Macedo P, Hew M, Torrego A, Jouneau S, Oates T, Durham A, Chung K F
Experimental Studies, Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK.
Clin Exp Allergy. 2009 Nov;39(11):1668-76. doi: 10.1111/j.1365-2222.2009.03319.x. Epub 2009 Jul 20.
About 5-10% of patients with asthma suffer from poorly-controlled disease despite corticosteroid (CS) therapy.
We determined whether there were any differences in inflammatory biomarkers between severe and non-severe asthma patients.
Nineteen severe and 20 non-severe asthma patients were recruited and underwent collection of induced sputum, bronchoalveolar lavage (BAL) fluid and bronchial biopsies.
Biopsy results showed no differences in eosinophils (major basic protein positive), neutrophils, macrophages, T cells and mast cells in the bronchial submucosa. However, subbasement membrane (SBM) thickness and smooth muscle area were increased in the biopsies. No significant differences were observed in the induced sputum inflammatory cells. In BAL fluid, there was a significant increase in neutrophils but a significant decrease in macrophages. Eosinophil counts were non-significantly increased threefold in both sputum and BAL in severe asthma. Levels of IL-8 and IL-13 in sputum supernatants were similar in both groups of asthma patients. There was a significant inverse correlation between post-bronchodilator forced expiratory volume in 1 s and provocative concentration of methacholine causing a 20% fall in FEV(1) with SBM thickness.
Differences in inflammatory cells were observed mainly in terms of increased neutrophils and reduction in macrophage numbers in BAL fluid with a trend towards increased eosinophils in severe asthma compared with non-severe asthma. However, the most notable features are the increase in features of airway wall remodelling of SBM thickness and smooth muscle area.
尽管接受了皮质类固醇（CS）治疗，但仍有5%-10%的哮喘患者病情控制不佳。
我们确定重度和非重度哮喘患者在炎症生物标志物方面是否存在差异。
招募了19名重度哮喘患者和20名非重度哮喘患者，收集诱导痰、支气管肺泡灌洗（BAL）液和支气管活检样本。
活检结果显示，支气管黏膜下层的嗜酸性粒细胞（主要碱性蛋白阳性）、中性粒细胞、巨噬细胞、T细胞和肥大细胞无差异。然而，活检样本中基底膜下（SBM）厚度和平滑肌面积增加。诱导痰炎症细胞未见明显差异。在BAL液中中性粒细胞显著增加，而巨噬细胞显著减少。重度哮喘患者的痰液和BAL液中嗜酸性粒细胞计数均无显著增加三倍。两组哮喘患者痰液上清液中IL-8和IL-13水平相似。支气管扩张剂后1秒用力呼气量与引起FEV（1）下降20%的乙酰甲胆碱激发浓度与SBM厚度之间存在显著负相关。
与非重度哮喘相比，重度哮喘在炎症细胞方面的差异主要表现为BAL液中中性粒细胞增加和巨噬细胞数量减少，嗜酸性粒细胞有增加趋势。然而，最显著的特征是气道壁重塑特征SBM厚度和平滑肌面积增加。
