摘要
目的从哮喘控制测试(asthma control test,ACT)评分、高分辨CT、肺功能及病理学等方面综合探讨药物干预对哮喘控制的影响。方法筛选哮喘患者48例于稳定期行HRCT、肺功能及留取痰液,根据GINA方案规范化分级治疗1年后再次随访,行ACT评分,并再次行上述检查,利用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)方法检测痰液中基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、基质金属蛋白酶抑制剂-1(tissue-inhibitor metalloproteinase,TIMP-1)、转化生长因子β1(transforming growth factor-β1,TGF-β1)的水平,并行痰涂片计数嗜酸粒细胞(EOS)百分比。结果①规律的药物治疗后,有34例患者进入实验组,进行1年来ACT评估:完全控制组15例,部分控制组12例,未控制组7例;各组间WA%、2T/D比较,完全控制组与部分控制组相比有统计学意义(P<0.05),TGF-β1在完全控制组与部分控制组、未控制组比较有统计学意义(P<0.05);②哮喘患者治疗后高分辨CT的2T/D、WA%、吸呼气相CT差值、MMP-9、TIMP-1、TGF-β1浓度较治疗前比较有统计学意义,呈降低趋势(P<0.01);③治疗后患者2T/D、WA%与MMP-9、TIMP-1、MMP-9/TIMP-1及TGF-β1呈正相关(P<0.05),而与FEV1%pred、FEV1/FVC%、FVC%pred呈负相关(P<0.05);且EOS%与FEV1%pred、FEV1/FVC%呈负相关(P<0.05)。结论①ACT评分、高分辨CT、肺功能及痰液检测等可综合全面的评价哮喘的控制情况;②药物干预治疗可使哮喘患者的气道壁厚度、气体潴留、肺功能得到改善,并使炎症细胞因子有所下降,从而阻止哮喘的反复发作及不可逆气流阻塞的形成。
Objective From aspects of asthma control test(ACT) score,high resolution computed tomography(HRCT),pulmonary function and pathological discuss comprehensivly drug intervention influence on asthma control.Methods Forty-eight patients with asthma were enrolled from the first hospital of Shanxi medical university.These patients were examined high-resolution computer tomography images,pulmonary function and induced sputum in the stable period,then they were standard treatment one year according to the Global Initiative for Asthma 2003,again follow-up visiting.Making use of ACT questionnaire assessing clinical controlling situation,who were reexamine like above,sputum smear determining level of matrix metalloproteinase-9(MMP-9),tissue-inhibitor metalloproteinase(TIMP-1) and transforming growth factor-β1(TGF-β1) with enzyme linked immunosorbent assay(ELISA) and counting eosinophil(EOS)in the percentage of white blood cells.Results ①After normative treatment being intervened by drug of 1year,there were 34 patients continuing to enter the experiment group,they were assessed by ACT,Achieving complete controlling 15 cases,portion controlling 12 cases,uncontrolling 7 cases.Comparising WA%,2T/D of the groups,complete controlling and partial controling groups were statistically significant(P<0.05),TGF-β1 in complete controlling group and portion controlling group with un-control group had statistical significance(P<0.05).②2T/D,WA%,inspiratory and expiratory lung tissue density phase difference of HRCT images,and also the level of MMP-9,TIMP-1 and TGF-β1 in sputum had statistical significance after treatment comparing with before treatment(P<0.05).③The 2T/D,WA% of patients after treatment were correlated positivly with the levels of MMP-9,TIMP-1,MMP-9/TIMP-1 and TGF-β1 of sputum,while are correlated negatively with FEV1/FVC%,FEV1%pred,FVC%pred of pulmonary function,and EOS% are correlated negatively with FEV1/FVC%,FEV1%pred of pulmonary function.Conclusions ①ACT,HRCT,function and sputum can be used to comprehensivly evaluate asthma control.②Drug intervention treatment could make airway wall thickness,gas retention,pulmonary function of the asthma patients be improved,and the inflammatory cytokines decreased,thereby prevented the repeated attacks of asthma and the formation of irreversible airflow obstruction.
出处
《中华哮喘杂志（电子版）》
CAS
2012年第2期27-31,共5页
Chinese Journal of Asthma(Electronic Version)
基金
2008年山西省国际合作项目2008081039
2008山西省回国留学人员科技资助项目晋人函字(2008)56号
关键词
支气管哮喘
高分辨CT
肺功能
诱导痰
Bronchial asthma
High resolution computed tomography
Pulmonary
Induced sputum
