摘要
目的探讨气道神经源性炎症在胃食管反流性咳嗽(GERC)发病中的作用。方法20例GERC患者(GERC组),与10名正常人(正常对照组)和8例其他病因咳嗽伴有胃食管反流(GERD)患者(GERD组)分别作对比分析,观察GERC患者治疗前、后气道黏膜与分泌物中神经肽的变化。用酶联免疫吸附测定(ELISA)法测定痰上清液P物质(SP)、神经肽A(NKA)、神经肽B(NKB)的含量;用放射免疫法测定痰上清液降钙素基因相关肽(CGRP)的浓度。用免疫组化法检测气道黏膜、诱导痰细胞SP、NKA及SP受体(NK1)的表达,结果用半定量病理学方法表示。结果GERC组患者痰上清液SP、CGRP含量[(266±207)ng/L、(180±83)ng/L]显著高于正常对照组[(143±36)ng/L、(105±64)ng/L,P分别<0.05、<0.01]和GERD组[(130±11)ng/L、(89±16)ng/L,P分别<0.05、<0.01],NKA、NKB的含量各组间比较差异无统计学意义(P均>0.05);GERC组痰细胞SP、NK1和NKA的表达显著高于正常对照组(P分别<0.01、<0.05,<0.05)和GERD组(P均<0.05);GERC组气道黏膜SP的表达也显著高于GERD组(P<0.01)。治疗后,诱导痰细胞SP、NK1、NKA的表达较治疗前显著降低(P<0.01,<0.01或<0.05),痰上清液CGRP的含量也较治疗前显著降低(P<0.05)。结论GERC患者气道存在明显的神经源性炎症,治疗后神经肽趋于正常,提示神经源性炎症与GERC的发病密切相关。
Objective To investigate the role of airway neurogenic itflammation in the pathogenesis of gastro-esophageal reflux induced cough （ GERC ）. Methods Sputum was induced by hypertonic saline aerosol inhalation in 20 patients with GERC（ GERC group） , 10 healthy subjects（ normal control group） and 8 patients with chronic cough due to other causes but complicated with gastro-esophageal reflux diseases （ GERD,GERD group）. Airway mucosal biopsy was performed in 6 patients with GERC and 4 patients with GERD using flexible fiberoptic bronchoscopy. The expression of substance P（SP） ,neurokinin 1 receptor and neurokinin A（NKA） in sputum cells and airway mucosa were detected by immunohistochemistry, and was assessed semi-quantitatively. SP,NKA,and NKB in the supernatant of induced sputum were measured with enzyme linked immunosorbent assay. Calcitonin gene-related peptide （CGRP） was measured with radioimmunoassay. Results The concentration of SP in the supernatant of induced sputum was significantly higher in GERC group[ （266 ± 207 ）ng/L] than those in normal control group [ （143 ±36）ng/L, P 〈 0. 05 ] and GERD group [ （ 130 ± 11 ） ng/L, P 〈 0. 05 ], and the sputum supernatant concentration of CGRP in GERC group[ （180 ± 83 ）ng/L] was significantly higher than those in normal control group [ （105 ± 64）ng/L, P 〈 0. 01 ] and GERD group[ （ 89 ± 16） ng/L, P 〈 0. 01 ]. The expression of SP, NK-1 receptor and NKA in induced sputum cells in GERC group were significantly higher than those in normal control group （ P 〈 0.01, 〈0.05, 〈 0. 05） and GERD group（all P 〈 0.05）; Expressions of SP in airway mucosa was significantly higher in GERC group than in GERD group（ P 〈 0. 01 ）. After treatment, the concentration of CGRP in the supernatant of sputum in GERC patients was significantly lower than that before treatment（P 〈 0. 05） ;the expression of SP, NK-1 and NKA in the induced sputum cells were significantly lower than that before treatment（P〈0.01, P〈0.01 orP〈0.05）. Conclusion There is airway neurogenic inflammation in GERC patients,which maybe closely related to the development of GERC.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2005年第8期520-524,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金资助项目(30370621)
广州市科技攻关重点基金资助项目(2002Z2E0091)
