Pathological features and inhaled corticosteroid response of eosinophilic and non-eosinophilic asthma
Pathological features and inhaled corticosteroid response of eosinophilic and non-eosinophilic asthma
复制标题
DOI：
10.1136/thx.2006.073429
复制
发表时间：
2007-12-01
期刊：
影响因子：
10
通讯作者：
Pavord, Ian D.
中科院分区：
文献类型：
--
作者：
Berry, Mike;Morgan, Angela;Pavord, Ian D.
背景资料：非嗜酸性粒细胞性哮喘是一种潜在的重要临床病理表型，因为有证据表明它对吸入性皮质类固醇治疗反应不佳。然而，鲜为人知的是，基本的气道免疫病理学，也没有数据安慰剂对照研究吸入性皮质类固醇激素的影响：气道免疫病理学进行了调查，诱导痰，支气管活检，支气管冲洗和支气管肺泡灌洗12例有症状的嗜酸性粒细胞性哮喘，11例非嗜酸性粒细胞性哮喘和10名健康对照。非嗜酸性粒细胞性哮喘患者和6名不同的嗜酸性粒细胞性哮喘患者参加了一项随机、双盲、安慰剂对照的交叉研究，研究了每天一次吸入莫米松400 μ g持续8周对气道反应性和哮喘生活质量的影响。非嗜酸性粒细胞性哮喘患者的粘膜中没有嗜酸性粒细胞（嗜酸性粒细胞性哮喘组中位细胞数为4.4个/ mm 2，正常对照组中位细胞数为23个/ mm 2，正常对照组为0个/mm 2; P = 0.03）和正常的上皮下层厚度（5.8 μ m vs嗜酸性粒细胞性哮喘的10.3 μ m和对照组的5.1 μ m，P = 0.002）。与正常对照组相比，非嗜酸性粒细胞哮喘组和嗜酸性粒细胞哮喘组的气道平滑肌中肥大细胞数量增加（9 vs 8 vs 0 cells/ mm 2，p = 0.016）。与安慰剂相比，吸入莫米松治疗8周导致乙酰甲胆碱PC 20改善较少（0.5 vs 5.5倍浓度，95% CI差异为1.1 - 9.1; p = 0.018）和哮喘生活质量（0.2 vs 1.0分，差异的95% CI为0.27至1.43; p = 0.008）。非嗜酸性粒细胞性哮喘代表一种病理学上不同的疾病表型，其特征在于不存在气道嗜酸性粒细胞增多，正常的上皮下层厚度和对吸入性皮质类固醇治疗的不良短期反应。
Background: Non-eosinophilic asthma is a potentially important clinicopathological phenotype since there is evidence that it responds poorly to inhaled corticosteroid therapy. However, little is known about the underlying airway immunopathology and there are no data from placebo-controlled studies examining the effect of inhaled corticosteroids.Methods: Airway immunopathology was investigated using induced sputum, bronchial biopsies, bronchial wash and bronchoalveolar lavage in 12 patients with symptomatic eosinophilic asthma, 11 patients with non-eosinophilic asthma and 10 healthy controls. The patients with non-eosinophilic asthma and 6 different patients with eosinophilic asthma entered a randomised, double-blind, placebo-controlled crossover study in which the effects of inhaled mometasone 400 mu g once daily for 8 weeks on airway responsiveness and asthma quality of life were investigated.Results: Patients with non-eosinophilic asthma had absence of eosinophils in the mucosa (median 4.4 cells/ mm(2) vs 23 cells/ mm(2) in eosinophilic asthma and 0 cells/ mm2 in normal controls; p = 0.03) and normal subepithelial layer thickness (5.8 mu m vs 10.3 mu m in eosinophilic asthma and 5.1 mu m in controls, p = 0.002). Non-eosinophilic and eosinophilic asthma groups had increased mast cell numbers in the airway smooth muscle compared with normal controls (9 vs 8 vs 0 cells/ mm(2), p = 0.016). Compared with placebo, 8 weeks of treatment with inhaled mometasone led to less improvement in methacholine PC20 (0.5 vs 5.5 doubling concentrations, 95% CI of difference 1.1 to 9.1; p = 0.018) and asthma quality of life (0.2 vs 1.0 points, 95% CI of difference 0.27 to 1.43; p = 0.008).Conclusions: Non-eosinophilic asthma represents a pathologically distinct disease phenotype which is characterised by the absence of airway eosinophilia, normal subepithelial layer thickness and a poor short-term response to treatment with inhaled corticosteroids.