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支气管哮喘合并过敏性鼻炎患者气道炎症特点与小气道功能分析

Analysis of inflammatory characteristics of air passage and small airway dysfunction in patients with bronchial asthma complicated with allergic rhinitis

    摘要
  • 摘要:
    目的 分析支气管哮喘合并过敏性鼻炎患者气道炎症特征与小气道功能变化特点。
    方法 采用横断面研究方法选取96例支气管哮喘患者作为研究对象，根据是否合并过敏性鼻炎分为过敏性鼻炎-哮喘综合征组38例和支气管哮喘组58例。评估2组患者哮喘控制测试(ACT)评分，检测2组患者外周血总免疫球蛋白E(IgE)、嗜酸性粒细胞(Eos)、C反应蛋白(CRP)水平和外周血清白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、白细胞介素-17A(IL-17A)、γ干扰素水平，并检测2组患者肺通气功能指标第1秒用力呼气容积占预计值百分比(FEV1%pred)、用力呼出50%肺活量时流速占预计值百分比(FEF50%pred)、最大呼气中期流量占预计值百分比(MMEF%pred)。采用Spearman相关分析法分析小气道功能与气道炎症的相关性。
    结果 过敏性鼻炎-哮喘综合征组FEV1%pred、FEF50%pred、MMEF%pred依次为(55.06±23.12)%、(60.48±21.33)%、(60.34±20.44)%，分别低于支气管哮喘组的(69.32±30.63)%、(75.54±26.51)%、(70.26±21.03)%，差异有统计学意义(P < 0.05)。过敏性鼻炎-哮喘综合征组患者外周血总IgE、Eos、CRP水平均高于支气管哮喘组患者，差异有统计学意义(P < 0.05)；过敏性鼻炎-哮喘综合征组患者ACT评分低于支气管哮喘组患者，差异有统计学意义(P < 0.05)。过敏性鼻炎-哮喘综合征组外周血清IL-4、IL-6水平均高于支气管哮喘组，差异有统计学意义(P < 0.05)；2组IL-17A、γ干扰素水平比较，差异无统计学意义(P>0.05)。Spearman相关分析显示，过敏性鼻炎-哮喘综合征患者小气道功能代表指标MMEF%pred、FEF50%pred均分别与IL-4、IL-6呈负相关(P < 0.05)。
    结论 过敏性鼻炎-哮喘综合征患者相较支气管哮喘患者具有更明显的炎症反应和小气道功能障碍，且其小气道功能可能受气道炎症的影响。

     

    Abstract:
    Objective To analyze the inflammation characteristics of air passage and small airway dysfunction in patients with asthma complicated with allergic rhinitis.
    Methods A total of 96 patients with bronchial asthma were selected as study subjects by cross-sectional study, and were divided into allergic rhinitis-asthma syndrome group (38 cases) and bronchial asthma group (58 cases) according to presence or absence of complicating with allergic rhinitis. Asthma Control Test (ACT) scores were evaluated in both groups. The levels of total immunoglobulin E (IgE), eosinophils (Eos), C-reactive protein (CRP) in peripheral blood, interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-17A (IL-17A), and γ interferon in peripheral blood of patients in two groups were detected. The lung function indicatorspercentage of forced expiratory volume in the first second to expected value (FEV1%pred), percentage of forced expiratory flow at 50% of FVC exhaled to expected value (FEF50%pred), maximum mid-expiratory flow to estimated value (MMEF%pred) were detected. Spearman correlation analysis was used to analyze the correlation between small airway function and airway inflammation.
    Results FEV1%pred, FEF50%pred and MMEF%pred were (55.06±23.12)%, (60.48±21.33)% and (60.34±20.44)% in allergic rhinitis-asthma syndrome group, respectively, which were (69.32±30.63)%, (75.54±26.51)% and (70.26±21.03)%, respectively in the bronchial asthma group (P < 0.05). The levels of total IgE, Eos and CRP in peripheral blood of patients in the allergic rhinitis-asthma syndrome group were higher than those of patients in the bronchial asthma group (P < 0.05). The ACT score of the allergic rhinitis-asthma syndrome group was lower than that of the bronchial asthma group (P < 0.05). The concentrations of serum IL-4 and IL-6 in the allergic rhinitis-asthma syndrome group were higher than those in the asthma group (P < 0.05). However, there were no significant differences in IL-17A and IFN-γ between two groups (P>0.05). Spearman correlation analysis showed that the small airway variables such as MMEF%pred and FEF50%pred in allergic rhinitis-asthma syndrome patients were separately negatively correlated with IL-4 and IL-6, respectively.
    Conclusion Asthma patients complicated with allergic rhinitis have more obvious inflammation and small airway dysfunction than patients with bronchial asthma. Small airway function may be affected by airway inflammation.

     

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