Wark P A B, Johnston S L, Moric I, Simpson J L, Hensley M J, Gibson P G
Airways Research Centre, John Hunter Hospital, Newcastle, Australia.
Eur Respir J. 2002 Jan;19(1):68-75. doi: 10.1183/09031936.02.00226302.
Acute exacerbations of asthma are frequently caused by viral infections, but the inflammatory mechanisms in virus-induced asthma are poorly understood. The aim of the present study was to determine whether viral infection in acute asthma was associated with increased sputum neutrophil degranulation and increased cellular lysis and whether these changes are related to clinical severity. Adults (n=49) presenting to the emergency department with acute asthma were examined for infection by means of sputum direct-fluorescence antigen detection, sputum culture, and sputum polymerase chain reaction for Mycoplasma, Chlamydia and Legionella pneumophila, and all common respiratory viruses. Subjects infected with one of these agents were classed as having an infective exacerbation. Spirometry and sputum induction were performed on presentation and 4-5 weeks later. Thirty-seven subjects (76%) had virus infection and acute asthma. Those with virus infection had increased sputum neutrophils (p<0.05) and increased neutrophil elastase (p<0.05), this was related to increased elevated sputum lactate dehydrogenase (LDH). Subjects with noninfective asthma had an increase in the proportion of sputum eosinophils. Both groups had elevated sputum eosinophil cationic protein (ECP) concentrations. Higher levels of sputum LDH and ECP were associated with a longer hospital stay. Virus infection and acute asthma is associated with neutrophilic inflammation, cell lysis and more severe clinical disease.
哮喘急性加重常由病毒感染引起，但病毒诱发哮喘的炎症机制尚不清楚。本研究的目的是确定急性哮喘中的病毒感染是否与痰液中性粒细胞脱颗粒增加和细胞溶解增加有关，以及这些变化是否与临床严重程度相关。对49名因急性哮喘到急诊科就诊的成年人进行了检查，通过痰液直接荧光抗原检测、痰液培养以及针对支原体、衣原体和嗜肺军团菌以及所有常见呼吸道病毒的痰液聚合酶链反应来检测感染情况。感染这些病原体之一的受试者被归类为感染性加重。在就诊时和4 - 5周后进行肺活量测定和痰液诱导。37名受试者（76%）患有病毒感染和急性哮喘。病毒感染患者的痰液中性粒细胞增加（p<0.05），中性粒细胞弹性蛋白酶增加（p<），这与痰液乳酸脱氢酶（LDH）升高有关。非感染性哮喘患者的痰液嗜酸性粒细胞比例增加。两组患者的痰液嗜酸性粒细胞阳离子蛋白（ECP）浓度均升高。痰液LDH和ECP水平较高与住院时间延长有关。病毒感染和急性哮喘与中性粒细胞炎症、细胞溶解以及更严重的临床疾病相关。
