支气管高反应性与甲苯二异氰酸酯。致敏哮喘患者的长期变化。

Bronchial hyperresponsiveness and toluene diisocyanate. Long-term change in sensitized asthmatic subjects.

作者信息

Paggiaro P L, Vagaggini B, Dente F L, Bacci E, Bancalari L, Carrara M, Di Franco A, Giannini D, Giuntini C

机构信息

Second Institute of Clinical Medicine, University of Pisa, Italy.

出版信息

Chest. 1993 Apr;103(4):1123-8. doi: 10.1378/chest.103.4.1123.

DOI:10.1378/chest.103.4.1123

PMID:8131451

Abstract

Long-term change in nonspecific and specific bronchial hyperresponsiveness was studied in 16 subjects with asthma induced by toluene diisocyanate (TDI). A significant positive correlation between months of follow-up and provocative dose inducing a 20 percent fall in FEV1 (PD20FEV1) methacholine was observed in 5 of 16 subjects. In 4 of these 5 subjects, a PD20FEV1 > 1 mg of methacholine was observed 30 to 48 months after the end of TDI exposure. In most subjects, nonspecific bronchial hyperresponsiveness did not change. Nine of 16 subjects became nonresponsive to TDI at follow-up examination, but only 3 of these showed a significant increase in PD20FEV1 methacholine. Seven subjects were still responsive to TDI. Recovery from TDI-induced asthma can occur and only after long-term work cessation. Nonspecific bronchial hyperresponsiveness to methacholine can persist even in the absence of bronchial hyperresponsiveness to TDI, suggesting permanent chronic damage to mechanisms controlling airway tone.

摘要

对16名由甲苯二异氰酸酯（TDI）诱发哮喘的受试者的非特异性和特异性支气管高反应性的长期变化进行了研究。16名受试者中有5名观察到随访月数与使第一秒用力呼气容积（FEV1）下降20%的乙酰甲胆碱激发剂量（PD20FEV1）之间存在显著正相关。在这5名受试者中的4名中，在TDI暴露结束后30至48个月观察到PD20FEV1>1毫克乙酰甲胆碱。在大多数受试者中，非特异性支气管高反应性没有变化。16名受试者中有9名在随访检查时对TDI无反应，但其中只有3名显示PD20FEV1乙酰甲胆碱有显著增加。7名受试者仍对TDI有反应。TDI诱发的哮喘可以恢复，且只有在长期停止工作后才会恢复。即使对TDI无支气管高反应性，对乙酰甲胆碱的非特异性支气管高反应性仍可能持续，提示控制气道张力的机制存在永久性慢性损伤。