哮喘吸烟者对金黄色葡萄球菌肠毒素的敏感性

2018/01/08

   摘要
   背景:对金黄色葡萄球菌肠毒素(SEs)的敏感性增加了哮喘中的嗜酸性粒细胞炎症。最近的流行病学研究表明,健康吸烟者对SEs的敏感性增加; 然而,没有证据表明SEs致敏与哮喘吸烟者嗜酸性粒细胞炎症之间存在联系。本文旨在阐明SEs在哮喘吸烟者临床指标包括嗜酸性粒细胞炎症和肺功能中的作用。
   方法:在成人哮喘患者中对SEs特应性致敏的频率进行了检查,在目前或既往吸烟的哮喘患者中,确定SEs致敏与嗜酸性粒细胞炎症,气流受限或治疗步骤的相关性。首次访视时检查临床指标,入组后6个月评估治疗步骤。
   结果:共有23名吸烟者,40名既往吸烟者和118名从未吸烟的哮喘病患者入组。相对于其它空气过敏原,对SEs致敏的频率在吸烟者,既往吸烟者,从未吸烟者中显著升高,且吸烟者中最高,从未吸烟者中最低。在目前或既往吸烟的哮喘患者中,6个月后对SEs表现敏感的患者比不敏感患者血清中总IgE和特异性IgE水平更高,血液嗜酸性粒细胞计数更高,气流受限更严重,以及更严重的疾病。吸烟戒烟时间较长与血清中特异性IgE有关,戒烟3年是最好的预测SEs不敏感的节点。
   结论:哮喘吸烟者对SEs的敏感性增加,可能是哮喘吸烟患者嗜酸性粒细胞炎症和重症哮喘的标志。

 
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Ann Allergy Asthma Immunol. 2017 Nov;119(5):408-414.e2. doi: 10.1016/j.anai.2017.08.001 [Epub ahead of print])

 
 
 
Sensitization to Staphylococcus aureus enterotoxins in smokers with asthma.
 
Nagasaki T1, Matsumoto H2, Oguma T1, Ito I1, Inoue H1, Iwata T1, Tajiri T1, Kanemitsu Y3, Izuhara Y1, Morimoto C1, Ishiyama Y1, Sunadome H1, Niimi A3, Hirai T1.
 
Abstract
BACKGROUND:Sensitization to Staphylococcus aureus enterotoxins (SEs) augments eosinophilic inflammation in asthma. Recent epidemiologic studies demonstrate that sensitization to SEs is increased in healthy smokers; however, there is no evidence on the association between sensitization to SEs and eosinophilic inflammation in smokers with asthma. To clarify the role of SEs on clinical indexes, including eosinophilic inflammation and lung function in smokers with asthma.
METHODS:The frequency of atopic sensitization to SEs was examined in adult patients with asthma. In current or ex-smokers with asthma, the association of sensitization to SEs with eosinophilic inflammation, airflow limitation, or treatment steps was determined. Clinical indexes were examined at the first visit, and treatment steps were assessed 6 months after enrollment.
RESULTS:Overall, 23 current smokers, 40 ex-smokers, and 118 never smokers with asthma were enrolled. The frequency of sensitization to SEs, but not to other aeroallergens, was significantly higher in current, ex-, and never smokers, in decreasing order. In current or ex-smokers with asthma, patients with sensitization to SEs exhibited higher serum levels of total and specific IgE to aeroallergens, higher blood eosinophil counts, greater airflow limitation, and more severe disease 6 months later than those without sensitization to SE. A longer smoking abstinence period was associated with serum specific IgE levels to SEs, and 3 years was the best cutoff of abstinence period to predict the absence of sensitization to SEs.
CONCLUSIONS:Sensitization to SEs is increased in smokers with asthma, and it may be a marker of eosinophilic inflammation and severe asthma in smokers with asthma.


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