同济大学学报（医学版）2011，Vol.32Issue(1)：95-100,6.DOI:10.3969/j.issn1008-0392.2011.01.095
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
Comparative study of cough variant asthma responsive and unresponsive to bronchodilator treatment
摘要
Abstract
Objectives 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 FEV1, 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 ). Conclusion 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.关键词
咳嗽变异性哮喘/支气管扩张剂/气道炎症分类
医药卫生引用本文复制引用
李馨,余莉,魏为利,吕寒静,邱忠民..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):95-100,6.基金项目
上海市科委科技发展基金资助项目(074119628) （074119628）
