类固醇对门诊哮喘纤毛粘膜清除的影响。

Rasik V Shah, Mohammad Amin, Sanjay Sangwan, Gerald C Smaldone
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引用次数: 9

摘要

哮喘是呼吸道的一种慢性炎症,对抗炎药物治疗有反应,例如吸入(ICS)和/或全身(SS)皮质类固醇。它与气道分泌物的清除受损有关。我们通过一项体内、随机、安慰剂对照的单盲研究,研究了ICS和SS对门诊哮喘患者粘液纤毛清除(MC)的影响,患者作为自己的对照。在雾化治疗4天和口服强的松治疗5天后,我们使用伽马照相机和放射性标记气溶胶测量了基线时的MC。MC表示为随着时间的推移保留活动的百分比。在每次MC研究前进行肺活量测定。布地奈德雾化治疗不影响MC或1秒用力呼气量(FEV1)。SS治疗与24小时MC显著改善相关(基线41 +/- 6;后ss, 36 +/- 5;P = 0.04)。事后分析显示,MC仅在沉积显著变化的患者中发生变化(特异性中央与外周比值C/P—基线,1.57 +/- 0.16;后ss, 1.73 +/- 0.21;N = 6;p = 0.05),表明MC的改变与治疗无直接关系。在门诊哮喘患者中,尽管FEV1发生了显著变化,但4-5天的抗炎治疗对MC没有影响。
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Steroid effects on mucociliary clearance in outpatient asthma.

Asthma, a chronic inflammatory condition of airways, responds to therapy with anti-inflammatory medications, for example, inhaled (ICS) and/or systemic (SS) corticosteroids. It is associated with impaired clearance of airway secretions. We studied effects of ICS and SS on mucociliary clearance (MC) in outpatient asthma through an in vivo, randomized, placebo-controlled single blind study with patients acting as their own control. Using a gamma camera and radiolabeled aerosol, we measured MC at baseline, after 4 days of nebulized treatment and after 5 days of oral prednisone. MC was expressed as percent of retained activity over time. Spirometry was performed before each MC study. Treatment with nebulized budesonide did not affect MC or forced expiratory volume at 1 sec (FEV1). Treatment with SS was associated with a significant improvement in MC at 24 h (baseline, 41 +/- 6; post-SS, 36 +/- 5; p = 0.04). Post hoc analysis revealed that MC changed only in those patients with significant changes in deposition (specific Central-to-Peripheral ratio C/P--baseline, 1.57 +/- 0.16; post-SS, 1.73 +/- 0.21; n = 6; p = 0.05), suggesting that the changes in MC were not directly related to therapy. In outpatient asthma, MC is unaffected by 4-5 days of anti-inflammatory therapy in spite of significant changes in FEV1.

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