Nakazawa T, Kagami M, Matumura R, Kawashima T, Matuzuwa Y, Takada M
Department of Internal Medicine, Toho University School of Medicine, Sakura Hospital.
Arerugi. 1999 Oct;48(10):1153-60.
Previous studies have shown that eosinophils and eosinophil cationic protein (ECP) levels in the sputum of patients with asthma closely reflect inflammatory activity of the bronchial mucosa. We examined whether the ECP level or eosinophil count in induced sputum provides information useful in determining whether to taper the dose of medications or to terminate treatment especially with inhaled corticosteroids in patients with well controlled asthma. We studied 15 adults with asthma who consistently maintained a peak expiratory flow (PEF) value within 80% or more of their predicted value (green zone) for at least 4 weeks with no asthmatic symptoms. All patients underwent at least two hypretonic saline inhalation tests. Forty sputum samples were obtained for evaluation of cell count and ECP level. Before the tests, patients were requested to record asthmatic symptoms, medications received, and morning and evening PEF values in a diary for more than 3 months. The relations among clinical and laboratory variables, including symptoms scores, medication scores, asthma scores (= symptom scores + medication scores). PEF values, forced expiratory volume (FEV1.0) during the test, and sputum eosinophil count or sputum ECP, were analyzed. The sputum ECP level correlated significantly with the percentage of eosinophils in the sputum (rs = 0.783). There were also significant correlations between the sputum ECP level and the mean weekly symptom scores (rs = 0.500-0.510), medication scores (rs = 0.510-0.540), and asthma scores (rs = 0.509-0.548). However, there were no significant correlations among sputum ECP level, mean morning PEF or evening PEF, daily variation in PEF, and FEV1.0. We conclude that the sputum ECP level is a sensitive laboratory variable useful in monitoring the presence of eosinophilic inflammation in the bronchial mucosa of patients with bronchial asthma, especially those who have mild or no symptoms with normal PEF.
以往研究表明，哮喘患者痰液中的嗜酸性粒细胞和嗜酸性粒细胞阳离子蛋白（ECP）水平密切反映支气管黏膜的炎症活动。我们研究了诱导痰中的ECP水平或嗜酸性粒细胞计数是否有助于确定是否应减少药物剂量或终止治疗，尤其是对于病情得到良好控制的哮喘患者吸入糖皮质激素的情况。我们研究了15名成年哮喘患者，他们在至少4周内始终保持呼气峰值流速（PEF）值在其预测值的80%或更高（绿色区域），且无哮喘症状。所有患者均接受了至少两次高渗盐水吸入试验。获取了40份痰液样本以评估细胞计数和ECP水平。在试验前，要求患者在日记中记录哮喘症状、所接受的药物以及早晚的PEF值，记录时间超过3个月。分析了临床和实验室变量之间的关系，包括症状评分、药物评分、哮喘评分（=症状评分+药物评分）、PEF值、试验期间的用力呼气量（FEV1.0）以及痰液嗜酸性粒细胞计数或痰液ECP。痰液ECP水平与痰液中嗜酸性粒细胞的百分比显著相关（rs = 0.783）。痰液ECP水平与平均每周症状评分（rs = 0.500 - 0.510）、药物评分（rs = 0.510 - 0.540）以及哮喘评分（rs = 0.509 - 0.548）之间也存在显著相关性。然而，痰液ECP水平与平均早晨PEF或晚上PEF、PEF的每日变化以及FEV1.0之间无显著相关性。我们得出结论，痰液ECP水平是一个敏感的实验室变量，有助于监测支气管哮喘患者支气管黏膜嗜酸性粒细胞炎症的存在，尤其是那些症状轻微或无症状且PEF正常的患者。
