Foresi A, Leone C, Pelucchi A, Mastropasqua B, Chetta A, D'Ippolito R, Marazzini L, Olivieri D
Servizio di Fisiopatologia Respiratoria, Modulo di Allergologia ed Immunopatologia Polmonare, Sesto San Giovanni, Parma, Italy.
J Allergy Clin Immunol. 1997 Jul;100(1):58-64. doi: 10.1016/s0091-6749(97)70195-7.
We attempted to determine whether inflammation is present in induced sputum of patients with seasonal allergic rhinitis (AR) as compared with those with perennial asthma (AS) and examined its relationship with bronchial responsiveness to methacholine.
Sputum was induced in 30 patients with seasonal rhinitis in response to grass pollens only and in 15 patients with stable, asymptomatic asthma. The AR group was divided according to methacholine PD20 value: the AR- group (n = 15) had a methacholine PD20 greater than 24 micromol; the AR+ group (n = 15) had a methacholine PD20 ranging between 2.2 and 19.6 micromol. In the AS group, methacholine PD20 ranged between 0.42 and 2.6 micromol. The percentage of eosinophils and metachromatic cells (alcian blue-positive) was assessed in sputum by light microscopy. Tryptase-positive cells and EG2+ cells were identified by immunocytochemistry with the mouse anti-human mast cell-tryptase monoclonal antibody and the monoclonal anti-eosinophil cationic protein antibody.
We found that the number of eosinophils in the AS group was greater than that in the AR+ group (p < 0.05) and in the AR- group (p < 0.01). Moreover, the eosinophil count was lower in the AR- group compared with the AR+ group (p < 0.05). Similarly, the number of EG2+ cells was greater in the AS group than in the AR group (p < 0.02) and the AR- group (p < 0.05). Moreover, the EG2+ cell count was lower in the AR- group than in the AR+ group (p < 0.05). The number of mast cells and basophils in the AS group was greater than that in the AR group (p < 0.05 and p < 0.01, respectively). Mast cells in sputum were tryptase-positive. Basophils were present in sputum from 23% of patients with AR and 53% of patients with asthma. There was a significant correlation between methacholine PD20 and eosinophils (p < 0.005) and mast cells (p < 0.02) but not with basophils in those patients showing a measurable methacholine PD20 (AR+ and AS groups).
Inflammatory cells are present not only in the airways of patients with asthma but also in airways of patients with seasonal AR, even outside natural exposure. Moreover, we provide evidence for the presence of basophils in sputum of patients with asthma even during clinical remission. The presence of bronchial responsiveness is associated with an increase in the number of eosinophils and metachromatic cells. Our findings are consistent with the hypothesis that eosinophils, as well as mast cells, contribute to bronchial responsiveness not only in AS but also in seasonal AR.
我们试图确定与常年性哮喘（AS）患者相比，季节性变应性鼻炎（AR）患者诱导痰中是否存在炎症，并研究其与支气管对乙酰甲胆碱反应性的关系。
仅对草花粉有反应的30例季节性鼻炎患者和15例病情稳定、无症状的哮喘患者进行痰液诱导。AR组根据乙酰甲胆碱PD20值进行分组：AR-组（n = 15）乙酰甲胆碱PD20大于24 μmol；AR+组（n = 15）乙酰甲胆碱PD20在2.2至19.6 μmol之间。AS组乙酰甲胆碱PD20在0.42至2.6 μmol之间。通过光学显微镜评估痰液中嗜酸性粒细胞和异染细胞（阿尔辛蓝阳性）的百分比。用小鼠抗人肥大细胞胰蛋白酶单克隆抗体和抗嗜酸性粒细胞阳离子蛋白单克隆抗体通过免疫细胞化学鉴定类胰蛋白酶阳性细胞和EG2+细胞。
我们发现AS组嗜酸性粒细胞数量多于AR+组（p < 0.05）和AR-组（p < 0.01）。此外，AR-组嗜酸性粒细胞计数低于AR+组（p < 0.05）。同样，AS组EG2+细胞数量多于AR组（p < 0.02）和AR-组（p < 0.05）。而且，AR-组EG2+细胞计数低于AR+组（p < 0.05）。AS组肥大细胞和嗜碱性粒细胞数量多于AR组（分别为p < 0.05和p < 0.01）。痰液中的肥大细胞为类胰蛋白酶阳性。23%的AR患者和53%的哮喘患者痰液中有嗜碱性粒细胞。在那些乙酰甲胆碱PD20可测量的患者（AR+组和AS组）中，乙酰甲胆碱PD20与嗜酸性粒细胞（p < 0.005）和肥大细胞（p < 0.02）之间存在显著相关性，但与嗜碱性粒细胞无相关性。
炎症细胞不仅存在于哮喘患者的气道中，也存在于季节性AR患者的气道中，即使在非自然暴露期间。此外，我们提供证据表明，即使在临床缓解期，哮喘患者痰液中也存在嗜碱性粒细胞。支气管反应性的存在与嗜酸性粒细胞和异染细胞数量的增加有关。我们的研究结果与以下假设一致，即嗜酸性粒细胞以及肥大细胞不仅在AS中，而且在季节性AR中都对支气管反应性有贡献。
