呼吸道病毒感染对哮喘患儿气道重塑与炎症反应的影响
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摘要
目的分析呼吸道病毒感染对哮喘患儿气道重塑与炎症反应程度的影响,为哮喘患儿诊治提供参考。方法选择2017年1月-2018年1月医院收治的哮喘合并呼吸道病毒感染患儿52例设为试验组,选择同期收治的52例单纯哮喘患儿作为对照组。检测两组患儿用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC,采用高分辨螺旋CT(HRCT)对两组患儿进行胸部扫描检查,获取患儿右上叶尖段支气管的管腔内径(ID)和外径(OD),支气管总面积(TA),管腔面积(LA),管壁厚度(WT),管壁面积(WA)等气道重塑指标,比较两组患儿中性粒细胞计数(N)、血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-4(IL-4)。结果试验组患儿肺功能指标FEV1、FEV1/FVC分别为(64.51±6.54)%、(51.47±5.35)低于对照组患儿(P<0.001)。试验组患儿HRCT显示,TA、LA、WA分别为:(27.25±4.36)mm2、(10.73±1.69)mm2、(14.95±1.42)%低于对照组患儿,而ID、OD、WT分别为(5.97±1.45)mm、(6.72±1.47)mm、(1.75±0.83)%高于对照组患儿(P<0.05);试验组患儿血清N、PCT、CRP、IL-4分别为(53.26±6.01)%、(0.51±0.09)ng/L、(31.47±4.34)ng/L、(24.58±3.28)ng/L均高于对照组患儿(P<0.05)。结论哮喘患儿合并呼吸道病毒感染会加重气道重塑及炎症反应,进一步降低患儿肺功能,临床对哮喘患儿进行诊治时,应重视合并呼吸道病毒感染的可能性,并采取抗病毒治疗促进治疗疗效。
OBJECTIVE To analyze the influence of respiratory virus infection on airway remodeling and inflammatory reaction in children with asthma,so as to provide reference for diagnosis and treatment of children with asthma.METHODS 52 children with asthma and respiratory virus infection admitted to the hospital in Jan.2017-Jan.2018 were selected as the observation group,and 52 children with simple asthma treated in the hospital in the same period were selected as the control group.Lung function-related indexes of the two groups of children were detected by lung function test apparatus,including forced vital capacity(FVC),1 second forced expiratory volume(FEV1)and FEV1/FVC.High-resolution spiral CT(HRCT)was used to scan the chest of the two groups of children,so as to obtain the internal diameter(ID)and outer diameter(OD)of the right upper leaf tip bronchus,total area of bronchus(TA),lumen area(LA),tube wall thickness(WT),tube wall area(WA),and other airway remodeling indexes.The neutrophils count(N),serum calcitonin(PCT),C reactive protein(CRP),and white medium-4(IL-4)were compared between the two groups of children.RESULTS The lung function indexes FEV1 and FEV1/FVC in the experimental group were(64.51±6.54)% and(51.47±5.35),significantly lower than those in the control group(P<0.001).HRCT showed that TA,LA and WA were(27.25±4.36)mm2,(10.73±1.69)mm2,(14.95±1.42)%,significantly lower than those of the control group,while ID,OD and WT were(5.97±1.45)mm,(6.72±1.47)mm,(1.75±0.83)%,significantly higher than those of the control group(P<0.05).N,PCT,CRP and IL-4 were(53.26±6.01)%,(0.51±0.09)ng/L,(31.47±4.34)ng/L,(24.58±3.28),significantly higher than those of the control group(P<0.05).CONCLUSION Respiratory virus infection in children with asthma can obviously aggravate airway remodeling and inflammation,and further reduce the pulmonary function of children.In the diagnosis and treatment of children with asthma,the possibility of combined respiratory virus infection should be paid attention to,and antiviral treatment should be taken to promote the therapeutic effect.
