Gizycki M J, Hattotuwa K L, Barnes N, Jeffery P K
Lung Pathology Unit, Imperial College School of Medicine at the Royal Brompton Hospital, London, UK London Chest Hospital, London, UK.
Thorax. 2002 Sep;57(9):799-803. doi: 10.1136/thorax.57.9.799.
Inhaled corticosteroids (ICS) markedly reduce bronchial mucosal inflammation in asthma but whether they have an anti-inflammatory effect in airway tissue in chronic obstructive pulmonary disease (COPD) is unknown.
A study of endobronchial biopsy samples was conducted as part of a double blind, placebo controlled, randomised trial of parallel design. Patients had mild to moderately severe COPD (FEV(1) 25-80% of predicted) and were given 3 months treatment with ICS, fluticasone propionate (FP; 500 micro g twice daily, n=14) or placebo (n=10). Biopsy tissue taken at baseline and after treatment was examined by transmission electron microscopy to count the numbers of all ultrastructurally distinct inflammatory cells.
Compared with their baseline values, FP resulted in a significant decrease (on average 65%) in the numbers of mucosal mast cells (median 7.8 (range 1-33) v 2.8 (1-14), p<0.05). The reductive effect of FP held true when the post-treatment values of the placebo and FP groups were compared: 8.8 (1-24) v 2.8 (1-14) (p<0.05). Unexpectedly, there were significantly more neutrophils in the FP than in the placebo group: 4.0 (0-23) v 1.7 (0-8), respectively (p<0.05). There were no alterations to other cell types including mononuclear cells. Symptoms markedly improved in the patients treated with FP for 3 months.
Fluticasone propionate given for 3 months to patients with COPD has selective effects on the inflammatory cells in the bronchial mucosa: the reduction in mast cell numbers may account for the improvement in symptoms over this time.
吸入性糖皮质激素（ICS）可显著减轻哮喘患者的支气管黏膜炎症，但它们对慢性阻塞性肺疾病（COPD）气道组织是否具有抗炎作用尚不清楚。
作为一项平行设计的双盲、安慰剂对照、随机试验的一部分，进行了一项支气管活检样本研究。患者患有轻度至中度重度COPD（FEV₁为预测值的25%-80%），并接受了3个月的ICS治疗，丙酸氟替卡松（FP；每日两次，每次500μg，n = 14）或安慰剂（n = 10）治疗。通过透射电子显微镜检查基线和治疗后的活检组织，以计数所有超微结构不同的炎症细胞数量。
与基线值相比，FP导致黏膜肥大细胞数量显著减少（平均减少65%）（中位数7.8（范围1-33）对2.8（1-14），p<0.05）。当比较安慰剂组和FP组的治疗后值时，FP的还原作用仍然成立：8.8（1-24）对2.8（1-14）（p<0.05）。出乎意料的是，FP组中的中性粒细胞明显多于安慰剂组：分别为4.0（0-23）对1.7（0-8）（p<0.05）。包括单核细胞在内的其他细胞类型没有变化。接受FP治疗3个月的患者症状明显改善。
给予COPD患者3个月的丙酸氟替卡松对支气管黏膜中的炎症细胞具有选择性作用：肥大细胞数量的减少可能解释了这段时间内症状的改善。
