Kunkel G, Rydén A C
Charité Virchow-Klinikum, Humboldt-University, Allergy and Asthma Clinic, Berlin, Germany.
Inflamm Res. 1999 Feb;48(2):94-100. doi: 10.1007/s000110050425.
The main objective was to establish the level of serum ECP in a group of adult asthmatic patients with acute exacerbation and the following resolution and in another group of adult, stable asthmatic patients during reduction of inhaled steroids.
Acute group: Twenty-one asthmatic patients admitted to the asthma clinic with acute deterioration of their asthma were set on oral steroids which were reduced to 0 within one week. Reduction group: Forty-four stable asthmatic patients on maintenance inhaled steroids were included and, on the basis of their peak expiratory flow (PEF) values, adjustments in the doses of steroids were made.
Twenty stable asthmatics on a constant dose of inhaled steroids were enrolled as controls.
All patients registered daily PEF measurements and spirometry was performed at each visit. Blood samples were drawn and analysed for eosinophil cationic protein (ECP), myeloperoxidase (MPO), eosinophils and neutrophils.
ECP was low and within the normal range for all three groups at study entry. (Acute group = 8.4 microg/l, reduction group = 3.7 microg/l and control group = 4.6 microg/l). Nevertheless, the value in the acute group was significantly higher than in the control group (p=0.005). The levels in the acute group decreased significantly (p=0.004) after one week on oral steroids. No significant changes in ECP were observed in the reduction group or in the control group during the follow-up period. The lung function was low in the acute group at inclusion, forced expiratory volume in one second (FEV1)=47.1% of predicted, and increased significantly during the treatment period (p = 0.006). The patients in the reduction- and control group showed small variations in lung function during the whole study, FEV1 >70% and PEF > 80% of predicted, respectively. No correlation between atopy and ECP was found in the patients irrespective of the stage of disease.
This study suggests that the resolution of acute asthma exacerbations during treatment could be followed using ECP determinations. In stable asthmatics on inhaled steroids and with normal ECP levels, a dose reduction could be indicated. A longer period after tapering off steroids is proposed to confirm the benefit of ECP measurements for controlling asthma.
主要目的是确定一组急性加重期并随后缓解的成年哮喘患者以及另一组在减少吸入性类固醇期间病情稳定的成年哮喘患者的血清嗜酸性粒细胞阳离子蛋白（ECP）水平。
急性加重组：21例因哮喘急性恶化而入住哮喘门诊的哮喘患者开始口服类固醇，一周内减至零。减量组：纳入44例使用维持剂量吸入性类固醇的病情稳定的哮喘患者，并根据其呼气峰值流速（PEF）值调整类固醇剂量。
20例使用固定剂量吸入性类固醇的病情稳定的哮喘患者作为对照。
所有患者每日记录PEF测量值，每次就诊时进行肺功能测定。采集血样并分析嗜酸性粒细胞阳离子蛋白（ECP）、髓过氧化物酶（MPO）、嗜酸性粒细胞和中性粒细胞。
研究开始时，三组患者的ECP均较低且在正常范围内。（急性加重组 = 8.4微克/升，减量组 = 3.7微克/升，对照组 = 4.6微克/升）。然而，急性加重组的值显著高于对照组（p = 0.005）。口服类固醇一周后，急性加重组的水平显著下降（p = 0.004）。在随访期间，减量组和对照组的ECP未观察到显著变化。急性加重组纳入时肺功能较低，一秒用力呼气量（FEV1）=预测值的47.1%，治疗期间显著增加（p = 0.006）。减量组和对照组患者在整个研究期间肺功能变化较小，FEV1分别>预测值的70%和PEF>预测值的80%。无论疾病处于何阶段，患者的特应性与ECP之间均未发现相关性。
本研究表明，治疗期间可通过测定ECP来跟踪急性哮喘加重的缓解情况。对于使用吸入性类固醇且ECP水平正常的病情稳定的哮喘患者，可考虑减少剂量。建议在逐渐减少类固醇剂量后延长观察期，以确认ECP测量对控制哮喘的益处。
