Guran T, Ersu R, Karadag B, Karakoc F, Demirel G Y, Hekim N, Dagli E
Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey.
J Clin Pharm Ther. 2008 Dec;33(6):603-11. doi: 10.1111/j.1365-2710.2008.00951.x.
To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non-cystic fibrosis (non-CF) bronchiectasis.
To evaluate the role of inhaled steroids in the treatment of children with non-CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis.
Twenty-seven children with steady-state non-CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) levels and neutrophil ratios in induced sputum before and after 12-week withdrawal of inhaled steroids.
There were 16 girls and 11 boys. Median (interquartile range) age was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years. Symptom scores (4 vs. 3; P = 0.27), oxygen saturation (95% vs. 97%; P = 0.06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0.73), sputum neutrophil ratios (29.9% vs. 46.8%; P = 0.20), TNF-alpha (58 pg/mL vs. 44.5 pg/mL; P = 0.55) and IL-8 (2.7 ng/mL vs. 2.4 ng/mL; P = 0.82) levels in induced sputum were similar before and after 12-week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0.016) and neutrophilic apoptosis in induced sputum decreased (42.8% vs. 20.2%; P = 0.03) after withdrawal.
In this study, 12 week-withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non-CF bronchiectasis was observed.
研究吸入性类固醇撤药对非囊性纤维化（非CF）支气管扩张症患儿支气管高反应性、痰液炎症标志物及中性粒细胞凋亡的影响。
评估吸入性类固醇在治疗非CF支气管扩张症患儿中的作用，重点关注支气管高反应性和中性粒细胞凋亡。
对27例处于稳定期的非CF支气管扩张症患儿进行初步评估，采用乙酰甲胆碱激发试验和诱导痰中凋亡中性粒细胞比例，其次在吸入性类固醇撤药12周前后，采用症状评分、肺功能测试以及诱导痰中肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）水平和中性粒细胞比例进行评估。
有16名女孩和11名男孩。中位（四分位间距）年龄为11.4（9.5 - 13.6）岁，随访时间为3.5（2 - 6.5）年。吸入性类固醇撤药12周前后，症状评分（4对3；P = 0.27）、血氧饱和度（95%对97%；P = 0.06）、肺功能测试（FEV1：预测值的82%对83%；P = 0.73）、痰液中性粒细胞比例（29.9%对46.8%；P = 0.20）、TNF-α（58 pg/mL对44.5 pg/mL；P = 0.55）和IL-8（2.7 ng/mL对2.4 ng/mL；P = 0.82）水平相似。然而，撤药后支气管高反应性患者数量增加（患者比例从37%增至63%；P = 0.016），诱导痰中的中性粒细胞凋亡减少（从42.8%降至20.2%；P = 0.03）。
在本研究中，吸入性类固醇治疗撤药12周导致非CF支气管扩张症患儿支气管高反应性显著增加，中性粒细胞凋亡减少，但未观察到痰液炎症标志物的变化。
