De Zotti R, Gubian F, Negro C
Istituto di Medicina del Lavoro, Università degli Studi di Trieste.
Med Lav. 1996 Mar-Apr;87(2):152-61.
We studied non-specific bronchial responsiveness (NSBR) and blood eosinophils before and 24 hours after a bronchoprovocation test (SBPT) with wheat flour (22 cases) and TDI (32 cases). Twelve patients developed asthma after exposure to wheat flour (7 early and 5 dual/late asthma), and 12 after exposure to TDI (6 early and 6 late/dual asthma). Responders and non responders to wheat flour exposure were similar for all general characteristics except IgE levels (p = 0.036) and NSBR (p = 0.047). A higher degree of airway responsiveness to methacholine was the only characteristic which differentiated responders from non responders to TDI exposure (p = 0.043). Airway responsiveness, assessed 24 hours after the SBPT (44 cases), did not show any change compared to pretest values; the data were similar both among non responders to wheat flour (Wilcoxon p = 0.1) or to TDI (p = 0.2) and responders to TDI (p = 0.6) or wheat flour (p = 0.3); also no significant changes were observed among early and dual/late asthma caused by wheat flour and TDI. Twenty-four hours after the SBPT, blood eosinophils were higher than pretest, but only among the 24 patients with asthma (Wilcoxon p = 0.002); the blood eosinophil increase was statistically significant among patients with early and late/dual asthma caused by wheat flour, and among those with early and late/dual TDI asthma. In our study, NSBR was confirmed as a common feature of occupational asthma, either IgE mediated (wheat flour) or non-IgE mediated (TDI). Twenty four hours after the specific exposure, among patients with asthma induced by wheat flour and TDI, there was an increase in blood eosinophils while in the same time interval no variation in non-specific bronchial responsiveness was observed.
我们在22例小麦粉和32例甲苯二异氰酸酯支气管激发试验(SBPT)前及24小时后研究了非特异性支气管反应性(NSBR)和血液嗜酸性粒细胞。12例患者在接触小麦粉后发生哮喘(7例早发型和5例迟发型/双相型哮喘),12例在接触甲苯二异氰酸酯后发生哮喘(6例早发型和6例迟发型/双相型哮喘)。除IgE水平(p = 0.036)和NSBR(p = 0.047)外,小麦粉暴露的反应者和非反应者在所有一般特征方面相似。对乙酰甲胆碱气道反应性较高是区分甲苯二异氰酸酯暴露反应者和非反应者的唯一特征(p = 0.043)。SBPT后24小时评估的气道反应性(44例)与测试前值相比未显示任何变化;小麦粉或甲苯二异氰酸酯非反应者(Wilcoxon p = 0.1)、甲苯二异氰酸酯或小麦粉反应者(p = 0.6或p = 0.3)的数据相似;小麦粉和甲苯二异氰酸酯引起的早发型和迟发型/双相型哮喘之间也未观察到显著变化。SBPT后24小时,血液嗜酸性粒细胞高于测试前,但仅在24例哮喘患者中如此(Wilcoxon p = 0.002);小麦粉引起的早发型和迟发型/双相型哮喘患者以及甲苯二异氰酸酯早发型和迟发型/双相型哮喘患者中血液嗜酸性粒细胞增加具有统计学意义。在我们的研究中,NSBR被确认为职业性哮喘的一个共同特征,无论是IgE介导的(小麦粉)还是非IgE介导的(甲苯二异氰酸酯)。在特定暴露后24小时,小麦粉和甲苯二异氰酸酯诱发哮喘的患者中血液嗜酸性粒细胞增加,而在同一时间间隔内未观察到非特异性支气管反应性的变化。