摘要目的 检测支气管哮喘(简称哮喘)急性发作期患者糖皮质激素治疗前后血清IL-18和IL-33水平的变化,探讨IL-18和IL-33在哮喘发病机制中的作用.方法 选择2009年6月至2010年10月大连医科大学附属第二医院呼吸内科收治的中～重度哮喘急性发作患者30例作为哮喘组,体检中心的23例健康体检者作为对照组,两组受试者均无吸烟史.哮喘组患者均静脉滴注甲泼尼龙(40 ～80 mg/d)治疗3～5d,同时配合雾化吸入布地奈德治疗1～2周.分别检测哮喘组治疗前后及对照组血清IL-18和IL-33的水平,同时检测免疫球蛋白E(IgE)、嗜酸粒细胞(EOS)数量及肺功能[包括FEV1占预计值％(FEV1％)]等,比较哮喘组治疗前后IL-18和IL-33水平的变化及其与对照组之间的差异,分析其与IgE、EOS和FEV1％等指标的相关性.结果 哮喘组治疗前血清IL-18和IL-33水平[分别为(300±181)ng/L和(208 ±95) ng/L]均高于对照组[分别为(158±45) ng/L和(143±32) ng/L],差异有统计学意义(t值分别为3.67和3.51,均P＜0.05),与IgE和EOS变化一致(t值分别为5.76和5.24,均P＜0.05).哮喘组治疗后血清IL-18和IL-33水平[分别为(183±83)ng/L和(148±77) ng/L]均低于治疗前,差异有统计学意义(t值分别为5.42和12.09,均P＜0.05),与IgE和EOS变化一致(t值分别为11.87和4.56,均P＜0.05),但哮喘组治疗后FEV1％水平为(81±16)％,高于治疗前的(54±14)％,差异有统计学意义(t=-7.81,P＜0.05).Pearson相关分析显示,IL-18和IL-33分别与IgE和EOS呈正相关(均P＜0.05)；而与FEV1％呈负相关(均P＜0.05).结论 IL-18和IL-33在哮喘急性发作过程中具有促进炎症反应的作用.

abstractsObjective To study the levels of serum interleukin (IL)-18 and IL-33 in asthmatic patients pre-and post-treatment with glucocorticoids during the acute exacerbation period and therefore to investigate the role of IL-18 and IL-33 in the pathogenesis of bronchial asthma.Methods Thirty cases of moderate to severe asthma admitted in the Second Affiliated Hospital of Dalian Medical University from June,2009 to October,2010 were chosen as the asthma group,and 23 healthy people who underwent routine physical examination were chosen as the control group.The subjects in the 2 groups were all nonsmokers.All the patients were treated with a glucocorticoid ( methylprednisolone 40 - 80 mg/d ) for 3 to 5 days and combined with aerosol inhalation of budesonide for 1 to 2 weeks as adjuvant therapy.The serum levels of IL-18 and IL-33 were detected for the asthma group before and after the treatment and for the control group.Other data including immunoglobulin E (IgE),the number of eosinophil cells (EOS) and the pulmonary function (FEV1％ pre) were measured as well.The differences of IL-18 and IL-33 levels between the asthma group before and after treatment and the control group were analyzed,and the correlation between IL-18,IL-33 and IgE,EOS and FEV1 ％ pre were analyzed as well by SPSS software.Results Compared with the healthy control group [(158 ±-45) ng/L and (143 ±32) ng/L],the levels of IL-18 and IL-33 in the asthma pre-treatment group were significantly increased [ (300 ± 181 ) ng/L and (208 ± 95 ) ng/L,t =3.67and 3.51,all P ＜ 0.05 ) ] ; and the IgE level and EOS count showed a similar change ( t =5.76 and 5.24,all P ＜0.05 ).After systemic glucocorticoid treatment and local aerosol inhalation,the levels of IL-18 and IL-33 [ (183±83 ) ng/L and (148 ± 77) ng/L] were decreased significantly in the asthma patients [ t =5.42 and 12.09,all P＜0.05],and the IgE level and EOS count also showed a same trend as well (t =11.87 and 4.56,all P ＜ 0.05),whereas FEV1％ pred [(54 ± 14)％ ] increased significantly [(81 ±16 ) ％,t =-7.81,P ＜ 0.05 ].The Pearson correlative analysis showed that there were positive correlations between the levels of IL-18,IL-33 and lgE and EOS,respectively (all P ＜ 0.05 ),and there were negative correlations between IL-18,IL-33 levels and FEV1％ pre,respectively ( all P ＜ 0.05 ).Conclusions Our results suggest that IL-18 and IL-33 participate in the pathogenesis of asthma,and may play stimulation role in the process of the disease.