吸入甘露醇可改善囊性纤维化患者痰液的水合作用和表面特性。

Inhaled mannitol improves the hydration and surface properties of sputum in patients with cystic fibrosis.

机构信息

Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, 11 West, Missenden Rd, Camperdown, Sydney, NSW 2050, Australia.

出版信息

Chest. 2010 Apr;137(4):861-8. doi: 10.1378/chest.09-2017. Epub 2009 Oct 31.

DOI:10.1378/chest.09-2017

PMID:19880909

Abstract

BACKGROUND

The airway mucus in patients with cystic fibrosis (CF) is dehydrated and adhesive and accumulates in the airways, resulting in chronic inflammation, infection, and progressive loss of lung function. Inhaled mannitol improves mucus clearance and, when administered over 2 weeks, it improves lung function in CF (Jaques et al. Chest. 2008;133(6):1388-1396). The changes in the physical properties of sputum after a 2-week treatment with mannitol were investigated in the same subjects with CF.

METHODS

Sputum was collected before and at the end of the 2-week treatment period from 28 subjects with CF who participated in the double-blind crossover study. Mannitol or placebo 420 mg bid was inhaled over 2 weeks. The solids content, surface tension, contact angle, and viscoelasticity were measured.

RESULTS

Two-week treatment with mannitol reduced the solids from 7.3% +/- 3.0% to 5.7% +/- 3.0% (P = .012), surface tension from 83.1 +/- 7.2 to 78.6 +/- 8.0 mN/m (P < .039), and contact angle from 52.4 +/- 7.7 to 47.9 +/- 7.3 degrees. There was no significant change in the viscoelastic properties of sputum (P > .1). Placebo treatment had no significant effect on the sputum properties. The change in solids content correlated with the change in both FEV(1) (r = -0.78, P = .004) and forced expiratory flow in the middle half of the FVC (r = -0.80, P = .003), and the percentage change in surface tension and contact angle correlated with the percentage change in the FEV(1) (r = -0.73, P = .012 and r = -0.63, P = .03, respectively) in these subjects.

CONCLUSION

Treatment with inhaled mannitol over 2 weeks improved the hydration and surface properties of sputum in patients with CF. This effect was sustained and correlated with airway function changes.

TRIAL REGISTRATION

clinicaltrials.gov; Identifier: NCT00455130.

摘要

背景

囊性纤维化（CF）患者的气道黏液脱水且具有粘性，在气道中积聚，导致慢性炎症、感染和肺功能进行性丧失。吸入甘露醇可改善黏液清除功能，连续治疗 2 周可改善 CF 患者的肺功能（Jaques 等人，《胸部》，2008 年；133（6）：1388-1396）。本研究旨在观察 CF 患者经 2 周甘露醇治疗后痰液的物理特性变化。

方法

本研究为双盲交叉研究，纳入 28 例 CF 患者，分别在 2 周治疗前后收集痰液。患者每日 2 次、每次 420mg 吸入甘露醇或安慰剂治疗 2 周。测量痰液的固体含量、表面张力、接触角和粘弹性。

结果

与治疗前相比，2 周甘露醇治疗可使固体含量从 7.3%±3.0%降至 5.7%±3.0%（P=0.012），表面张力从 83.1±7.2 降至 78.6±8.0mN/m（P<0.039），接触角从 52.4±7.7 降至 47.9±7.3°。痰液粘弹性无显著变化（P>0.1）。安慰剂治疗对痰液性质无显著影响。固体含量的变化与 FEV1（r=-0.78，P=0.004）和用力肺活量中间一半的呼气流量（r=-0.80，P=0.003）的变化均呈负相关，表面张力和接触角的变化百分比与 FEV1 的变化百分比呈负相关（r=-0.73，P=0.012 和 r=-0.63，P=0.03）。