OBJECTIVE To analyze the influence of respiratory virus infection on airway remodeling and inflammatory reaction in children with asthma,so as to provide reference for diagnosis and treatment of children with asthma.METHODS 52 children with asthma and respiratory virus infection admitted to the hospital in Jan.2017-Jan.2018 were selected as the observation group,and 52 children with simple asthma treated in the hospital in the same period were selected as the control group.Lung function-related indexes of the two groups of children were detected by lung function test apparatus,including forced vital capacity(FVC),1 second forced expiratory volume(FEV1)and FEV1/FVC.High-resolution spiral CT(HRCT)was used to scan the chest of the two groups of children,so as to obtain the internal diameter(ID)and outer diameter(OD)of the right upper leaf tip bronchus,total area of bronchus(TA),lumen area(LA),tube wall thickness(WT),tube wall area(WA),and other airway remodeling indexes.The neutrophils count(N),serum calcitonin(PCT),C reactive protein(CRP),and white medium-4(IL-4)were compared between the two groups of children.RESULTS The lung function indexes FEV1 and FEV1/FVC in the experimental group were(64.51±6.54)% and(51.47±5.35),significantly lower than those in the control group(P<0.001).HRCT showed that TA,LA and WA were(27.25±4.36)mm2,(10.73±1.69)mm2,(14.95±1.42)%,significantly lower than those of the control group,while ID,OD and WT were(5.97±1.45)mm,(6.72±1.47)mm,(1.75±0.83)%,significantly higher than those of the control group(P<0.05).N,PCT,CRP and IL-4 were(53.26±6.01)%,(0.51±0.09)ng/L,(31.47±4.34)ng/L,(24.58±3.28),significantly higher than those of the control group(P<0.05).CONCLUSION Respiratory virus infection in children with asthma can obviously aggravate airway remodeling and inflammation,and further reduce the pulmonary function of children.In the diagnosis and treatment of children with asthma,the possibility of combined respiratory virus infection should be paid attention to,and antiviral treatment should be taken to promote the therapeutic effect.
引文
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[12]李海燕,郑有光,韩利红,等.难治性哮喘患者肺部感染病原菌分析及肺泡灌洗液与血清炎症因子水平[J].中华医院感染学杂志,2018,28(3):355-359.
[13]Barton JH,Ireland A,Fitzpatrick M,et al.Adiposity influences airway wall thickness and the asthma phenotype of HIV-associated obstructive lung disease:a cross-sectional study.[J].BMC Pulm Med,2016,16(1):111.
[14]Proud D,Leigh R.Epithelial cells and airway diseases[J].Immunol Rev,2011,242(1):186-204.
[15]殷晓霞,温翠玲,刘建华,等.呼吸道合胞病毒感染相关性哮喘的发病机制研究[J].中华医院感染学杂志,2015,25(9):1940-1942.
[2]McLellan K,Shields M,Power U,et al.Primary airway epithelial cell culture and asthma in children-lessons learnt and yet to come[J].Pediatr Pulmonol,2015,50(12):1393-1405.
[3]杜璐玲,陈建永,郑淑梅.吸入布地奈德联合细菌溶解产物对成人支气管哮喘患者炎症因子基质金属蛋白酶-9金属蛋白酶抑制酶-1水平及气道重塑的影响[J].山西医药杂志,2016,45(21):2526-2528.
[4]Wieczfinska J,Pawliczak R.Thymic stromal lymphopoietin and apocynin alter the expression of airway remodeling factors in human rhinovirus-infected cells[J].Immunobiology,2017,222(8-9):892-899.
[5]蒋婧瑾.TLR3参与COPD气道重塑的发生及机制研究[D].浙江大学,2015.
[6]Leigh R,Proud D.modulation of lower airway diseases:pathogenesis and pharmacologic approaches to treatment[J].Pharmacol Ther,2015,148:185-198.
[7]张建梅,张粉霞,加妍,等.支原体肺炎患儿接受顺尔宁联合丙卡特罗治疗后的气道重塑、炎症反应的评估[J].海南医学院学报,2016,22(17):1983-1985.
[8]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(2016年版).中华结核和呼吸杂志,2016,39(9):675-697.
[9]中华医学会儿科学分会呼吸学组.反复呼吸道感染的临床概念和处理原则[J].中华儿科杂志,2008,46(2):108-110.
[10]李红燕,隆红艳.儿童咳嗽变异性哮喘气道炎症研究[J].长春中医药大学学报,2015,31(2):414-417.
[11]Hirakawa S,Kojima T,Obata K,et al.Marked induction of matrix metalloproteinase-10by respiratory syncytial virus infection in human nasal epithelial cells[J].J Med Virol,2013,85(12):2141-2150.
[12]李海燕,郑有光,韩利红,等.难治性哮喘患者肺部感染病原菌分析及肺泡灌洗液与血清炎症因子水平[J].中华医院感染学杂志,2018,28(3):355-359.
[13]Barton JH,Ireland A,Fitzpatrick M,et al.Adiposity influences airway wall thickness and the asthma phenotype of HIV-associated obstructive lung disease:a cross-sectional study.[J].BMC Pulm Med,2016,16(1):111.
[14]Proud D,Leigh R.Epithelial cells and airway diseases[J].Immunol Rev,2011,242(1):186-204.
[15]殷晓霞,温翠玲,刘建华,等.呼吸道合胞病毒感染相关性哮喘的发病机制研究[J].中华医院感染学杂志,2015,25(9):1940-1942.