The Variation And Clinical Value Of Serum Eotaxin In Patients With Bronchial Asthma And COPD

Bronchial asthma(abbreviated asthma) and COPD which are two kinds of common chronic airway inflammation diseases in the world-wide which have caused great morbidity and mortality and have brought about heavier economic and social burdens. Besides the burden is increasing with the changing of population age structure and approaching of the old-age society in the world. Therefore human beings have invested heavily in the study of pathogenesy and pathological process to improve our ability to diagnose and treat the diseases mentioned above.Studys discovered that among the airway inflammation of two diseases there are some similarities but evident differences.The asthma's pathological characteristic is the infiltration of eos and CD4+ T lymphocyte in the patient's lung tissue. Eotaxin plays an important roll in the recruitment of the eos in lung tissue,which can make the eos, macrophage, B lymphocyte and hypertrophic cell recruit to the airway epithelium,then the cells can be activated, synthetized and released various inflammation mediums that can cause bronchus smooth muscle to contract and the airway hyperreactiveness(AHR),meanwhile the capillary vessel wall was more permeable and mucus gland externalization increased,all of which would lead to the occurence of asthma's pathological process. But in the patients with COPD, numbers of neutrophils were accumulated in the airway lumen and many macrophages infiltrated in airway lumen, airway wall, and parenchyma. And CD8+ lymphocytes were recruited to airway wall and parenchyma and also sometimes have eos infiltration. Since the eotaxin was discovered in the BALF of antigen sensitized guinea pig in 1994, the research of eotaxin have developed very quickly. Its structure, function, position on chromosome, the expression and regulation of the gene, peculiar receptor and the relationship of the two kinds of common airway inflamematory disease: the asthma and COPD was gradually revealed to people.It proved that the eotaxin is one of the main chemotatic factors that lead to infiltrateing by eos in asthma's airway based on animal model and clinical trials.And there exists certain correlativity among eotaxin,the severity of the disease,the FEV1%predicted value(FEV1%Pred) and the eos counting in peripheral blood.At the same time,the study discovered the CCR3 besides expressed highly not only in eos butalso in basophile granulocyte, mast cell and lymphocyte in certain degrees and it cannot be expressed in neutrophils.So we can infer that the eotaxin does not have big functions to recruit the neutrophils. But the COPD's airway inflammation gives first place to neutrophils infiltration exactly so that it can be presumed that the relationship of eos and COPD are not very close in theory. At present many researches discovered that there was eos infiltrating and eotaxin increasing in the airway in patients with COPD. So we supposed that the COPD airway inflammation may be connected with eotaxin too.Besides some reports believed that part of COPD patients'eotaxin level of serum is a little higher than healthy people and it also relates to the severity degree. But researches about this are few at present and researchers can not reach a concordance in views. Objective:This trial is designed to use the ELISA method to detect the eotaxin concentration in serum among asthma and COPD group, comparing with the healthy people's, observing its varience, diagnosing and distinguishing diagnostic values. The asthma group is divided into three groups strictly: the acute groups, chronic persistent groups and paracmastic groups and we also observe the varience,diagnosing and distinguishing diagnostic values and also compared with COPD group and the healthy group. At the same time we analysed the correlativity among the eotaxin and eos counting, FEV1%Pred and the improving rate of PEF(PEF%Chg) after inhalation of bronchodilator (Salbutamol Sulfate Aerosol,trade name:Ventolin 200 ug) and increased the understanding about the pathological process of asthma and COPD.Maybe it also can increase the distinguishing diagnostic ability between two diseases.And treating specifically in eotaxin's effect-link may possibly open up a new direction for managements of asthma.Method:The trial collected 34 inpatients with asthma in China-Japan Union Hospital of Jilin University with acute exacer- bated asthma 12 cases, chronic persistent asthma 13 cases and paracmastic asthma 9 cases during 2006.3～2007.1. There were 15 male and 19 female,ages 24-71 and the average age(50.38±13.40), the diagnosis consistented with"the diagnosis standard of asthma"made by Chinese Medical Association;And the COPD group has 20 cases, with male 9 cases,female 11 cases,ages 30-72 and the average age(56.85±10.21).all patients are in acute exacerbated period and thediagnosis consistented with"the diagnosis standard of COPD"made by Chinese Medical Association;Healthy control group 17 cases(all are the healthy people who have took physical examination in our hospital at the same period):with male 8 cases,female 9 cases,ages 28-71 and the average age(48.88±15.50). All participators signed in informed consent.The age,gender(sex ratio),body mass index(BMI) and smoking history(pack years)of them has comparability and there is no evident statistically difference in every groups(P>0.05).Deter- mine every group's serum eotaxin by ELISA before medical treatments and also note eos counting in peripheral blood, FEV1%Pred, PEF%Chg respectively. Then the statistics handles should be made on the data properly, It has significant difference when P<0.05.Results:The serum eotaxin level in diseased and healthy groups, the acute exacerbated asthma group314.565±98.583pg/ml; the chro- nic persistent asthma group189.986±50.254pg/ml; the paracmastic asthma group134.159±68.824pg/ml; the COPD group 120.441±63.733pg/ml; the healthy control group 98.962±44.628pg/ml.The results demonstrated that the acute exacerbated asthma group's serumeotaxin is significantly high than the chronic persistent asthma group's (P<0.01),the paracmastic asthma group's,the COPD group's and the healthy control groups(P<0.05). Besides, the chronic persistent asthma group's is significantly high than COPD group's and the healthy control group's (P<0.05).But it has no notable difference with the paracmastic asthma group's(P>0.05). There is no notable difference among the paracmastic asthma group,COPD group and the healthy control group(P>0.05).The acute exacerbated asthma and chronic persistent asthma group's serum eotaxin level were positively correlated to the amounts of eos in peripheral blood (r = 0.581, 0.556 respectively,P<0.05) and the PEF%Chg (r = 0.596, 0.567 respectively, P<0.05).But inversely correlated to the FEV1%Pred (r =-0.585,-0.571 respectively, P <0.05).And serum eotaxin level in COPD groups have no clearly correlatation to the amounts of eos in peripheral blood, PEF%Chg and FEV1%Pred.And the conclusion demonstrated that the serum eotaxin highiy correlated with asthma, it is one of the main participant that lead to the occurence of asthma's pathological process.The asthma serumeotaxin level is not only connected with the severity of the exacerbated states of the disease but also relates to the chronic persistent states.We can concluded that the droping speed of serum's level may be connected with the asthma's curative effect and whether or not it can be turned into chronic persistent states easily.Meanwhile it can reflect both the troubling extent of lung function in certain degrees and whether it has AHR. There some overlaps between the serum eotaxin level of the chronic persistent group and the healthy control group.So it was infered that eotaxin may be just one of the chemotactic factors that caused the eos infiltrating in asthma. Treating specifically in eotaxin effect-link may become a new direction of the asthma's mangements. At present, for the terminal periods of asthma and COPD there is still short of a kind of effective method that can distinguishing each other.And this is very important to the therapeutic decision-making(such as weather choose antibiotics or not) of the two diseases, The result demonstrates that asthma group's serum eotaxin is more notable than control group. But the COPD group's serum Eotaxin group has no notable difference compared with the control group. So it possible has somediagnosing and distinguishing diagnostic values to the diseases mentioned above. It may be possibly become one kind of method to distinguishing above-mentioned diseases simply and effectively if being able to be coordinated with some other indices.