気管支喘息における複合温泉療法と気道炎症反応

Efficacy of complex spa therapy was studied in 55 patients with bronchial asthma. Complex spa therapy was effective in 47 (85.5%) of the 55 patients with bronchial asthma : marked efficacy was observed in 15 (27.3%), moderate in 32 (58.2%), slight in 6 (10.9%) and no efficacy in 2 patients (3.6%). Improvement of clinical symptoms and findings by complex spa therapy was more clearly observed in patients with an increased proportion of BAL lymphocytes, neutrophils and eosinophils. These findings suggest that complex spa therapy more affects cell infiltration in the airways than bronchoconstriction induced by chemical mediators. Improvement of ventilatory function represented by FEV1.0% value was higher in patients with a low proportion of BAL neutrophils, suggesting that patients with increased number of BAL neutrophils require longer complex spa therapy than those without BAL neutrophilia.気管支喘息55例を対象に,複合温泉療法(温泉プール水泳訓練+ヨードゾル吸入+鉱泥湿布療法)を試み,その臨床効果と気道炎症反応との関連について,若干の検討を加えた｡1.複合温泉療法の臨床効果では,著効15例(27.3%),有効32例(58.2%),やや有効6例,無効2例であり,明らかに有効と判断された症 例は,55例中47例(85.5%)であった｡2.複合温泉療法は,気管支肺胞洗浄液(BALF)中の細胞成分(リンパ球,好中球,好酸球など)が多い症例,すなわち気道炎症反応がより強い症例により有効であった｡このことは,複合温泉療法が,単純性の(化学伝達物質による)気管支攣縮よりも,気道炎症反応をともなった病態により強く影響を及ぼすことを示している｡3.複合温泉療法による換気機能の改善(1秒量)は,BAL液中の好中球数が少ない症例においてより高度であった｡このことは,BAL液中に高度な好中球増多が見られる症例に対しては,より長期的な複合温泉療法が必要であることを示しているものと考えられた

ステロイド依存性重症難治性喘息における気道反応の特徴

Characteristics of airway response in steroid-dependent intractable asthma (SDIA) were examined in 86 asthma patients (43 with SDIA and 43 with non-SDIA) divided into three age groups: 20-39, 40-59 and 60+ years, by observing cellular composition of bronchoalveolar lavage (BAL) fluid and ventilatory function. 1. The level of serum cortisol was significantly lower in patients with SDIA than in those with non-SDIA in all age groups. 2. The proportion of lymphocytes in BAL fluid was significantly decreased in patients with SDIA compared to results in non-SDIA patients in the age between 40-59, and over 60+ years, While BAL neutrophils were significantly increased in SDIA patients compared to results in non-SDIA patients in the age group over 60 years. 3. Of ventilatory parameters, the values of % FVC, FEV(1.0%), % MMF and % V(25) were significantly lower in SDIA patients over the age of 60 compared with non-SDIA subjects of the same age group. These results show that in SDIA patients the proportion of BAL lymphocytes decreases and the proportion of BAL neutrophils increases with aging, and that ventilatory function in SDIA patients also decreases with aging compared to non-SDIA patients.年齢により3群(20-39才,40-59才,60才以上)に分類された気管支喘息86例(ステロイド依存性重症難治性喘息:SDIA;43例,非SDIA;43例)を対象に,気管支肺胞洗浄液(BALF)中の細胞成分および換気機能よりSDIAにおける気 道反応の特徴を検討した｡1.血清コーチゾ-ル値は,SDIA症例において, 非SDIA症例に比べいずれの年齢層においても有意の低値を示した｡2.BALF中リンパ球頻度は,40-59才および60才以上のSDIA症例において,同年齢の非SDIA症例に比べ有意の低値を示した｡一方,BALF中好中球頻度は,60才以上のSDIA症例で,同年齢層の非SDIA症例に比べ有意に高い値を示 した｡また,BALF中好酸球頻度は,いずれの年齢層においても,SDIAと非SDIA症例の間に有意の差は見られなかった｡3.換気機能では,% FVC, FEV1.0%,% MMF, % V(25)などの換気パラメーターは,60才以上の SDIA症例において,同年齢層の非SDIA症例に比べて有意の低値を示した｡ これらの結果は,40-59才あるいは60才以上のSDIA症例では,非SDIA症例に比べ,BALF中リンパ球頻度の低下,好中球頻度の増加,換気パラメーター値の低下などがより高度に見られることを示している

