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目的探讨职业性哮喘(OA)和过敏性哮喘(AA)的气道炎症差异。方法采用随机抽样方法,分别以非急性发作期的OA、AA患者各20例作为OA组和AA组。2组患者均采用哮喘控制测试(ACT)问卷评分和第1秒用力呼气容积占预计值百分比(FEV1%)评估哮喘控制程度,采集周围血检测嗜酸性粒细胞(EOS)百分比(EOS%)和血清总免疫球蛋白E(Ig E)水平,采集诱导痰检测EOS%、中性粒细胞(NEUT)百分比(NEUT%)、白细胞介素(IL)-4、IL-8、IL-13、嗜酸粒细胞阳离子蛋白(ECP)和髓过氧化物酶(MPO)水平。结果 OA组和AA组患者ACT评分和FEV1%分别比较,差异均无统计学意义[(20.6±2.2)vs(19.9±3.0)分,(70.9±4.5)%vs(68.9±4.0)%,P>0.05]。OA组患者血清总Ig E和周围血EOS%水平均低于AA组[(79.9±13.8)×103vs(458.8±34.9)×103U/L,(2.5±1.1)%vs(3.9±1.4)%,P<0.01]。OA组患者诱导痰中EOS%、IL-4、IL-13和ECP水平低于AA组[(5.9±2.1)%vs(14.9±2.4)%,(16.5±3.1)vs(23.9±2.4)μg/L,(44.9±3.4)vs(58.4±2.4)μg/L,(33.6±16.5)vs(89.5±24.5)μg/L,P<0.01],NEUT%、IL-8和MPO水平均高于AA组[(57.8±9.7)%vs(33.9±3.6)%,(735.9±102.1)vs(414.9±112.4)μg/L,(3.9±0.6)vs(2.7±0.5)μg/L,P<0.01]。OA组和AA组患者诱导痰中EOS%均高于同组患者的周围血EOS%(P<0.01)。结论 OA的气道炎症反应与AA存在差异,诱导痰中EOS%、NEUT%、IL-8、IL-4、IL-13、ECP和MPO等免疫学指标检测对于OA的鉴别诊断有一定的临床意义。
Objective To investigate the differences of airway inflammation between occupational asthma (OA) and allergic asthma (AA). Methods A random sample of 20 cases of OA and AA patients with non-acute exacerbation as OA and AA groups respectively. The asthma control test (ACT) questionnaire score and forced expiratory volume 1 second (FEV1%) were used to assess the degree of asthma control in both groups. The percentage of eosinophils (EOS) (EUT), neutrophil (NEUT), interleukin (IL) -4, IL-8, IL-13, Eosinophil cationic protein (ECP) and myeloperoxidase (MPO) levels. Results There were no significant differences in ACT score and FEV1% between OA group and AA group [(20.6 ± 2.2) vs (19.9 ± 3.0), (70.9 ± 4.5)% vs (68.9 ± 4.0)%, P > 0.05]. The serum total Ig E and peripheral blood EOS% of OA patients were lower than that of AA patients [(79.9 ± 13.8) × 103 vs (458.8 ± 34.9) × 103U / L, (2.5 ± 1.1) vs (3.9 ± 1.4)%, P <0.01]. The levels of EOS%, IL-4, IL-13 and ECP in induced sputum in OA patients were lower than those in AA patients [(5.9 ± 2.1) vs (14.9 ± 2.4)%, (16.5 ± 3.1) vs (23.9 ± 2.4) (44.9 ± 3.4) vs (58.4 ± 2.4) μg / L, (33.6 ± 16.5) vs (89.5 ± 24.5) μg / L, P <0.01), NEUT%, IL-8 and MPO (57.8 ± 9.7)% vs (33.9 ± 3.6)%, (735.9 ± 102.1) vs (414.9 ± 112.4) μg / L, (3.9 ± 0.6) vs (2.7 ± 0.5) μg / ]. The EOS% of induced sputum in OA and AA patients were higher than that in the same group (P <0.01). Conclusions The airway inflammatory response in OA is different from that in AA, and the detection of immunologic indexes such as EOS%, NEUT%, IL-8, IL-4, IL-13, ECP and MPO in induced sputum has some clinical significance in the differential diagnosis of OA significance.