Ni L, Xu Y, Yao S
Department of Respiratory Medicine, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China.
Zhonghua Nei Ke Za Zhi. 2001 Nov;40(11):744-6.
To study the mechanism of asthma remission. The plasma soluble vascular cell adhesion molecule-1 (sVCAM-1), airway responsiveness (PC20) and other relative factors were measured in asthmatics with remission at least 3 years and compared with healthy controls.
Group I (asthmatics with remission at puberty): 20 cases including 11 males and 9 females, mean age of 21 years. All of the patients were definitely diagnosed as asthmatics in childhood and got natural remission for at least 3 years(with median duration of 6 years). Group II (normal controls): 21 healthy college students including 10 males and 11 females, mean age of 22.5 years, had no history of asthma or other allergic diseases. The intravenous blood was taken from all subjects with EDTA as anticoagulant for study. The airway responsiveness were measured by methacholine bronchial provocation test(PC20). The sVCAM-1 was measured with ELISA, according to the manual of the kit. Methacholine was atomized by Wright atomizer [Devilbiss AP-50, USA, driven by air compressor, with a constant atomizing volume of (0.13 +/- 0.02) ml/min, diameter of atomizes particles 1.3-3.0 microns]. Its concentration was redoubled from 0.03 to 128 g/L until a certain dose as PC20 value triggering forced expiratory volume in one second (FEV1) decreased by 20% reached. The eosinophil cationic protein (ECP) levels were measured with enzyme-linked immuno-CAP system. Blood eosinophils(> 330/mm3 as being above normal) and basophils (> 33/mm3 as abnormally increased) were counted using Acian blue dyeing.
(1) The mean value of sVCAM-1 of group I (63.7 +/- 31.7) micrograms/L was significantly higher than that of group II (41.9 +/- 11.7) micrograms/L. (2) The percentage of the cases with increased eosinophils in group I was 15.0% (3/20), had no significant difference compared with that in group II (4.8%, 1/21). The percentage of the cases with increased basophils of group I was 45.0%(9/20), significantly higher than that of group II, 4.8%(1/21), P < 0.01. (3) The blood ECP level of group I was (2.7 +/- 1.3) micrograms/L, simillar to that of group II (2.18 +/- 0.5) micrograms/L. (4) The PC20 value of group I (M = 2.6 g/L) was significantly lower than that of group II (M = 128 g/L). (5) The basophil count negatively correlated with the PC20(r = -0.66), however, the sVCAM-1 did not have significant correlation with the basophil count or with the PC20.
The quantity and activity of eosinophils in asthmatics with remission at least 3 years are droped to the normal level, but the expression of VCAM-1, quantity of basophils were still higher than normal. The airway responsiveness had negative correlation with the basophil count.
研究哮喘缓解的机制。对至少已缓解3年的哮喘患者的血浆可溶性血管细胞黏附分子-1（sVCAM-1）、气道反应性（PC20）及其他相关因素进行检测，并与健康对照者进行比较。
第一组（青春期缓解的哮喘患者）：20例，其中男性11例，女性9例，平均年龄21岁。所有患者均在儿童期确诊为哮喘，且自然缓解至少3年（中位缓解时间为6年）。第二组（正常对照）：21名健康大学生，其中男性10例，女性11例，平均年龄22.5岁，无哮喘或其他过敏性疾病史。采集所有受试者的静脉血，以乙二胺四乙酸（EDTA）作为抗凝剂用于研究。采用乙酰甲胆碱支气管激发试验（PC20）测定气道反应性。根据试剂盒说明书，采用酶联免疫吸附测定法（ELISA）测定sVCAM-1。乙酰甲胆碱由Wright雾化器（美国德维比斯AP-50，由空气压缩机驱动，恒定雾化量为（0.13±0.02）ml/min，雾化颗粒直径为1.3 - 3.0微米）雾化。其浓度从0.03 g/L翻倍至128 g/L，直至达到触发一秒用力呼气容积（FEV1）下降20%的某一剂量作为PC20值。采用酶联免疫CAP系统测定嗜酸性粒细胞阳离子蛋白（ECP）水平。使用酸性亚甲蓝染色法计数血液中的嗜酸性粒细胞（>330/mm³为高于正常）和嗜碱性粒细胞（>33/mm³为异常升高）。
（1）第一组sVCAM-1的平均值为（63.7±31.7）μg/L，显著高于第二组（41.9±11.7）μg/L。（2）第一组嗜酸性粒细胞增多的病例百分比为15.0%（3/20），与第二组（4.8%，1/21）相比无显著差异。第一组嗜碱性粒细胞增多的病例百分比为45.0%（9/20），显著高于第二组的4.8%（1/21），P<0.01。（3）第一组血液ECP水平为（2.7±1.3）μg/L，与第二组（2.18±0.5）μg/L相似。（4）第一组的PC20值（M = 2.6 g/L）显著低于第二组（M = 128 g/L）。（5）嗜碱性粒细胞计数与PC20呈负相关（r = -0.66），然而，sVCAM-1与嗜碱性粒细胞计数或PC20均无显著相关性。
至少已缓解3年的哮喘患者中嗜酸性粒细胞的数量和活性降至正常水平，但血管细胞黏附分子-1（VCAM-1）的表达、嗜碱性粒细胞数量仍高于正常。气道反应性与嗜碱性粒细胞计数呈负相关。
