夜间哮喘发作患者血GM-CSF和皮质醇含量 动态变化及意义

摘要

In order to explore the relationship between variation of GM-CSFand cortisone and the nocturnal worsening of symptoms in patients with nocturnal asthma.Serum GM-CSF and cortisone were measured in 14 cases acute exacerbation and stablity of nocturnal asthmatic patients and 14 normal control subjects at 4am and 4pm.Results showed that the level of GM-CSF in acute exacerbation of asthmatic group was higher than that of normal subjects at 4 am（P＜0.01）and 4 pm（P＜0.05）.It was also higher than stable asthmatic group at both 4 am and 4 pm（P＜0.05）.Neither stable asthmatic group nor normal subjects had circadian variation of serum GM-CSF.In acute excerbation asthmatic group，GM-CSF was relatively higher median at 4 am than 4 pm（42.28 to 36.28pg／dl），but it had no statistical significance（P＞0.05）.The level of cortisone in both asthmatic groups showed significantly lower than that in normal control subjects in respective time（P＜0.01）.It also showed that both groups of asthmatic subjects had no circadian variaton of serum cortisone.However，the level of cortisone was higher at 4 am and lower at 4 pm in normal subjects.This suggests that the increasing level of GM-CSF is related to acute excerbation of asthma.The relationship between the level of GM-CSF and worsening symptoms of asthma at night is unclear.The lower level and no circadian variation of cirtisone promote nocturnal worsening symptoms of asthma.%为探讨哮喘患者粒细胞巨噬细胞集落刺激因子（GM-CSF）和肾上腺皮质功能变化与哮喘夜间发作或加重的关系，采用放免法测定了14例夜间哮喘发作患者发作期和缓解期早晨4时（4am）和下午4时（4pm）血中GM-CSF和皮质醇含量，并与健康人比较。结果显示，哮喘发作期患者血GM-CSF含量明显高于对照组（P＜0.01、0.05），也高于缓解期患者（P＜0.05），4am时GM-CSF含量（42.48±15.90）高于4pm时（36.28±8.05），但无统计学意义；发作期及缓解期患者皮质醇含量均低于对照组（P＜0.01），且无正常人昼夜变化规律。认为GM-CSF增高与哮喘急性发作有关，但与夜间加重的关系尚不能肯定；哮喘患者肾上腺皮质功能减弱且缺乏凌晨增高的规律是促进其夜间加重和哮喘发作的原因。