摘要目的 测定支气管哮喘(简称哮喘)患者在糖皮质激素(简称激素)治疗前后诱导痰中基质细胞衍生因子-1(SDF-1)和白细胞介素(IL)-17的水平,探讨SDF-1在哮喘发病机制中的作用.方法 收集2009年6月至2010年9月郑州大学第一附属医院门诊及住院的慢性持续期的哮喘患者99例(按病情严重程度分为轻、中、重度组)及健康体检者30名,哮喘患者在回答哮喘控制问卷(ACQ)后,两组研究对象分别进行肺功能检测和诱导痰检查,记录FEV1占预计值%,行诱导痰炎症细胞分类计数,酶联免疫吸附试验(ELISA)法检测诱导痰中SDF-1和IL-17水平;所有哮喘患者均参照支气管哮喘指南给予规范的吸入激素为主的治疗,4周后测定诱导痰中SDF-1、IL-17的水平及炎症细胞比率.结果 轻、中、重度持续组的ACQ评分及FEV1占预计值%差异均有统计学意义(F值分别为79.271和457.448,均P<0.01).治疗前哮喘组诱导痰嗜酸粒细胞比率、IL-17水平及SDF-1水平均高于健康对照组(均P<0.01);重度哮喘患者诱导痰中两种炎症细胞比率及SDF-1和IL-17水平均高于轻度哮喘患者(均P<0.05).哮喘患者FEV1占预计值%与诱导痰中嗜酸粒细胞、中性粒细胞比率均呈负相关(r值分别为-0.316和-0.409,均P<0.05);诱导痰中SDF-1与嗜酸粒细胞比率及中性粒细胞比率呈正相关(r值分别为0.875和0.716,均P<0.01);诱导痰中IL-17与嗜酸粒细胞及中性粒细胞比率呈正相关(r值分别为0.878和0.846,均P<0.01);诱导痰中SDF-1与IL-17水平呈正相关(r=0.872,P<0.01).治疗后哮喘患者诱导痰中两种炎症细胞比率及SDF-1和IL-17水平均低于治疗前患者(均P<0.01);治疗后未控制组哮喘患者诱导痰中性粒细胞比率、SDF-1水平和IL-17水平明显高于完全控制组(均P<0.05).结论 SDF-1和IL-17通过募集炎症细胞,特别是中性粒细胞参与了哮喘气道炎症的发生,SDF-1可作为哮喘患者临床病情判定和疗效观察的参考指标.

abstractsObjective To evaluate concentrations of stromal cell-derived factor 1 (SDF-1) and IL-17 in induced sputum supernatants from asthmatic patients before and after treatment with glucocorticosteroids. Methods Induced sputum was collected from 30 healthy controls and 99 patients with chronic persistent asthma from 2009-2010. Sputum samples were obtained before and after 4 week treatment with inhaled glucocorticosteroids. The sputum concentrations of SDF-1 and IL-17 were measured by ELISA. Results The FEV1% and the asthma control score of patients with severe asthma were decreased as compared with patients with moderate persistent and mild persistent asthma (F=457.448 and 79.271, all P<0.01). The concentrations of SDF-1 ,IL-17 and the percentage of eosinophils were increased in asthma group compared with control subjects (all P<0.01),but the percentage of sputum neutrophils was lower than that in the healthy controls(P<0.01). The percentage of sputum neutrophils and eosinophils and the level of SDF-1 and IL-17 in patients with severe persistent asthma were significantly higher than those in patients with mild persistent asthma (all P<0.05). The percentage of sputum neutrophils and eosinophils were negatively correlated with FEV1%(r=-0.409 and -0.316,all P<0.05). The levels of IL-17 and SDF-1 were positively correlated with the percentage of sputum neutrophils and eosinophils (all P<0.01). The levels of IL-17 were positively correlated with the levels of SDF-1(r=0.872, P<0.01).After glucocorticosteroid therapy, the percentage of eosinophils and neutrophils, the levels of IL-17 and SDF-1 decreased significantly in all patients(all P<0.01), while the percentage of sputum neutrophils and the levels of IL-17and SDF-1 in uncontrolled patients increased significantly compared with the controlled and partly controlled groups(all P<0.05). Conclusions SDF-1 and IL-17 may contribute to airway inflammation in asthma by chemotactic activity towards neutrophils. The concentration of SDF-1 may be used to evaluate the inflammation and the therapeutic effects.