Trapp J F, Watt J L, Frees K L, Quinn T J, Nonnenmann M W, Schwartz D A
Department of Internal Medicine, The University of Iowa College of Medicine, Iowa City 52242-1081, USA.
Chest. 1998 Feb;113(2):505-13. doi: 10.1378/chest.113.2.505.
To determine the effect of glucocorticoids on grain dust-induced airflow obstruction and airway inflammation.
Randomized controlled trial.
University hospital.
Health volunteers.
Two randomized, placebo-controlled trials, each studying 10 healthy volunteers who were pretreated with either triamcinolone acetonide (Azmacort) oral inhaler 4 puffs twice daily (800 microg daily) for 7 consecutive days or IV hydrocortisone (3 microg/kg/min) as a 14-h continuous infusion, then subjected to a controlled inhalation exposure to corn dust extract (CDE) (endotoxin exposure dose of 3 microg/kg). A single-blind, crossover study design was performed for each trial enrolling 10 healthy, lifetime nonsmokers, with no history of lung disease or environmental exposure to grain dust.
Following each inhalation exposure to CDE, spirometry was performed at regular intervals and BAL was performed at 4 h. Both treatment and placebo groups demonstrated significant decrements in spirometry and increments in BAL cellularity following CDE inhalation compared with placebo. Inhaled steroid treatment resulted in a significantly higher FEV1 only at the 2-h time point following CDE inhalation with no significant differences observed in the BAL total cell concentration or cellular differential compared with placebo. IV hydrocortisone treatment resulted in a significantly higher FEV1 and FVC between 2 and 4 h after CDE inhalation, as well as significant reductions in the BAL total cell, macrophage, and eosinophil concentrations. Interestingly, the concentration of tumor necrosis factor-alpha and interleukin-8 in the BAL fluid was also decreased following treatment with IV glucocorticoids.
These results demonstrate that glucocorticoids, administered IV and perhaps by inhalation, have a mildly protective effect on airflow obstruction and airway inflammation induced by inhalation of grain dust.
确定糖皮质激素对谷物粉尘诱发的气流阻塞和气道炎症的影响。
随机对照试验。
大学医院。
健康志愿者。
两项随机、安慰剂对照试验，每项试验研究10名健康志愿者，他们连续7天每天两次吸入4喷曲安奈德（必可酮）口腔吸入剂（每日800微克）进行预处理，或静脉注射氢化可的松（3微克/千克/分钟）持续输注14小时，然后接受受控的玉米粉尘提取物（CDE）吸入暴露（内毒素暴露剂量为3微克/千克）。每项试验采用单盲交叉研究设计，招募10名健康的终身不吸烟者，无肺部疾病史或无谷物粉尘环境暴露史。
每次吸入CDE后，定期进行肺功能测定，并在4小时时进行支气管肺泡灌洗（BAL）。与安慰剂相比，治疗组和安慰剂组在吸入CDE后肺功能测定均出现显著下降，BAL细胞增多。吸入类固醇治疗仅在吸入CDE后2小时时间点导致FEV1显著升高，与安慰剂相比，BAL总细胞浓度或细胞分类无显著差异。静脉注射氢化可的松治疗在吸入CDE后2至4小时导致FEV1和FVC显著升高，同时BAL总细胞、巨噬细胞和嗜酸性粒细胞浓度显著降低。有趣的是，静脉注射糖皮质激素治疗后，BAL液中肿瘤坏死因子-α和白细胞介素-8的浓度也降低。
这些结果表明，静脉注射以及可能通过吸入给予的糖皮质激素对吸入谷物粉尘诱发的气流阻塞和气道炎症有轻度保护作用。
