Martin R J, Cicutto L C, Smith H R, Ballard R D, Szefler S J
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.
Am Rev Respir Dis. 1991 Feb;143(2):351-7. doi: 10.1164/ajrccm/143.2.351.
Nocturnal asthma is a frequent problem, but the mechanism is unclear. We investigated the possibility that airways inflammation occurred during the night. Bronchoalveolar lavage fluid was analyzed in asthmatic patients with (n = 7) and without nocturnal asthma (n = 7) at 1600 and 0400 h. The nocturnal asthma group had an increase in the total leukocyte count (24.0 +/- 7.0 to 41.1 +/- 9.9 x 10(4) cells/ml, p less than 0.05), neutrophils (1.1 +/- 0.6 to 3.7 +/- 1.5 x 10(4) cells/ml, p less than 0.05), and eosinophils (0.5 +/- 0.1 to 1.7 +/- 0.7 x 10(4) cells/ml, p less than 0.05) from 1600 to 0400 h. Cellular components for the non-nocturnal asthma group did not change. Between groups, the 1600-h cells were similar. At 0400 h the nocturnal asthma group had significantly higher total leukocyte, neutrophil, eosinophil, lymphocyte, and epithelial cell counts. For all subjects, the overnight fall in peak expiratory flow rates was correlated to the change in neutrophils (r = 0.54, p less than 0.05) and eosinophils (r = 0.77, p less than 0.05). We conclude that the nocturnal worsening of asthma has an associated cellular inflammatory response that is not seen in patients without overnight decrements in lung function. This inflammatory response together with epithelial damage may be important factors in the etiology of nocturnal asthma.
夜间哮喘是一个常见问题，但其机制尚不清楚。我们研究了夜间气道炎症发生的可能性。对有（n = 7）和无夜间哮喘（n = 7）的哮喘患者在16:00和04:00进行支气管肺泡灌洗。夜间哮喘组总白细胞计数（从24.0±7.0增至41.1±9.9×10⁴个细胞/毫升，p<0.05）、中性粒细胞（从1.1±0.6增至3.7±1.5×10⁴个细胞/毫升，p<0.05）和嗜酸性粒细胞（从0.5±0.1增至1.7±0.7×10⁴个细胞/毫升，p<0.05）在16:00至04:00期间有所增加。非夜间哮喘组的细胞成分无变化。两组间，16:00时的细胞相似。在04:00时，夜间哮喘组的总白细胞、中性粒细胞、嗜酸性粒细胞、淋巴细胞和上皮细胞计数显著更高。对于所有受试者，夜间呼气峰值流速的下降与中性粒细胞变化（r = 0.54，p<0.05）和嗜酸性粒细胞变化（r = 0.77，p<0.05）相关。我们得出结论，哮喘的夜间恶化伴有细胞炎症反应，而肺功能无夜间下降的患者则未出现这种反应。这种炎症反应连同上皮损伤可能是夜间哮喘病因中的重要因素。
