鼻炎患者支气管高反应性的决定因素。
Determinants of bronchial hyperresponsiveness in subjects with rhinitis.
作者信息
Di Lorenzo G, Pacor M L, Mansueto P, Esposito Pellitteri M, Lo Bianco C, Ditta V, Leto-Barone M S, Napoli N, Di Fede G, Rini G B
机构信息
Dipartimento di Medicina Clinica e delle Patologie Emergenti, Universitá degli Studi di Palermo, Italy.
出版信息
Int J Immunopathol Pharmacol. 2005 Oct-Dec;18(4):715-22. doi: 10.1177/039463200501800414.
Subjects with rhinitis but without asthma may have coexisting bronchial hyperresponsiveness, although the reasons for this are uncertain. To evaluate the factors that determine BHR in rhinitis we examined 410 patients with symptomatic rhinitis with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)>or=80% of the predicted value. In all subjects a skin prick test (SPT) was performed, a determination of total serum IgE and an eosinophils count in the blood. Of the 410 subjects we found that 161 (39.3%) exhibited a methacholine PD20 of 800 mg or less (Group A), whereas 249 (60.7%) had a methacholine PD20 more of 800 mg (Group B). Despite the matched mean values for FEV1 and FVC, compared with Group B, Group A had a lower predicted forced expiratory flow between 25% and 75%(FEF25%-75%) (86.7 +/- 12.0 vs. 93.7 +/- 7.3, P < 0.0001). A great portion of the subjects of the Group Ain respect to subjects of the Group B were exposed to passive smoke (37.8% vs. 22.0%, P = 0.0008), reported having mothers with asthma (34.1% vs. 6.0%, P < 0.0001), presented a positive skin prick test (93.7% vs. 67.0%, P < 0.0001), had higher levels of total serum IgE (geometric mean of Log10 2.46 +/- 0.27 kU/L vs. 2.06 +/- 0.38 kU/L, P < 0.0001) and higher blood eosinophil counts (geometric mean of Log10 2.67 +/- 0.07 x 10(-3) mL vs. 2.57 +/- 0.09 x 10(-3) mL, P < 0.0001), and reported increased nasal obstruction (2.0 (95% CI 1.8 to 2.2) vs. 0.6 (95% CI 0.5 to 0.7), P < 0.0001). Logistic regression demonstrates that nasal obstruction (OR 2.19, 95% CI 1.72 to 2.80) and the presence of positive SPT (OR 6.15, 95% CI 2.42 to 15.61) were the most available predictors to discriminate between subjects with BHR and subjects without BHR. In addition, BHR was positively related to blood eosinophil counts (OR= 2.80, 95% CI 1.54 to 5.07), FEF25%-75% values (OR= 2.72, 95% CI 1.23 to 5.99) and familiarity (mother) for asthma (OR = 2.45, 95% CI 1.10 to 5.46). Whereas passive smoke and total serum IgE were not positively related to BHR. Increased nasal obstruction and the presence of positive SPT were the most available predictors to discriminate between subjects with and without BHR. Finally, BHR was positively related to blood eosinophil counts, FEF25%-75% values and to familiarity (mother) for asthma.
患有鼻炎但无哮喘的患者可能并存支气管高反应性，但其原因尚不确定。为了评估决定鼻炎患者支气管高反应性的因素，我们对410例有症状的鼻炎患者进行了检查，这些患者的一秒用力呼气容积（FEV1）和用力肺活量（FVC）≥预测值的80%。对所有受试者进行了皮肤点刺试验（SPT）、血清总IgE测定和血液嗜酸性粒细胞计数。在410名受试者中，我们发现161名（39.3%）乙酰甲胆碱PD20为800mg或更低（A组），而249名（60.7%）乙酰甲胆碱PD20超过800mg（B组）。尽管FEV1和FVC的均值匹配，但与B组相比，A组25%至75%用力呼气流量（FEF25%-75%）的预测值更低（86.7±12.0 vs. 93.7±7.3，P<0.0001）。与B组受试者相比，A组很大一部分受试者暴露于被动吸烟（37.8% vs. 22.0%，P = 0.0008），报告其母亲患有哮喘（34.1% vs. 6.0%，P<0.0001），皮肤点刺试验呈阳性（93.7% vs. 67.0%，P<0.0001），血清总IgE水平更高（Log10的几何均值2.46±0.27 kU/L vs. 2.06±0.38 kU/L，P<0.0001），血液嗜酸性粒细胞计数更高（Log10的几何均值2.67±0.07×10⁻³/mL vs. 2.57±0.09×10⁻³/mL，P<0.0001），且报告鼻塞加重（2.0（95%CI 1.8至2.2）vs. 0.6（95%CI 0.5至0.7），P<0.0001）。逻辑回归显示，鼻塞（OR 2.19，95%CI 1.72至2.80）和皮肤点刺试验阳性（OR 6.15，95%CI 2.42至15.61）是区分有支气管高反应性和无支气管高反应性受试者的最有效预测指标。此外，支气管高反应性与血液嗜酸性粒细胞计数（OR = 2.80，95%CI 1.54至5.07）、FEF25%-75%值（OR = 2.72，95%CI 1.23至5.99）以及哮喘家族史（母亲）（OR = 2.45，95%CI 1.10至5.46）呈正相关。而被动吸烟和血清总IgE与支气管高反应性无正相关。鼻塞加重和皮肤点刺试验阳性是区分有和无支气管高反应性受试者的最有效预测指标。最后，支气管高反应性与血液嗜酸性粒细胞计数、FEF25%-75%值以及哮喘家族史（母亲）呈正相关。
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