郭炳宏2006-07-262018-07-112006-07-262018-07-112000http://ntur.lib.ntu.edu.tw//handle/246246/23443呼吸道高反應性為氣喘病患重要 表徵之一。吸入性腺核甘 (Adenosine) 在1980 年代就被發現具有支氣管縮作 用，一般認為其乃透過間接的方式於 過敏性發炎呼吸道中可經由其受體促 進肥胖細胞釋出發炎介質等引起支氣 管收縮。近年來有學者發現吸入性 AMP 對氣喘病患之特異性優於 methacholine ，但臨床應用仍未普遍。 究竟氣喘病患呼吸道對AMP 之高反應 性與呼吸道發炎有無相關仍未有定 論。非侵襲性呼吸道發炎反應之評估方 面，吐氣中一氧化氮(NO)的濃度已被認 為可作為氣喘病患呼吸道發炎反應之 指標，且可監傳測各種抗發炎藥物治療 後之療效。本計畫之目的在研究呼吸道 對AMP 之高反應性與氣喘病患呼吸道 發炎之相關。首先使用脈衝振動法測量 吸入性腺核甘單磷酸對25 位具有氣典 型哮鳴發作之病患以及12 位咳嗽變異 型氣喘病人之影響。並測量試驗前後吐 氣一氧化氣(NO)以及吐氣濃液中過氧 化氫的含量變化。我們發現氣喘病人之 AMP 支氣管高反應性明顯高於咳嗽變 異型氣喘病患，但吐氣一氧化氮及吐氣 濃縮液中H2O2 之濃度則無差異。在吸 入性類固醇治療後。有16 位氣喘病患 及8 位咳嗽變異性病患再次接受AMP 支氣管激發試驗。氣喘病患及咳嗽變異 性病患之AMP 高反應性有下降且兩組 呈現無差異。吐氣濃縮液H2O2 有下但 吐氣中NO 無法看出有變動之跡象。這 些結果顯示AMP 支氣管反應性及吐氣 濃縮液H2O2 似乎可反映氣喘病患呼吸 道發炎反應及敏感度之差異。但吐氣 NO 則無法反映此一現象。其臨床用途 值得懷疑。Recently, airway hyperresponsiveness (AHR) to adenosine monophosphate (AMP) may be a better marker of airway inflammation than methacholine or histamine. This study was undertaken to assess the usefulness of noninvasive measurements of AHR to AMP in the assessment of airway inflammation in asthmatics. First, we compared AHR to AMP in 25 typical asthmatics (Group A) and in 12 patients with cough-variant asthma (Group B). Bronchoprovocation was monitored by impulse oscillometry (IOS) until respiratory resistance at 5 Hz (R5) increased for > 50% (PC50R5). Exhaled nitric oxide (NO) was determined using a real-time chemiluminence analyzer. Hydrogen peroxides (H2 O2 ) in the breath condensate was measured by a determined before and after AMP inhalation challenge. The PC50R5 values were higher in Group B (150.2 ± 70.2 mg/ml) than those in Group A (86.3 ± 60.7 mg/ml) (P < 0.001). In Group A, there was a significant correlation (R = 0.48, p < 0.05) between AHR to AMP and exhaled H2 O2 concentrations but not to the levels of expired NO. After 1 month of asthma therapy, 16 patients in Group A and 8 patients in Group B underwent AMP bronchoprovocation again and the PC50R5 increased to 291.3 ± 95.2 and 313.6 ± 118.2 mg/ml, respectively) (P=NS). The levels of expired H2 O2 also decreased after steroid therapy in both groups but we could not find a significant difference in the levels of expired NO. These data indicate that AHR to AMP and expired H2 O2 , but not expired NO, may provide noninvasive markers that may be helpful in the monitoring of disease activity in asthmatics.application/pdf35764 bytesapplication/pdfzh-TW國立臺灣大學醫學院內科氣喘呼吸道發炎反應腺核甘單磷酸呼吸道高反應性吐氣一氧化氮濃度吐氣濃縮液過氧化氫AsthmaAirway inflammationAdenosine monophosphate airway hyperresponsivenessnitric oxidereporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/23443/1/892314B002063.pdf