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支气管扩张症患者存在脂质失调

2021-11-24 小文子 MedSci原创

LXA4治疗支气管扩张症的疗效有待进一步研究。

中性粒细胞炎症是支气管扩张症的重要特征。脂质介质如前列腺素和白三烯在炎症反应中起着至关重要的作用。进一步研究脂质特性,了解抗炎和促炎脂质介质的相互作用,有助于开发新型支气管扩张抗炎疗法。Thorax杂志的一项研究描述了支气管扩张症患者在稳定状态下从血清和气道获得脂质的特征。

研究招募了6名健康志愿者,10例轻度支气管扩张患者,15例中度支气管扩张患者和9例重度支气管扩张患者。所有参与者均在稳定状态下采集60毫升血液并接受支气管镜检查。对血清和支气管肺泡灌洗液(BALF)进行脂质组学研究。纳入标准包括特发性或感染后支气管扩张症,年龄>18岁,给予血清/支气管镜检查前至少4周内未发生支气管扩张症感染性加重。

结果发现,稳定状态下,与健康志愿者相比,中重度支气管扩张症患者血清中的前列腺素E2(PGE2)、15-羟基二十碳四烯酸(15-HETE)和白三烯B4(LTB4)水平显著升高(分别为p=0.03、p=0.03和p=0.02)。严重支气管扩张症患者的脂蛋白A4(LXA4)水平显著降低,P=0.04

与健康志愿者相比,中重度患者的支气管肺泡灌洗液PGE2、5-HETE、15-HETE、9-羟基十八碳二烯酸和LTB4水平显著升高(分别为p<0.0001、p=0.004、p=0.005、p=0.04和p<0.0001)。稳定状态下,PGE2和LTB4与FEV1%呈负相关(r=−0.46, 95% CI −0.15- −0.69, p=0.004;r=−0.58, 95% CI −0.3- −0.76, p=0.0003),与抗生素疗程呈正相关(r=0.78,95%CI 0.61-0.88,p<0.0001;r=0.76,95%CI 0.56-0.87,p<0.0001)。LXA4改善支气管扩张症患者血液和气道中性粒细胞吞噬和细菌杀灭作用。此外,LXA4可减少中性粒细胞活化和脱颗粒。

结果表明,支气管扩张症患者存在脂质介质失调,并伴有过多的促炎症脂质。LXA4改善重组粒细胞的功能。LXA4治疗支气管扩张症的疗效有待进一步研究。

原文出处:

Bedi P , Ziegler K, Whitfield PD, et al. Thorax, 2021. Dysregulation of prostaglandins, leukotrienes and lipoxin A4 in bronchiectasis. doi:10.1136/thoraxjnl-2020-216475.

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