Jang A S, Choi I S
Department of Internal Medicine, Seonam University College of Medicine, Korea.
Respir Med. 1999 Dec;93(12):912-8. doi: 10.1016/s0954-6111(99)90059-8.
Nitric oxide (NO) plays an important role in physiological regulation of the airways. The monitoring of airway inflammation has being observed in bronchial asthma directly, by sputum examination, and indirectly, by measurements in peripheral blood. To investigate the diagnostic value of these two methods, we compared NO metabolites in induced sputum and serum obtained in patients with asthma and control subjects. Hypertonic saline induced sputum and serum were obtained in 13 patients with asthma and 10 control subjects. NO metabolite level was assayed by using modified Griess reaction. Eosinophil cationic protein (ECP) was measured by fluoroimmunoassay, and detected interleukin (IL)-5 by a sandwich ELISA. The accuracy of the tests was measured by plotting the data in receiver operating characteristic (ROC) curves and comparing the area under the curve for NO metabolites. Asthmatic patients, compared with control subjects, had significantly higher NO metabolites in induced sputum (1252.5+/-203.3 mol l(-1) vs. 557.2+/-101.5 mol l(-1), P<0.01) but not in serum. IL-5 in induced sputum was detected more frequently in patients with asthma than in control subjects [11/13 (84.6%) vs. 1/10 (10%), P<0.01]. Asthmatic patients, compared with control subjects, had significantly higher ECP concentration in induced sputum (1270.0+/-197.9 g l vs. 154.6+/-47.4 g l(-1), P<0.01). There were significant positive correlations between NO metabolites in induced sputum and eosinophils, ECP in induced sputum (r=0.58 P<0.05; r=0.64, P<0.01) in patients with asthma but not in serum. The area under the ROC curve showed that NO metabolites in induced sputum (0.78) are more accurate marker than NO metabolites in serum (0.53) (P<0.05). These findings suggest that NO metabolites in induced sputum is a more valuable indicator to monitor asthmatic airway inflammation than those in serum.
一氧化氮（NO）在气道的生理调节中发挥着重要作用。对气道炎症的监测可通过痰液检查直接观察支气管哮喘，也可通过外周血检测间接进行。为了研究这两种方法的诊断价值，我们比较了哮喘患者和对照受试者诱导痰液及血清中的NO代谢产物。13例哮喘患者和10例对照受试者采集了高渗盐水诱导痰液及血清。采用改良的格里斯反应测定NO代谢产物水平。用荧光免疫分析法测定嗜酸性粒细胞阳离子蛋白（ECP），并用夹心酶联免疫吸附测定法检测白细胞介素（IL）-5。通过绘制受试者工作特征（ROC）曲线中的数据并比较NO代谢产物曲线下面积来衡量检测的准确性。与对照受试者相比，哮喘患者诱导痰液中的NO代谢产物显著更高（1252.5±203.3 μmol l⁻¹ 对557.2±101.5 μmol l⁻¹，P<0.01），但血清中无此差异。哮喘患者诱导痰液中IL-5的检出率高于对照受试者[11/13（84.6%）对1/10（10%），P<0.01]。与对照受试者相比，哮喘患者诱导痰液中的ECP浓度显著更高（1270.0±197.9 μg l 对154.6±47.4 μg l⁻¹，P<0.01）。哮喘患者诱导痰液中的NO代谢产物与嗜酸性粒细胞、诱导痰液中的ECP之间存在显著正相关（r=0.58，P<0.05；r=0.64，P<0.01），但血清中无此相关性。ROC曲线下面积显示，诱导痰液中的NO代谢产物（0.78）比血清中的NO代谢产物（0.53）是更准确的标志物（P<0.05）。这些发现表明，诱导痰液中的NO代谢产物比血清中的NO代谢产物更有价值作为监测哮喘气道炎症的指标。
