白三烯D鼻腔激发试验对合并过敏性鼻炎的哮喘患者支气管反应性和炎症的影响。
Effects of leukotriene D nasal challenge on bronchial responsiveness and inflammation in asthmatic patients with allergic rhinitis.
作者信息
Zhu Zheng, Xie Yanqing, Guan Weijie, Gao Yi, Huang Rongquan, Xia Shu, Jian Wenhua, Liang Zhiyu, Zheng Jinping
机构信息
State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
出版信息
J Thorac Dis. 2017 Feb;9(2):271-277. doi: 10.21037/jtd.2017.02.36.
BACKGROUND
In asthmatic patients with allergic rhinitis (AR), increased cysteinyl leukotrienes (CysLTs) production in the secretion of nasal mucosa has been associated with greater bronchial hyperresponsiveness (BHR) after nasal allergen challenge. However, the role of CysLTs in eliciting BHR after nasal allergen challenge has not been evaluated. The aim of this study is to evaluate the effect of LTD nasal challenge on BHR and inflammation in asthmatic patients with AR.
METHODS
In this self-controlled study, fifteen eligible consecutively recruited subjects underwent methacholine (Mch) bronchial provocation test before and 30 minutes after LTD nasal provocation test. The cumulative concentration of LTD inducing a 60% increase in nasal airway resistance (PCNAR) was calculated. The mean values of cumulative doses inducing a 20% decrease in forced expiratory flow in one second (PDFEV) for Mch before and after nasal challenge were compared. Fractional exhaled nitric oxide (FeNO), differential inflammatory cell counts in nasal lavage and induced sputum before and after nasal challenge were compared.
RESULTS
House dust mites were the major allergens accounting for 10/15 (66.7%) of asthmatic patients with AR. The PCNAR for LT was (8.39±3.48)×10 mg·mL. The PDFEV before and after nasal challenge was 3.05±3.81 and 2.70±3.81 µmol, respectively (P=0.45). The percentages of eosinophils were (38.36±23.14)% and (45.70±24.86)% in nasal lavage, and (17.51±11.05)% and (24.29±16.52)% in induced sputum before and 24 hours after nasal challenge. The neutrophil counts were (60.64±23.14)% and (53.30±24.46)% in nasal lavage, and (53.83±23.27)% and (56.19±22.28)% in induced sputum before and 24 hours after nasal challenge. The values of FeNO were 40 [35] and 43 [30] ppb before and 24 hours after nasal challenge. No severe adverse effects were reported during the tests.
CONCLUSIONS
Although most asthmatic patients with AR were sensitive to LTD nasal challenge, LTD nasal provocation tests do not confer any major effect on BHR. LTD might not play a vital role in eliciting bronchial responsiveness induced by nasal allergen challenge.
背景
在患有过敏性鼻炎（AR）的哮喘患者中，鼻黏膜分泌物中半胱氨酰白三烯（CysLTs）生成增加与鼻过敏原激发后更高的支气管高反应性（BHR）相关。然而，CysLTs在鼻过敏原激发后引发BHR中的作用尚未得到评估。本研究的目的是评估白三烯D4（LTD）鼻激发对患有AR的哮喘患者的BHR和炎症的影响。
方法
在这项自身对照研究中，15名连续入选的符合条件的受试者在LTD鼻激发试验前和试验后30分钟接受了乙酰甲胆碱（Mch）支气管激发试验。计算诱导鼻气道阻力增加60%的LTD累积浓度（PCNAR）。比较鼻激发前后诱导一秒用力呼气流量降低20%的Mch累积剂量的平均值。比较鼻激发前后呼出一氧化氮分数（FeNO）、鼻灌洗和诱导痰中的炎性细胞分类计数。
结果
屋尘螨是主要过敏原，占患有AR的哮喘患者的10/15（66.7%）。LT的PCNAR为（8.39±3.48）×10 mg·mL。鼻激发前后的PDFEV分别为3.05±3.81和2.70±3.81 μmol（P = 0.45）。鼻灌洗中嗜酸性粒细胞百分比在鼻激发前和激发后24小时分别为（38.36±23.14）%和（45.70±24.86）%，诱导痰中分别为（17.51±11.05）%和（24.29±16.52）%。鼻灌洗中中性粒细胞计数在鼻激发前和激发后24小时分别为（60.64±23.14）%和（53.30±24.46）%，诱导痰中分别为（53.83±23.27）%和（56.19±22.28）%。鼻激发前和激发后24小时的FeNO值分别为40 [35]和43 [30] ppb。试验期间未报告严重不良反应。
结论
虽然大多数患有AR 的哮喘患者对LTD鼻激发敏感，但LTD鼻激发试验对BHR没有任何重大影响。LTD可能在引发鼻过敏原激发诱导的支气管反应性中不发挥重要作用。
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