Shindo K, Fukumura M, Miyakawa K
First Department of Internal Medicine, Yokohama City University School of Medicine, Japan.
Eur Respir J. 1995 Apr;8(4):605-10.
Prednisolone is very effective in controlling wheezing attacks of bronchial asthma, but its mechanism and the pathogenic role of leukotriene B4 remain unclear. We measured changes in plasma levels of leukotriene B4 in an open study during the clinical course of bronchial asthma, with or without water-soluble prednisolone treatment. Two millilitres of blood was drawn from the radial artery of patients on three occasions: 1) during remission; 2) on admission to hospital with an asthma attack; and 3) 2 days after admission and treatment with intravenous prednisolone (1,000 mg.day-1). Leukotriene B4 was detected by chromatographic fractionation and radioimmunoassay. In 11 asthmatic patients, leukotriene B4 levels on the three occasions were 26.8 (10.7), 106.0 (39.9) and 51.6 (20.2) pg.ml-1 (mean (SD)), respectively. In contrast, the mean leukotriene B4 level of 10 normal controls was 35.9 (10.5) pg.ml-1. Leukotriene B4 levels differed significantly between remission and attack treated without prednisolone, and between attacks treated with and without prednisolone. Mean arterial carbon dioxide (PaCO2) values were 4.8 (0.4) kPa (36.0 (3.0) mmHg), 6.1 (0.4) kPa (45.6 (2.9) mmHg), and 5.5 (0.3) kPa (41.6 (2.0) mmHg), respectively. There were significant differences between these mean PaCO2 values. The mean leukotriene B4 levels on the three occasions were correlated with the mean PaCO2 values. Thus, leukotriene B4 levels in arterial blood reflect the severity of asthmatic attacks and may be affected by intravenous prednisolone.
泼尼松龙在控制支气管哮喘的喘息发作方面非常有效，但其机制以及白三烯B4的致病作用仍不清楚。在一项开放性研究中，我们在支气管哮喘的临床过程中，测量了接受或未接受水溶性泼尼松龙治疗的患者血浆白三烯B4水平的变化。在三个时间点从患者的桡动脉抽取2毫升血液：1）缓解期；2）因哮喘发作入院时；3）入院并接受静脉注射泼尼松龙（1000毫克/天）治疗2天后。通过色谱分离和放射免疫测定法检测白三烯B4。11例哮喘患者在这三个时间点的白三烯B4水平分别为26.8（10.7）、106.0（39.9）和51.6（20.2）皮克/毫升（平均值（标准差））。相比之下，10名正常对照者的白三烯B4平均水平为35.9（10.5）皮克/毫升。未用泼尼松龙治疗的缓解期与发作期之间以及用与不用泼尼松龙治疗的发作期之间，白三烯B4水平存在显著差异。平均动脉二氧化碳（PaCO2）值分别为4.8（0.4）千帕（36.0（3.0）毫米汞柱）、6.1（0.4）千帕（45.6（2.9）毫米汞柱）和5.5（0.3）千帕（41.6（2.0）毫米汞柱）。这些平均PaCO2值之间存在显著差异。这三个时间点的白三烯B4平均水平与平均PaCO2值相关。因此，动脉血中的白三烯B4水平反映了哮喘发作的严重程度，并可能受静脉注射泼尼松龙的影响。
