Henry R L, Gibson P G, Carty K, Cai Y, Francis J L
School of Paediatrics, The University of New South Wales, Randwick, Australia.
Pediatr Pulmonol. 1998 Aug;26(2):97-100. doi: 10.1002/(sici)1099-0496(199808)26:2<97::aid-ppul4>3.0.co;2-e.
Recombinant human deoxyribonuclease (rhDNase) has been shown to reduce sputum viscoelasticity and to improve lung function in patients with cystic fibrosis (CF). The aim of this study was to determine whether airway inflammation would decrease after administration of rhDNase. Twenty patients with CF and chronic suppurative lung disease inhaled 2.5 mg of rhDNase daily for 1 month. Before and after the 1-month trial, lung function was measured and sputum was obtained, either after spontaneous expectoration or after sputum induction with hypertonic saline. Sputum total cell and differential counts were measured using techniques previously described. The mean age of the patients was 16.8 years (range, 6.7-27.5). After 1 month of rhDNase, mean FEV1 increased from a baseline of 62.3% predicted to 70.8% (P= 0.02, paired t test); and FVC increased from 74.4% to 83.9% predicted (P=0.007). No significant differences were found in sputum cytology before or after rhDNase (median total cell counts 16.0 x 10(6)/ml vs. 19.3 x 10(6)/ml, P=0.68). Thirteen patients had a 10% or greater increase in FEV1 after rhDNase (responders). Initial lung function was less in responders than in nonresponders (53.5% vs. 78.6%, P=0.007). There was no significant change in total cell count and neutrophil count after rhDNase in either responders or nonresponders. We conclude that airway inflammation, as measured by total cell counts in sputum, was a prominent feature in cystic fibrosis, and neutrophils were the dominant inflammatory cells. Although the administration of rhDNase resulted in significant improvements in FEV1, there was no evidence of accompanying changes in airway inflammation.
重组人脱氧核糖核酸酶（rhDNase）已被证明可降低囊性纤维化（CF）患者痰液的粘弹性并改善其肺功能。本研究的目的是确定给予rhDNase后气道炎症是否会减轻。20例患有CF和慢性化脓性肺病的患者每天吸入2.5mg rhDNase，持续1个月。在为期1个月的试验前后，测量肺功能并获取痰液，痰液可通过自然咳痰或用高渗盐水诱导咳痰获得。使用先前描述的技术测量痰液中的总细胞数和分类计数。患者的平均年龄为16.8岁（范围为6.7 - 27.5岁）。rhDNase治疗1个月后，平均第一秒用力呼气容积（FEV1）从预测基线的62.3%增加到70.8%（P = 0.02，配对t检验）；用力肺活量（FVC）从预测的74.4%增加到83.9%（P = 0.007）。rhDNase治疗前后痰液细胞学检查未发现显著差异（总细胞数中位数分别为16.0×10⁶/ml和19.3×10⁶/ml，P = 0.68）。13例患者在使用rhDNase后FEV1增加了10%或更多（反应者）。反应者的初始肺功能低于无反应者（53.5%对78.6%，P = 0.007）。反应者和无反应者在rhDNase治疗后总细胞数和中性粒细胞数均无显著变化。我们得出结论，以痰液中的总细胞数衡量，气道炎症是囊性纤维化的一个突出特征，中性粒细胞是主要的炎症细胞。尽管给予rhDNase可使FEV1显著改善，但没有证据表明气道炎症会随之发生变化。
