Consistency Study Of Upper And Lower Airway Inflammation In Patients With Different Phenotypes Of Asthma

[objective] :to explore the characteristics and consistency of upper and lower airway inflammation in different phenotypes of asthma.[research methods] :A total of 58 subjects were collected in this study,including 21 cases of severe asthma(36%)and 37 cases of non-severe asthma(64%).Collect the general clinical data of two groups of patients,including demographic and routine blood,lung function,induced sputum,breath nitric oxide(FENO),chest and paranasal sinus CT and bronchoscopy line of nasal mucosa(lower right middle turbinate)and bronchial mucosa biopsy(right lower lobe bronchus),alveolar lavage fluid(BALF)such as inspection,bronchial mucosa of nasal mucosa and pathological features include basement membrane thickness,submucosal acidophilic granulocyte count,the number of mast cells measuring quantitative comparison;Line and bronchial mucosa of nasal mucosa and immunohistochemical,including 5 ac mucin(Muc-5 ac),Laminin(Laminin),interleukin(IL-33)33,interleukin(IL-31),31-platelet endothelial cell adhesion molecules(CD31),vascular endothelial growth factor(VEGF)and Collagen type IIV(antibody)(Collagen IIV),type IV Collagen(antibody)(Collagen IV),and to quantify the immunohistochemical.To compare the differences of airway inflammation characteristics between severe asthma and non-severe asthma and to explore the consistency of upper airway inflammation and lower airway inflammation in different phenotypes of asthma.[results] :1.Compared with the clinical indicators of the non-severe asthma group,the age(year)of the severe asthma group was older [p= 0.003].Induced sputum EOS(%)was higher [p<0.01].Induced sputum NEU(%)was lower [ p<0.01].BALF EOS(%)was significantly increased [p<0.01].Blood EOS was higher [p= 0.010].Blood NEU was low [p=0.001].FENO increased significantly [p=0.003].Lung function test showed a decrease in %FEV1 [p<0.01].%FEF25-75 decreased significantly [p=0.010].There was no difference in other clinical indicators between the two groups.2.Compared with the non-severe asthma group,the pathological features of nasal mucosa and bronchial mucosa of severe asthma included the thickness of basal membrane {nose [7.86(1.69)vs.8.31(3.47),p=0.686];Bronchus [9.41(4.41)vs8.95(1.65),p=0.421]};Submucosal eosinophil count {nose [6.50(30)vs 2.00(20),p=0.444];Bronchus [4.50(11)vs 4.00(8),p=0.273]};Number of mast cells {nose [14.50(21)vs 22.00(25),p=0.285];Bronchus [14.00(56)Vs 28.00(35),p=0.180]} no difference was found.There was no difference in the immunohistochemistry of airway inflammatory factors between the severe asthma group and the non-severe asthma group.3.There was a correlation between the expression of inflammatory factors in the upper airway(nasal mucosa)and the lower airway(bronchial mucosa)in the asthma group,and Laminin [r=0.371,p=0.004].Il-33 [r= 0.450,p <0.01];CD31(r = 0.386,p = 0.003),Collagen VII(r = 0.529,p < 0.01] there are positive correlation.While Muc-5 ac,IL-31,VEGF,Collagen IV,there is no correlation.4.Phenotypic grouping was conducted according to the proportion of induced sputum eosinophils and neutrophils: eosinophils 3% and neutrophils < 61% were eosinophils;Phlegm eosinophils < 3% and neutrophils 61% were neutrophil type.Sputum eosinophils 3% and neutrophils > 61% were mixed cell type.Sputum eosinophils < 3% and neutrophils < 61% were oligonuclear.Among them,eosinophil type included eosinophil type and mixed cell type(42 cases).Non-eosinophil types included neutrophil and oligocyte types(13 cases).The difference between eosinophilic and non-eosinophilic upper and lower airway inflammatory factors was analyzed and compared.The results showed that there were differences between the two groups in upper airway inflammatory factor CD31 [p=0.035],VEGF [p<0.01] and lower airway inflammatory factor Laminin [p=0.048],and the eosinophilic type was higher than the non-eosinophilic type.There was no difference in other upper and lower airway inflammatory cytokines between the two groups.5.Asthma group of acidophilic granulocyte type on airway inflammation factor Laminin(r = 0.477,p = 0.001),IL-33(r = 0.476,p = 0.001),CD31(r = 0.498,p = 0.001),and Collagen VII(r = 0.738,p < 0.01)positive correlation;Non acidophilic granulocyte in Collagen VII(r = 0.708,p = 0.007),Collagen IV(r = 0.635,p = 0.020)there were significant positive correlations;There was no correlation between other inflammatory factors in the upper and lower airway of the two groups.[conclusion] :1.Compared with non-severe asthma,patients with severe asthma had older age,poorer lung function,higher induced sputum and BALF EOS(%),FENO and blood EOS,and lower induced sputum and blood neutrophils.2.Pathological features of nasal mucosa and bronchial mucosa showed no difference between severe asthma group and non-severe asthma group.3.There was a positive correlation between the expression levels of inflammatory factors in the upper airway(nasal mucosa)and the lower airway(bronchial mucosa)in the asthma group.4.There was a significant correlation between inflammatory mediators in the upper and lower airway of eosinophil asthma,and there was also a certain correlation between inflammatory mediators in the upper and lower airway of non-eosinophil asthma.