螨致敏哮喘患者的支气管激发试验:颗粒大小在支气管反应中的作用。

Anne Casset, Ashok Purohit, Emile Birba, Marie-Pierre Chenard, Béatrice Uring Lambert, Siamak Bahram, Pierre Meyer, Gabrielle Pauli, Frédéric De Blay
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引用次数: 28

摘要

虽然主要的室内尘螨过敏原(Der p 1)主要携带在大颗粒(>10微米)上,但标准支气管激发试验(BCT)使用的雾化器可以释放较小的颗粒(尺寸从1到5微米),因此可能不能反映实际的家庭暴露。本研究的目的是评价飞甲提取物的颗粒大小对支气管反应的影响。采用不同的质量中值气动直径(MMAD): 1.1、5.6和9.7微米进行特定的BCT。19例螨虫致敏患者均接受三次螨虫BCT治疗,每种雾化器一次。观察诱导痰和血液样本中IL-5水平。Der p1的PD(20)与颗粒大小有很大的不同,产生最大颗粒(9.7微米)的PD(20)所需的Der p1 (11.2 ng)较少,而5.6微米颗粒的PD(20)为18.1 ng, 1.1微米颗粒的PD(20)为142.5 ng (p < 0.0001)。大颗粒也比小颗粒更容易引起早期反应(100% vs. 63%)。尽管所有三种粒径的后期反应(LPR)频率相似,但与较小粒径的LPR相比,较大粒径的LPR需要较低的平均口服皮质类固醇剂量(23 mg), 5.6微米的为34 mg, 1.1微米的为51 mg。与较大的颗粒相比,1.1微米颗粒使痰液和血液中IL-5浓度显著增加。大颗粒显然在对螨虫过敏的哮喘患者的直接支气管反应中起作用,因此,应该包括在人类的药理学研究中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bronchial challenge test in asthmatics sensitized to mites: role of particle size in bronchial response.

Although major house dust mite allergen (Der p 1) is carried mainly on large particles (>10 microm), standard bronchial challenge tests (BCT) use nebulizers that deliver smaller particles (sizes from 1 to 5 microm) and may therefore not reflect actual domestic exposure. The objective of this study was to evaluate the influence of particle size of Dermatophagoides pteronyssinus extract on bronchial response. Specific BCT were performed with different mass median aerodynamic diameters (MMAD): 1.1, 5.6, and 9.7 microm. Each of the 19 mite-sensitized patients underwent mite BCT three times, once with each nebulizer. IL-5 levels were assessed in induced sputum and blood samples. The PD(20) for Der p 1 differed substantially with particle size, with less Der p 1 (11.2 ng) needed to produce a PD(20) with the largest particles (9.7 microm), compared to 18.1 ng for the 5.6 microm particles and 142.5 ng for the 1.1 microm particles (p < 0.0001). Large particles also induced an early phase response significantly more often than small particles (100% vs. 63%). Although the late phase reaction (LPR) frequency was similar with all three particle sizes, lower mean oral corticosteroid doses were needed to treat LPR with the largest particles (23 mg), compared to the smaller particles, with 34 mg for the 5.6 microm particles and 51 mg for the 1.1 microm. The 1.1 microm particles produced a significantly greater increase in IL-5 concentrations in sputum and blood compared to the larger particles. Large particles clearly play a role in the immediate bronchial response in asthmatics sensitized to mites and, therefore, should be included in pharmacological studies in humans.

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