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支气管哮喘发病率逐步上升,同时治疗手段发展,治疗效果有了很大提高,但仍有部分病人虽经规范化治疗仍得不到良好控制。在重症哮喘诊断与处理中国专家共识[1]中,结合2014年欧洲呼吸学会/美国胸科学会指南[2],将重症哮喘定义为:在过去一年中,需要使用全球哮喘防治创议(GINA)建议的第4级或第5级哮喘药物治疗,才能够维持控制,或即使在上述治疗下仍表现为“未控制”哮喘。
哮喘是一种异质性疾病,具有不同的临床病程和治疗反应。识别特定表型的特征,将有助于哮喘的预后评估,且可能有助于个体化治疗方案的选择(如靶向治疗或其他更有效的治疗方法)[3],对重症哮喘病人的治疗具有重要意义。
SIMPSON等[4]通过痰细胞计数,将哮喘分为四种不同的表型,即嗜酸粒细胞性哮喘、中性粒细胞性哮喘、混合粒细胞性哮喘和少粒细胞性哮喘。痰细胞计数可以作为哮喘分型的有效生物标志物,然而在临床检验过程中受许多因素影响,难以得到广泛的临床应用。
呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)的水平可以反映嗜酸粒细胞炎症的程度、预测激素治疗的有效性以及靶向治疗(抗IgE等)的反应性[5]。中性粒细胞是重度哮喘气道炎症的重要组成成分,是重度难治性哮喘的发病机制之一[6]。髓过氧化物酶(myeloperoxidase,MPO)由中性粒细胞产生,MPO水平与中性粒细胞的数量和活动相关[7]。
本研究拟通过对稳定期支气管哮喘病人进行FeNO和血清MPO的测定,以识别重症哮喘病人表型从而指导治疗。
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各组血清MPO水平间差异有统计学意义(P<0.01);重症哮喘组血清MPO水平明显高于对照组和非重症哮喘组(P<0.01)。各组外周血中性粒细胞水平差异无统计学意义(P>0.05)(见表 1)。
分组 n MPO/(pg/mL) 外周血中性粒细胞/(×109/L) 对照组 20 16.37±3.78 3.54±0.61 非重症哮喘组 20 17.62±4.33 4.46±2.13 重症哮喘组 20 37.74±23.10**## 4.96±2.70 F — 15.23 2.55 P — <0.01 >0.05 MS组内 — 188.882 4.066 q检验:与对照组比较* * P < 0.05;与非重症哮喘组相比##P < 0.01 表 1 各组血清MPO、外周血中性粒细胞水平比较(x±s)
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各组FeNO、IgE水平间差异均有统计学意义(P < 0.01);重症哮喘组FeNO水平均明显高于对照组和非重症哮喘组(P<0.01);非重症哮喘组、重症哮喘组IgE水平均高于对照组(P<0.05和P<0.01)。各组嗜酸粒细胞水平差异均无统计学意义(P>0.05)(见表 2)。
分组 n FeNO/ppb 嗜酸粒细胞/(×109/L) IgE/(IU/mL) 对照组 20 12.25±7.75 0.16±0.12 42.60±29.68 非重症哮喘组 20 23.80±15.69 0.17±0.14 83.44±18.66* 重症哮喘组 20 44.40±37.17**## 0.28±0.35 145.05±146.68** F — 9.43 1.70 7.02 P — <0.01 >0.05 <0.01 MS组内 — 562.616 0.052 586.213 q检验:与对照组比较*P < 0.05,**P < 0.01;与非重症哮喘组比较##P < 0.01 表 2 各组FeNO、嗜酸粒细胞、IgE水平比较(x±s)
呼出气一氧化氮及血清髓过氧化物酶测定在重症哮喘表型识别中的应用
Application value of fractional exhaled nitric oxide and myeloperoxidase in phenotypic recognition of severe asthma
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摘要:
目的探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和血清髓过氧化物酶(myeloperoxidase,MPO)测定在重症哮喘表型识别中的应用。 方法选取稳定期支气管哮喘病人40例(重症哮喘20例,非重症哮喘20例)作为研究对象,并选择同期体检的20名健康人员作为对照组。采用酶联免疫吸附法测定血清MPO水平,使用FeNO检测仪检测FeNO水平,同时测定血常规(中性粒细胞及嗜酸粒细胞计数)和IgE水平。比较各组FeNO、血清MPO、中性粒细胞、嗜酸粒细胞和IgE水平。 结果对照组、非重症哮喘组、重症哮喘组血清MPO水平差异有统计学意义(P < 0.01);重症哮喘组血清MPO水平明显高于对照组和非重症哮喘组(P < 0.01)。各组外周血中性粒细胞水平差异无统计学意义(P>0.05)。各组FeNO、IgE水平差异均有统计学意义(P < 0.01);重症哮喘组FeNO水平明显高于对照组和非重症哮喘组(P < 0.01);非重症哮喘组、重症哮喘组IgE水平高于对照组(P < 0.05和P < 0.01)。各组嗜酸粒细胞水平差异无统计学意义(P>0.05)。 结论重症哮喘病人存在血清MPO和FeNO水平的升高,通过检测血清MPO、FeNO水平有助于识别重症支气管哮喘病人表型,对重症哮喘的个体化治疗具有重要指导意义。 