| ObjectiveObservation of sputum cytology counts, the level of nerve growth factor (NGF) and IL-4 in cough variant asthma (CVA) patients and the change of their level after using glucocorticoids combined with P2-adrenergic agonists one month, to investigate CVA's Characteristics of airway inflammation.MethodsIn May 2008～October 2009,the 400 cases of chronic cough patients of the respiratory clinic service in our hospital, randomly selected in36 patients with untreated CVA,19 patients with been treated CVA and 23 healthy controls. All enrolled patients were excluded other lung diseases by chest imaging, pulmonary ventilatory function, bronchial provocation tests, and strictly in accordance with the diagnostic criteria for induction into the group of parallel sputum examination, the patient coughed up sputum cell HE staining, differential Cell Count. In induced sputum's supernatant, the level of NGF and IL-4 was determined by enzyme-linked immunosorbent assay. Statistical analysis was done by SPSS 16.0, the percentage of EOS is non-normal distribution with the median, the comparison between the two groups use the rank sum test. The remaining results is normal distribution, which was expressed as mean±SEM(SE).The comparison between various by single factor analysis of variance, the compare between the two groups are by independent sample t-test, before and after treatment was assessed by matching t-test for comparisons, the correlation between variables used pearson correlation analysis, with statistical significance judged as P <0.05.ResultsMedian of sputum eosinophils have showed significant difference among the three groups:CVA patients (8)%, CVA group after treatment (2)%, healthy control group (1)%, CVA group, CVA group after treatment The EOS percentage was significantly higher than the control group (P<0.001); CVA group after treatment than in the CVA group the percentage of eosinophils decreased (P<0.05). The level of NGF and IL-4 in induced sputum concentrations of CVA group were (9.50±1.69) pg/ml and (257.37±53.57) pg/ml, after treatment CVA group (8.44±1.02) pg/ml and (216.56±49.40) pg/ml, healthy control group (6.98±0.69) pg/ml and (166.44±24.75) pg/ml, NGF treatment before and after the CVA group and the level of IL-4 compared with the healthy control group, the difference was statistically significance (all P<0.001), CVA group before and after treatment, the level of NGF and IL-4 paired difference was significant (P<0.001). All selected by the percentage of induced sputum EOS and sputum supernatant concentrations of NGF and IL-4 there is relationship (r=0.351, P<0.01; r=0.325, P<0.01), All patients in induced sputum supernatant concentration of NGF and IL-4 there is a significant correlation (r=0.507, P<0.001).ConclusionEOS percentage increase in induced sputum in CVA. The concentrations of NGF and IL-4 in induced sputum in patients with CVA were significantly higher, so EOS, NGF and IL-4 concentration's elevat may cause coughing and other clinical symptoms. Combined corticosteroids and long-actingβ2 receptor agonist inhalation therapy can significantly improve symptoms of cough, significantly lower the level of NGF, IL-4 and the EOS, to reduce neurogenic inflammation, immunology, inflammation and eosinophilic inflammation. There is a positive correlation between NGF,IL-4 and the percentage of EOS, and further confirmed the NGF and IL-4 with the related EOS airway inflammation. There were significantly positive correlation between NGF and IL-4, confirmed the close relationship between the neurogenic inflammation and immune inflammation in patients with CVA, the mechanism will be further clarified. Induced sputum examination is non-invasive, economical, simple, easily accepted by patients, and repeatable, widely used in clinical. |
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