Neutrophilic inflammation in severe persistent asthma
Neutrophilic inflammation in severe persistent asthma
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DOI：
10.1164/ajrccm.160.5.9806170
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发表时间：
1999-11-01
影响因子：
24.7
通讯作者：
Barnes, PJ
中科院分区：
文献类型：
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作者：
Jatakanon, A;Uasuf, C;Barnes, PJ
重症哮喘的呼吸道炎症特征不是很好，但可能涉及中性粒细胞。我们比较了不同严重程度的哮喘患者和正常对照组患者的诱导痰情况。我们还测量了呼出的一氧化氮(NO)作为炎症的非侵入性标志。哮喘的严重程度基于治疗前的临床特征和诱导痰时维持哮喘控制所需的最低药物，并被分类为(1)轻度：偶尔使用吸入β(2)-激动剂(n=23；FEV1，91%；最大呼气流量(PEF)变异性，10.5%)；(2)中等：需要中剂量吸入类固醇以维持控制(n=16；FEV1，88%；PEF变异性，9.1%)；(3)重度：尽管使用吸入和口服类固醇(n=16；FEVI，61%；PEF变异性，36.2%)。哮喘患者为非吸烟者，有呼吸道高反应性或可逆性气道阻塞的证据，至少6wk内没有呼吸道感染。与轻度哮喘(35.4[29.8-46.1]%)和正常对照组(27.7[20.6-42.2]%)相比，重症哮喘组中性粒细胞数显著增加(53.0[38.4-73.5]%，p<；0.05)。哮喘患者白细胞介素8(IL-8)和中性粒细胞髓过氧化物酶(MPO)水平均升高，以重度哮喘最高。轻度和重度哮喘患者的嗜酸性粒细胞数量均增加，但白细胞介素5(IL-5)水平在轻度哮喘患者中最高，而嗜酸性粒细胞阳离子蛋白(ECP)水平在重度哮喘患者中最高。未经糖皮质激素治疗的哮喘患者呼出的NO水平最高，但无论临床哮喘的严重程度如何，使用糖皮质激素的患者(第2组和第3组)呼出的NO水平没有显著差异。这证实了嗜酸性粒细胞在哮喘中的作用，但也暗示了中性粒细胞在更严重的哮喘中的潜在作用。
Airway inflammation in severe asthma is not well characterized but may involve neutrophils. We have compared induced sputum profiles in patients with asthma of varying severity and normal control subjects. We have also measured exhaled nitric oxide (NO) as a noninvasive marker of inflammation. Asthma severity was based on clinical features before treatment and the minimum medication required to maintain asthma control at the time of sputum induction, and classified as (1) mild: treated with inhaled beta(2)-agonist occasionally (n = 23; FEV1, 91%; peak expiratory flow (PEF) variability, 10.5%), (2) moderate: requiring medium dose inhaled steroids to maintain control (n = 16; FEV1, 88%; PEF variability, 9.1%), and (3) severe: despite using inhaled and oral steroids (n = 16; FEV I, 61%; PEF variability, 36.2%). The asthmatic patients were nonsmokers with evidence of airway hyperresponsiveness or reversible airway obstruction, and free of respiratory tract infection for at least 6 wk. Sputum revealed significantly increased neutrophil numbers in severe asthma (53.0 [38.4-73.5]%, p < 0.05) compared with mild asthma (35.4 [29.8-46.1]%) and normal control subjects (27.7 [20.6-42.2]%). Interleukin-8 (IL-8) and neutrophil myeloperoxidase (MPO) levels were increased in asthmatic patients, with the highest levels in severe asthma. Eosinophil numbers were increased in both mild and severe asthma, but interleukin-5 (IL-5) revels were highest in mild asthma, whereas eosinophil cationic protein (ECP) levels were highest in severe asthma. Exhaled NO levels were highest in asthmatic untreated with corticosteroids, but there was no significant difference between asthmatics using corticosteroids (Croups 2 and 3), regardless of clinical asthma severity. This confirms the role of eosinophits in asthma but suggests a potential role of neutrophils in more severe asthma.