关键词: 糖皮质激素类；诱导痰；嗜酸性粒细胞；非嗜酸性粒细胞；哮喘

Abstract:

Abstract:Objective To observe the effects of inhaled glucocorticoids on the two kinds of inflammatory bronchial asthma by analyzing sputum inflammatory phenotypes of the asthmatic patients with  eosinophilic asthma (EA) or non-eosinophilic asthma (NEA).Methods 156 cases of patients with asthma and 30 cases of healthy control were enrolled in the study.Induced sputum technique was applied to collect sputum and for cytological analysis,the patients with asthma were devided into EA 86 cases and NEA 70 cases.The patients with asthma were inhaled with fluticasone 500 μg·d-1 and placebo,4 weeks later,the airway responsiveness and life  quality score for asthma were observed.Results In NEA patients,the number of sputum eosinophils was significantly decreased compared with EA patients (0.5%±0.1%  vs  9.9%±0.2%,P<0.05),and the number of neutrophils was higher than that of EA patients(64.5% ± 8.5%  vs  37.3% ± 7.5%,P<0.05). After inhaled fluticasone  500 μg·d-1 for 4 weeks,in EA patients,compared with placebo group,the score of life quality in treatment group was significantly increased(P<0.01),the methacholine PC20 was increased group(P<0.05),and FEV1(%)was also increased (P<0.05),the number of sputum eosinophils was significantly decreased (P<0.01);while compared with placebo group,the above indexes in NEA patients had no significant difference(P>0.05).The differences   of  methacholine PC20,sputum eosinophil numbers and the scores of life quality after treatment between EA group and NEA group were significant (P<0.05) .Conclusion NEA is characterized by the less number of airway eosinophils.After inhaled corticosteroid,the changes of methacholine PC20,sputum eosinophil numbers and the score of life quality in patients are not significant.But the characteristics of EA are opposite.So the patients with asthma can be treated targetely based on asthma phenotype according to sputum analysis.

Key words: glucocorticoids, induced sputum, eosinophils, non-eosinophils, asthma