显着影响痰中性粒细胞或嗜酸性粒细胞与安慰剂治疗相比，在总组。关于痰嗜酸性粒细胞，维生素D的作用似乎依赖于基线痰嗜酸性粒细胞水平（相互作用P = 0.015）。在嗜酸性粒细胞水平为26.2%或更高的患者中（痰嗜酸性粒细胞增多患者的中位数> 3%），维生素D治疗后嗜酸性粒细胞从中位数41.0%降至11.8%，而安慰剂组患者从51.8%增至63.3%（P = 0.034）。维生素D治疗也导致哮喘控制问卷评分略好（P = .08）。结论：维生素D补充减少非特应性哮喘伴严重嗜酸性粒细胞气道炎症患者的嗜酸性粒细胞气道炎症，但不影响痰中性粒细胞。此外，还观察到对哮喘控制的微小影响。这些发现表明，维生素D可能有潜力作为嗜酸性粒细胞哮喘的附加治疗选择。
Background: Low levels of vitamin D are associated with asthma severity, airway remodeling, and exacerbation rate increase, especially in nonatopic asthma. Reduced steroid responsiveness or impaired antimicrobial defense might be underlying mechanisms.Objective: We sought to evaluate the effect of vitamin D supplementation on eosinophilic and neutrophilic airway inflammation in patients with nonatopic asthma.Methods: In a double-blind, randomized, placebo-controlled trial, we investigated the effect of long-acting vitamin D-3 (400,000 IU) on sputum neutrophils and eosinophils in 44 patients with nonatopic asthma with neutrophilic (>= 53%) and/or eosinophilic (>= 3%) airway inflammation. Sputum induction was performed at baseline and after 9 weeks. Other measurements included questionnaires, blood samples, and pulmonary function.Results: Treatment with vitamin D did not significantly affect sputum neutrophils or eosinophils compared with treatment with placebo in the total group. Regarding sputum eosinophils, the effect of vitamin D appeared to be dependent on baseline sputum eosinophil levels (interaction P = .015). In patients with eosinophil levels of 26.2% or more (median in patients with sputum eosinophilia, > 3%), eosinophils decreased from a median of 41.0% to 11.8% after vitamin D treatment as compared with an increase from 51.8% to 63.3% in patients receiving placebo (P = .034). Vitamin D treatment also resulted in slightly better Asthma Control Questionnaire scores (P = .08).Conclusions: Vitamin D supplementation reduced eosinophilic airway inflammation in patients with nonatopic asthma with severe eosinophilic airway inflammation, but did not affect sputum neutrophils. Also, a small effect on asthma control was observed. These findings suggest that vitamin D might have potential as an add-on treatment option in eosinophilic asthma.