老年支气管哮喘患者临床表现及炎症特征分析

摘要

Objective To discuss the clinical manifestations and inflammatory characteristics of bronchial asthma in the elderly.Methods 137 elderly with bronchial asthma were selected and divided into 2 groups:elderly group (n=92)and non-elderly group (n=45);the clinical data,laboratory examination,pulmonary ventilation function and image examination were collected and a comparative study was made between the 2 groups;the level of inflammation markers,including IgE,IL-4,IL-13 and IL-17 of the peripheral blood,were detected in all the patients.Results The initial age of the patients in elderly group with obvious seasonal paroxysm was older than that in non elderly group;the main clinical manifestations of the patients in elderly group included cough,expectoration,chest tightness,shortness of breath and dyspnea while episodic wheeze was the main clinical manifestation in non-elderly group;the imaging examination indicated that the occurrence of lung over-inflation,pulmonary hyperinflation,pulmonary bullae,emphysema and thickened airway wall in elderly group was higher than that in non-elderly group while the occurrence of FEV 1 pred ％ decrease and the ratio of positive bronchodilation test in elderly group were lower than those in non-elderly group (P＜0.01);the proportion of eosinophils increasing and the levels of IgE and FeNo in elderly group were all lower than those in non-elderly group (P ＜ 0.01);the levels of IL-4 and IL-13 of the peripheral blood in elderly gzroup were lower than those in non-elderly group while the difference was of no statistical significance (P＞0.05);the level of IL-17 in elderly group was much higher than that in non-elderly group (P＜0.01).Conclusions Bronchial asthma in the elderly shows out different characteristics in clinical symptoms,imaging and inflammation,and is more prone to neutrophilic asthma and the occurrence of airway remodeling.%目的 探讨老年支气管哮喘患者的临床及炎症特征,为临床诊治提供参考.方法 选取支气管哮喘患者137例,分为老年组(n=92)和非老年组(n=45),收集并比较2组的临床、检验、肺通气功能及影像检查等资料,检测外周血清IgE、IL-4、IL-13及IL-17等炎性标志物水平.结果 老年组的首发年龄高于于非老年组,有明显的季节发作性;老年组临床症状以咳嗽、咳痰、胸闷、气急和呼吸困难为主;而非老年组以发作性喘息为主;影像学检查提示,老年组肺过度充气、肺透光度增高、肺大疱、肺气肿和气管壁增厚发生率明显高于非老年组,而发生FEV1 pred％的下降及支气管舒张试验阳性比率显著低于非老年组(P＜0.01);老年组嗜酸性粒细胞升高比例、IgE及FeNo水平均明显低于非老年组(P＜0.01);老年组外周血清L-4和IL-13水平均低于非老年组,但差异无统计学意义(P＞0.05);老年组IL-17水平明显高于非老年组(P＜0.01).结论 老年支气管哮喘在临床症状、影像表现及炎症等各方面具有其特征,更倾向于中性粒细胞性哮喘并发生气道重塑.