吸入性糖皮质激素对支气管哮喘患儿气道重塑的影响

目的探讨吸入性糖皮质激素对支气管哮喘（简称哮喘）患儿气道重塑的影响。方法对年龄在5～15岁的30例中重度持续哮喘的住院患儿（哮喘组）、30例健康儿童（对照组）、15例经规范化糖皮质激素吸入治疗6个月以上的哮喘缓解期（缓解组）患儿用5％高渗盐水进行超声雾化诱导痰液，以酶联免疫吸附试验（ELISA）测定诱导痰中IL-5水平，免疫细胞化学方法测定诱导痰中转化生长因子β1（TGF-β1）表达，同时进行诱导痰中嗜酸粒细胞（EOS）计数，测定第1秒用力呼气容积占预计值百分比（FEV1％pred），进行肺部高分辨CT（HRCT）检查，测定肺CT的段及亚段支气管壁厚度／气道外径（T／D）和气道壁面积占气道总面积百分比（WA％）。结果①哮喘组EOS计数为（17．24±12．11）％、IL-5为（25．45±18．05）pg／L；缓解组EOS计数为（3．66±2．13）％、IL-5为（7．33±4．39）pg／L；对照组EOS计数为（1．40±1．27）％、IL-5为（6．49±5．31）pg／L，哮喘组与对照组、哮喘组与缓解组比较差异有统计学意义，P值均〈0．01。②30例哮喘患儿有27例痰液中出现TGF-β1阳性表达，缓解组有2例TGF-β1阳性表达，而对照组中未见有TGF-β1阳性表达。③哮喘组T／D（18．16±2．42）％、WA％（59．25±6．54）％、FEV1％pred（71．82±23．08）％；缓解组T／D（17．17±1．9）％、WA％（56．01±3．91）％、FEV1％pred（96．18±12．8）％；对照组T／D（16．45±2．30）％、WA％（53．91±7．72）％、FEV1％pred（107.46±17．11）％，哮喘组与对照组、哮喘组与缓解组比较差异有统计学意义，P值均〈0．05。结论气道重塑在儿童哮喘中已经形成；吸入糖皮质激素可有效地调控气道炎症的发生、发展，经较长疗程的吸入糖皮质激素治疗后气道重塑部分可以逆转。

Effects of inhaled glucocorticosteroid treatment in airway remodeling in children with bronchial asthma

Objective To investigate the effect of inhaled glueocorticosteroid treatment in airway remodeling in children with bronchial asthma（asthma）. Methods Thirty hospitalized children（aged 5 to 15 years） with moderate-severe persistent asthma（asthma group）, 30 healthy children （control group）, 15 asthmatic eases regularly inhaled glueocorticosteroid for more than six months （remission group） were studied. Ultrasonically nebulized 5 % hypertonic saline was used to induce sputum. The 165 level in induced sputum was determined using ELISA. Immunocytochemistry assay was used to determine TGF-β1 expression of inflammatory cells. The forced expiratory volume in first second percent （FEV1%） predicted （FEV1% pred） and the eosinophils（EOS） counting in the sputum were measured. The percentage of airway wall area to total airway cross sectional area（WA%） and wall thickness to airway diameter ratio（T/D） were calculated at the segmental and subsegmental on HRCT. Results （1）The EOS counting and IL-5 level in induced sputum of astham group were （ 17.24 ± 12.11 ） %, （ 25.45 ± 18.05 ） pg/L, remission group were （3.66±2.13）%,（7.33±4.39） pg/L,control group were （1.4± 1.27）%,（6.49±5.31） pg/L,there are statistical significant differences between asthma group and control group, and the remission group（ P 〈 0.01）. （2）Twenty-seven of 30 asthma cases showed positive expression of TGF-β1 in inflammatory cells in induced sputum, 2 cases in the remission group, there is no positive expression of TGF-β1 in control group. （3） Asthma groupT/D （18.16±2.42）G,WA% （59.25±6.54）% ,FEV1% pred （71. 82±23.08）,remission group T/D （17.17±1.9） %,WA% （56. 01±3.91）G,FEV1% pred （96.18± 12.8）% . Control group T/D （16.45±2.30） %, WAG （53.91±7.72） %,FEV1 % pred （107.46 ± 17.11） %. Asthma and control group,and the remission group had a significant difference（ P 〈0.05）. Conclusions Airway remodeling had formed in children with as