摘要
目的探讨咳嗽敏感性在咳嗽变异性哮喘(cough variant asthma,CVA)咳嗽发生中的作用差异及机制。方法 68例CVA按辣椒素咳嗽阈值C5分为增高组(21例)和正常组(47例),另设正常对照组(26例)。比较三组间咳嗽症状积分、肺功能和诱导痰细胞学改变,并用酶联免疫法检测诱导痰上清液中白细胞介素-8(interleukin-8,IL-8)及中性粒细胞弹性蛋白酶(neutrophil elastase,NE)水平。结果咳嗽敏感性增高组CVA咳嗽程度重于正常组CVA(4.0±1.0 vs 3.1±0.9,P<0.01)。CVA与健康志愿者间肺功能虽无差别,但诱导痰中细胞总数及中性白细胞比例增高,IL-8和NE也增高。其中咳嗽敏感性增高组CVA中性粒细胞比例高于正常组CVA(50.1±25.4)%vs(36.6±19.7)%,P<0.05,伴有IL-8(360.4±181.2)pg/ml vs(228.0±107.9)pg/ml,P<0.01和NE(94.1±16.9)ng/ml vs(67.6±12.9)ng/ml,P<0.01,有关指标进一步升高。相关性分析示IL-8与中性粒细胞比例、NE均呈正相关(P<0.01),NE与Log C5呈负相关(P<0.05)。结论 CVA可分为咳嗽敏感性增高和正常两种亚型。中性粒细胞在气道浸润和活化程度不同可能是造成CVA咳嗽敏感性差异的重要原因。
Objectives To study the different effects of cough reflex sensitivity on the pathogenesis of cough in CVA and to explore its underlying mechanism.Methods Sixty-eight patients with CVA were divided into two subgroups according to the established normal value of cough sensitivity threshold C5： CVA with increased（21 cases） or normal（47 cases） cough reflex sensitivity.Twenty-six healthy volunteers were enrolled as control group.Changes in cough symptom score,lung function parameters,total cell number and differentials in induced sputum were compared among three groups.Moreover,levels of interleukin-8（IL-8） and neutrophil elastase（NE） were analyzed in supernatants of induced sputum by ELISA.Results Cough was more severe in CVA with increased cough reflex sensitivity than in CVA with normal sensitivity（4.0±1.0 vs 3.1±0.9,P0.01）.Compared with the control group,lung function parameters in both subgroups of CVA had no significant differences,while the total cells,percentages of neutrophils,IL-8 and NE were increased significantly in both subgroups of CVA.The percentage of neutrophils in induced sputum in CVA patients with increased cough reflex sensitivity was higher than that in CVA patients with normal sensitivity[（50.1±25.4）%vs（36.6±19.7）%,P0.05].Similarly,the levels of IL-8 and NE supernatants in induced sputum were higher in CVA patients with increased cough reflex sensitivity than those with the normal one [IL-8：（360.4±181.2） pg/ml vs（228.0±107.9） pg/ml,P0.01,NE：（94.1±16.9） ng/ml vs（67.6±12.9） ng/ml,P0.01].Moreover,there was an apparent positive correlation between IL-8 and the percentage of neutrophils（P0.01） or NE（P0.01）,and a negative correlation between NE and Log C5（P0.01）.Conclusion CVA can be divided into two subgroups with increased or normal cough reflex sensitivity.The varied degrees of infiltration and the activation of neutrophils in the airway may be crucial factors associated with the difference in cough reflex sensitivity in patient
出处
《同济大学学报（医学版）》
CAS
2011年第1期68-72,共5页
Journal of Tongji University(Medical Science)
基金
上海市科委科技发展基金资助项目(074119628)
