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糖皮质激素抵抗型哮喘的临床 糖皮质激素受体及细胞因子特征 |
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孙永昌 罗慰慈 朱元珏
【摘要】 目的 探讨糖皮质激素抵抗(SR)型哮喘的临床特征及发生机制。方法 选择SR型哮喘患者15例及糖皮质激素敏感(SS)型哮喘患者15例，比较两型患者的一般临床资料和基础肺功能。采用放射配基结合位点分析法检测外周血单个核细胞(PBMC)的糖皮质激素受体(GCR)水平，观察氟美松(10-7mol/L)对PBMC产生白细胞介素(IL)-4的抑制作用。结果 除了对泼尼松治疗的临床反应明显不同外，SR型与SS型哮喘在一般临床特征及基础肺功能方面差异均无显著性。SR型哮喘患者PBMC的GCR水平显著低于SS型哮喘患者(P＜0.05)。氟美松对PBMC产生IL-4的抑制作用在SR型哮喘显著低于SS型哮喘(P＜0.001)。结论 对糖皮质激素治疗的反应性差是SR型哮喘的惟一临床特征。T细胞对糖皮质激素的抑制作用相对不敏感是SR型哮喘的细胞学基础，GCR异常可能是其原因之一。
【关键词】 哮喘 受体，糖皮质激素 糖皮质激素
Steroid-resistant asthma: clinical characteristics and abnormality in glucocorticoid receptor and cytokine Sun Yongchang*, Luo Weici, Zhu Yuanjue. Department of Respiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730 (*Department of Respiratory Diseases, The Third Hospital Beijing Medical University, Beijing 100083)
【Abstract】 Objective To investigate the clinical characteristics and the pathogenesis of steroi-dresistant (SR) asthma. Methods 15 patients with SR asthma were studied and 15 patients with steroid-sensitive (SS) asthma served as controls. Clinical data and baseline pulmonary function were compared between the two groups. Glucocorticoid receptors (GCR) in peripheral blood mononuclear cells (PBMC) were measured by using radioligand-binding assay, and the dexamethasone (10-7 mol/L) inhibition of IL-4 production by PBMC was evaluated. Results There was no significant difference between SR and SS asthma both in clinical characteristics and baseline pulmonary function, but the response to prednisone therapy was different. Number of GCR in PBMC from SR asthmatics was significantly less than that from SS asthmatics (P<0.05). Dexamethasone inhibited IL-4 production by PBMC to a much greater degree in SS asthmatics than in SR asthmatics (P<0.001). Conclusion The results indicate that a poor response to glucocorticoid therapy is the only clinical characteristic of SR asthma. The relative insensit[1] [2] 下一页
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