Predictive value of airways hyperresponsiveness and circulating IgE for identifying types of responses to toluene diisocyanate inhalation challenge.
Predictive value of airways hyperresponsiveness and circulating IgE for identifying types of responses to toluene diisocyanate inhalation challenge.
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气道高反应性和循环 IgE 对识别甲苯二异氰酸酯吸入挑战反应类型的预测价值。
DOI：
10.1164/ajrccm.149.3.8118626
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发表时间：
1994
影响因子：
24.7
通讯作者：
C. Mapp
中科院分区：
文献类型：
--
作者：
M. Karol;D. Tollerud;T. P. Campbell;L. Fabbri;P. Maestrelli;M. Saetta;C. Mapp
暴露于甲苯二异氰酸酯（TDI）后哮喘的发展已被公认在各种职业环境中。然而，异氰酸酯诱导的哮喘的发病机制仍然存在争议。特别是，IgE在TDI诱导的哮喘发展中的作用仍然不确定。为了研究TDI吸入激发反应的预测因素，我们分析了63例被认为与TDI致敏相关的呼吸道症状评价受试者的数据。TDI激发前，所有受试者均接受访谈、常规抽血、肺功能测定、乙酰甲胆碱激发和过敏皮肤试验。TDI激发后1天重复肺量测定和乙酰甲胆碱激发。确定使FEV 1（PD 20）降低20%所需的乙酰甲胆碱累积剂量。PD 20为1.4 mg或更高被认为是正常的。受试者在9 m3的暴露室中暴露于5 - 10 ppb TDI长达30 min。阳性反应为TDI暴露后1小时内（早期）或超过1小时（晚期）FEV 1降低20%或更多。34例受试者（54%）有阳性应答，其中12例（35%的应答者）有孤立的早期应答，13例（38%）有孤立的晚期应答，其余受试者有双重应答。TDI激发前，32名个体（51%）对乙酰甲胆碱（AR+）有阳性反应。AR+与阳性TDI激发密切相关：23名AR+受试者（72%）TDI激发阳性，而只有11名AR-受试者（35%）（p < 0.01）。AR阳性不能预测TDI反应的开始时间。（250字处删节）
Development of asthma after exposure to toluene diisocyanate (TDI) has been recognized in a variety of occupational settings. However, the pathogenesis of isocyanate-induced asthma remains controversial. In particular, the role of IgE in the development of TDI-induced asthma has remained uncertain. To investigate predictive factors for response to inhalation challenge with TDI, we analyzed data from 63 subjects referred for evaluation of respiratory symptoms thought to be related to TDI sensitization. All subjects underwent interview, routine phlebotomy, spirometry, methacholine challenge, and allergy skin testing prior to TDI challenge. Spirometry and methacholine challenge were repeated 1 day after TDI challenge. The cumulative dose of methacholine needed to produce a 20% decrease in FEV1 (PD20) was determined. A PD20 of 1.4 mg or more was considered normal. Subjects were challenged by exposure to 5 to 10 ppb TDI for up to 30 min in a 9 m3 exposure chamber. A positive response was a 20% or more decrease in FEV1 within 1 h (early) or beyond 1 h (late) after TDI exposure. Thirty-four subjects (54%) had a positive response, of whom 12 (35% of responders) had isolated early responses, 13 (38%) had isolated late responses, and the remainder had dual responses. Thirty-two individuals (51%) had a positive response to methacholine (AR+) prior to TDI challenge. AR+ was strongly associated with a positive TDI challenge: 23 AR+ subjects (72%) had a positive TDI challenge, compared with only 11 AR- subjects (35%) (p < 0.01). AR positivity did not predict the time of onset of TDI response.(ABSTRACT TRUNCATED AT 250 WORDS)