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首页> 外文期刊>Allergy >Inflammation and functional outcome in diisocyanate-induced asthma after cessation of exposure.
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Inflammation and functional outcome in diisocyanate-induced asthma after cessation of exposure.

机译：停止接触后由二异氰酸酯诱发的哮喘的炎症和功能预后。

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BACKGROUND: The clinical outcome of diisocyanate-induced asthma has been found to be poor despite cessation of exposure. Our aim was to study the outcome of diisocyanate-induced asthma after initiation of inhaled steroid treatment at a mean period of 7 months (range 2-60 months) after cessation of exposure by following up lung function and bronchial inflammation. METHODS: Bronchoscopy was performed on 17 patients 2 days after a positive inhalation challenge test, after which budesonide 1600 mug a day was started. Bronchoscopy, spirometry, and histamine challenge tests were repeated at 6 months and on average 3 years. The results were also compared with those obtained from 15 healthy control subjects. RESULTS: Nonspecific bronchial hyperreactivity diminished significantly (P = 0.006); however, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values decreased, with a median yearly reduction of FEV1 of 79 ml. The count of mast cells in bronchial mucosa decreased (P = 0.012) and that of macrophages increased (P = 0.001). Interleukin-4 level in mucosa was during the first year significantly higher than in controls but its level decreased in the follow-up. Interleukin-6, interleukin-15, and tumour necrosis factor alpha messenger-RNA levels were significantly higher in hyperreactive patients than in nonhyperreactive patients at the end of the follow-up. CONCLUSION: Our results indicate that inflammation may persist in diisocyanate-induced asthma despite inhaled steroid medication. However, TH2-type inflammation diminished. Persistent nonspecific bronchial hyperreactivity was associated with proinflammatory acting cytokines produced mainly by macrophages. Considering the poor prognosis of the disease the findings could be utilized to develop the follow-up and treatment of diisocyanate-induced asthma.
机译：背景：尽管停止暴露，但发现二异氰酸酯诱发的哮喘的临床结局较差。我们的目的是通过随访肺功能和支气管炎症来研究吸入类固醇治疗后平均7个月（2-60个月）开始吸入类固醇药物后由二异氰酸酯诱导的哮喘的预后。方法：对吸入性激发试验阳性2天后的17例患者进行了支气管镜检查，然后开始每天服用布地奈德1600杯。分别在6个月和平均3年重复进行支气管镜检查，肺活量测定和组胺激发试验。还将结果与从15名健康对照受试者获得的结果进行了比较。结果：非特异性支气管高反应性显着降低（P = 0.006）;然而，在1 s内的强制呼气量（FEV1）和强制肺活量（FVC）值下降，FEV1的中位数年减少量为79 ml。支气管粘膜肥大细胞计数减少（P = 0.012），巨噬细胞计数增加（P = 0.001）。粘膜中白细胞介素4水平在第一年显着高于对照组，但其水平在随访中下降。在随访结束时，高反应性患者的白细胞介素6，白细胞介素15和肿瘤坏死因子α信使RNA水平显着高于非高反应性患者。结论：我们的结果表明，尽管吸入类固醇药物，但在二异氰酸酯诱发的哮喘中炎症仍可能持续。但是，TH2型炎症减轻了。持续性非特异性支气管高反应性与主要由巨噬细胞产生的促炎性细胞因子有关。考虑到该疾病的预后不良，该发现可用于开展二异氰酸酯诱导的哮喘的随访和治疗。

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