Kelly C, Ward C, Stenton C S, Bird G, Hendrick D J, Walters E H
Department of Medicine, Newcastle General Hospital, Newcastle Upon Tyne.
Thorax. 1988 Sep;43(9):684-92. doi: 10.1136/thx.43.9.684.
Bronchial responsiveness to inhaled methacholine was measured four to six days before fibreoptic bronchoscopy in 22 asthmatic patients (10 smokers) and 20 control subjects (12 smokers). The asthmatic patients had a baseline FEV1 greater than 60% predicted and a PD20FEV1 (provocative dose of methacholine causing a 20% fall in FEV1) of 0.006-3.7 mg. The 20 control subjects had normal pulmonary function and a PD20FEV1 above the maximum cumulative dose of methacholine of 6.4 mg. Bronchoalveolar lavage of a middle lobe segment (lingula in four subjects) was performed with three sequential 60 ml aliquots of sterile saline. Cellular metabolic activity was stimulated with latex in aliquots of resuspended cells, and measured by means of luminol enhanced chemiluminescence to assess neutrophil activity and lucigenin enhanced chemiluminescence to assess macrophage activity. Mean absolute total cell counts were similar in the asthmatic and control groups but there were differences in differential cell counts, with a significant increase in eosinophil (p less than 0.05) and lymphocyte (p less than 0.005) counts in asthma. PD20FEV1 was negatively correlated with percentage neutrophil counts (p less than 0.005). Luminol enhanced chemiluminescence/1000 neutrophils was increased about twofold in asthmatic subjects (p less than 0.001), but was not correlated with PD20FEV1 Lucigenin enhanced chemiluminescence/1000 macrophages was increased nearly fourfold in asthmatic patients (p less than 0.001) and showed a negative correlation with PD20FEV1 (p less than 0.01). The macrophage count was increased twofold in current smokers in both groups, but other cell numbers were not altered significantly. Smoking did not affect cellular metabolic activity in either group. This study supports the idea that an inflammatory process is present in the airways of those with asthma, and suggests a relation between bronchial responsiveness and both neutrophil numbers and macrophage activity.
在22例哮喘患者（10例吸烟者）和20例对照者（12例吸烟者）中，于纤维支气管镜检查前4至6天测量支气管对吸入乙酰甲胆碱的反应性。哮喘患者的基线第一秒用力呼气容积（FEV1）大于预测值的60%，乙酰甲胆碱激发剂量（引起FEV1下降20%的剂量，即PD20FEV1）为0.006 - 3.7毫克。20例对照者肺功能正常，其PD20FEV1高于6.4毫克的最大累积乙酰甲胆碱剂量。对中叶节段（4例为舌叶）进行支气管肺泡灌洗，每次用60毫升无菌生理盐水分三次进行。在重悬细胞的等分试样中用乳胶刺激细胞代谢活性，通过鲁米诺增强化学发光法测量以评估中性粒细胞活性，通过光泽精增强化学发光法测量以评估巨噬细胞活性。哮喘组和对照组的平均绝对总细胞计数相似，但细胞分类计数存在差异，哮喘患者的嗜酸性粒细胞（p<0.05）和淋巴细胞（p<0.005）计数显著增加。PD20FEV1与中性粒细胞计数百分比呈负相关（p<0.005）。哮喘患者中鲁米诺增强化学发光/1000个中性粒细胞增加约两倍（p<0.001），但与PD20FEV1无相关性。光泽精增强化学发光/1000个巨噬细胞在哮喘患者中增加近四倍（p<0.001），并与PD20FEV1呈负相关（p<0.01）。两组中当前吸烟者的巨噬细胞计数增加两倍，但其他细胞数量无明显改变。吸烟对两组的细胞代谢活性均无影响。本研究支持哮喘患者气道存在炎症过程的观点，并提示支气管反应性与中性粒细胞数量和巨噬细胞活性之间存在关联。
