Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Allergy Asthma Proc. 2011 Jul-Aug;32(4):18-21. doi: 10.2500/aap.2011.32.3454.
Although evaluation of induced sputum has shown promise as a marker of eosinophilic airway inflammation in asthmatic subjects, most studies, to date, do not adequately address the potential effect that inhaled corticosteroids may have on sputum eosinophilia. This study was designed to prospectively evaluate analysis of fluticasone propionate (FP) in whole sputum by mass spectrometry as a tool to determine recent administration of inhaled FP. Induced sputum of nonsmoking asthmatic subjects was prospectively analyzed 16-24 hours after witnessed administration of orally inhaled FP. FP was extracted from whole sputum via an acetonitrile protein precipitation followed by methylene chloride liquid extraction of the supernatant (AB 4000; AB Sciex). A portion of the reconstituted sample was analyzed by liquid chromatography tandem mass spectrometry using a triple quad tandem mass spectrometer. Results were compared with those from nonsmoking asthmatic subjects not receiving inhaled FP. Twenty-two asthmatic subjects on FP and 9 asthmatic subjects without FP underwent sputum induction 16-24 hours following witnessed administration of FP. Sufficient sputum for analysis was obtained from 30 of 31 subjects. FP was detected in 22 of 22 asthmatic subjects receiving FP (range, 29-133,000 pg/mL) and was undetectable in 8 of 8 subjects not receiving FP. The sensitivity and specificity of tandem mass spectrometry's ability to detect FP in sputum was 100% and 100%, respectively. Analysis of FP in induced sputum is a reliable method to verify recent administration of inhaled FP. Induced asthmatic sputum from one induction may be used to concomitantly assess sputum eosinophilia as well as recent administration of FP.
尽管诱导痰检查已显示出作为哮喘患者气道嗜酸性粒细胞炎症标志物的潜力，但迄今为止，大多数研究并未充分解决吸入皮质激素可能对痰嗜酸性粒细胞产生的潜在影响。本研究旨在前瞻性评估丙酸氟替卡松（FP）在整个痰中的质谱分析作为确定近期吸入 FP 给药的工具。前瞻性分析了经过口吸 FP 治疗后 16-24 小时非吸烟哮喘患者的诱导痰。FP 通过乙腈蛋白沉淀从整个痰中提取，然后用二氯甲烷提取上清液（AB 4000；AB Sciex）。部分重新配制的样品通过使用三重四极串联质谱仪的液相色谱串联质谱分析。将结果与未接受吸入 FP 的非吸烟哮喘患者进行比较。22 名接受 FP 的哮喘患者和 9 名未接受 FP 的哮喘患者在 FP 治疗后 16-24 小时进行了痰诱导。从 31 名受试者中的 30 名获得了足够的痰进行分析。在接受 FP 的 22 名哮喘患者中的 22 名（范围 29-133000pg/ml）中检测到 FP，在未接受 FP 的 8 名患者中未检测到 FP。串联质谱法检测痰中 FP 的灵敏度和特异性分别为 100%和 100%。诱导痰中 FP 的分析是验证近期吸入 FP 给药的可靠方法。一次诱导的哮喘患者痰可同时评估痰嗜酸性粒细胞和近期 FP 给药。