Abstract:ObjectiveTo explore the application value of the detection of serum myeloperoxidase(MPO) and fractional exhaled nitric oxide(FeNO) in severe asthma phenotyping. MethodsForty patients with stable bronchial asthma included 20 cases with severe asthma and 20 cases with non-severe asthma.Twenty cases with severe asthma, 20 cases with non-severe asthma and 20 healthy people were divided into the severe asthma group, non-severe asthma group and control group, respectively.The serum level of MPO was detected using enzyme-linked immunosorbent assay, and the FeNO level was detected using FeNO detector.The neutrophilic granulocyte count, eosinophile granulocyte count and IgE level in the peripheral blood were also detected.The levels of serum MPO, FeNO, neutrophilic granulocyte, eosinophile granulocyte and IgE among three groups were compared. ResultsThe differences of the serum MPO level among three groups were statistically significant(P < 0.01), and the serum MPO level in severe asthma group was significantly higher than that in control group and non-severe asthma group(P < 0.01).The difference of the neutrophil level in peripheral blood among three groups was not statistically significant(P>0.05).The differences of the levels of FeNO and IgE among three groups were statistically significant(P < 0.01), the FeNO level in severe asthma group was significantly higher than that in control group and non-severe asthma group(P < 0.01), and the levels of IgE in non-severe asthma group and severe asthma group were higher than that in control group(P < 0.05 and P < 0.01).There was no statistical significance in the eosinophil level among three groups(P>0.05). ConclusionsThe serum levels of MPO and FeNO in severe asthma patients increase.The detection of serum MPO and FeNO level is helpful to identify phenotypes in patients with severe bronchial asthma, which has great significance in the individualized treatment of disease. -
Key words:
- severe asthma /
- fractional exhaled nitric oxide /
- myeloperoxidase
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表 1 各组血清MPO、外周血中性粒细胞水平比较(x±s)
分组 n MPO/(pg/mL) 外周血中性粒细胞/(×109/L) 对照组 20 16.37±3.78 3.54±0.61 非重症哮喘组 20 17.62±4.33 4.46±2.13 重症哮喘组 20 37.74±23.10**## 4.96±2.70 F — 15.23 2.55 P — <0.01 >0.05 MS组内 — 188.882 4.066 q检验:与对照组比较* * P < 0.05;与非重症哮喘组相比##P < 0.01 表 2 各组FeNO、嗜酸粒细胞、IgE水平比较(x±s)
分组 n FeNO/ppb 嗜酸粒细胞/(×109/L) IgE/(IU/mL) 对照组 20 12.25±7.75 0.16±0.12 42.60±29.68 非重症哮喘组 20 23.80±15.69 0.17±0.14 83.44±18.66* 重症哮喘组 20 44.40±37.17**## 0.28±0.35 145.05±146.68** F — 9.43 1.70 7.02 P — <0.01 >0.05 <0.01 MS组内 — 562.616 0.052 586.213 q检验:与对照组比较*P < 0.05,**P < 0.01;与非重症哮喘组比较##P < 0.01 -
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