気管支喘息における血清免疫グロブリン値,末梢血リンパ球数と気管支肺胞洗浄液中の細胞成分との関連

Changes in airway inflammation by glucocorticoids were examined in 26 patients with bronchial asthma, divided into two age groups ; 20-59 and 60+ years, in relation to serum immunoglobulin levels and peripheral lymphocyte count. 1. The levels of IgG, IgA and IgM were significantly lower in patients with steroid-dependent intractable asthma (SDIA) of age over 60 years than in those with non-SDIA of the same age group. In patients between the ages of 20 and 59, only serum IgG level was significantly lower in SDIA than in non-SDIA patients. 2. Peripheral lymphocyte count was significantly decreased in SDIA patients than in non-SDIA patients in age group over 60, but not in age group between 20 and 59. 3. Number of lymphocytes in bronchoalveolar lavage (BAL) fluid was significantly lower and number of BAL neutrophils was significantly higher in SDIA patients than in non-SDIA patients in age group over 60, but not in age group between 20 and 59. These results suggest that levels of IgG, IgA and IgM, and peripheral lymphocyte count were significantly suppressed in SDIA patients of age over 60, accompanied with decrease of BAL lymphocytes and increase of BAL neutrophils.気管支喘息26例(ステロイド依存性重症難治性喘息,SDIA 13例,非SDIA 13例)を対象に,血清免疫グロブリン,IgG,IgAおよびIgM値,および末梢血リンパ球数との関連のもとに,副腎皮質ホルモン長期投与による気道炎症細胞の出現頻度の変化について検討を加えた｡なお,年齢による影響を観察する目的で,SDIAおよび非SDIA各13例を,20-59才と60才以上の2群に分けて,それ ぞれのグループの特徴について検討した｡1.血清IgG,IgAおよびIgM値は,60才以上の症例において,いずれも非SDIA症例に比べ,SDIA症例で有意に低い値を示した｡一方,20-59才の症例群においては,IgG値のみSDIA症例で有意の低下傾向が見られた｡2.末梢血リンパ球数は,60才以上の症例では,SDIA症例で,非SDIA症例に比べ有意の低値を示したが,20-59才の症例では両群間に有意の差は見られなかった｡3.気管支肺胞洗浄(BAL)液中のリンパ球数 は,60才以上のSDIA症例で,非SDIA症例に比べ有意に少なく,また同時にこれらの症例ではBAL液中好中球が有意に多い傾向が観察された｡しかし,20-59才の症例群では,SDIAと非SDIAの間にいずれも有意の差は見られなかっ た｡これらの結果より,60才以上の症例では,20-59才の症例群に比べ,副腎皮質ホルモンの長期投与により,血清IgG,IgAおよびIgM値,末梢血リンパ球数の減少とともに,BAL液中のリンパ球減少,好中球増加をきたしやすいことが明らかにされた

気管支喘息における末梢血白血球および気管支肺胞洗浄液中の細胞からのヒスタミンおよびロイコトリエンC(4),B(4)遊離と気道過敏性

The proportions of cells in bronchoalveolar lavage (BAL) fluid, the release of histamine, leukotrienes C(4) and B(4) from leucocytes and BAL cells, and bronchial reactivity to methacholine were examined in 40 patients with asthma in relation to patient age. 1. The proportions of lymphocytes and neutrophils in BAL fluid were higher in older patients over age 60 than in younger patients between 20 and 49. The proportions of eosinophils and basophilic cells in BAL fluid were higher in younger patients than in older patients, and the difference in the proportion of BAL basophilic cells was significant between the two groups (p<0.05). 2. The release of histamine from BAL cells was significantly higher in younger patients than in older patients (p<0.001). The release of LTC(4) from BAL cells was higher in older patients compared to younger patients. 3. Bronchial reactivity to methacholine was higher in younger patients than in older patients. The number of patients reactive to low concentration of methacholine (390μg/mℓ or less) was larger in younger patients (12/16 ; 75.0%) than in older patients (5/14 ; 35.7%). These results suggest that bronchial hyperresponsiveness changes with aging, accompanied by changes in the release of chemical mediators from BAL cells and in the proportion of BAL cells.気管支喘息を対象に,気管支肺胞洗浄(BAL)液中の細胞の出現頻度,末梢血白血球およびBAL細胞からのヒスタミン,ロイコトリエンC(4),B(4)遊離,気道過敏性などについて,患者年齢との関連のもとに検討を加えた｡1.BAL液中のリンパ球および好中球頻度は,60才以上の老齢症例で,20-49才の若青年症例に比べやや高い傾向が見られたが,推計学的には有意の差は見られなかった｡BAL液中の好酸球,好塩基細胞の頻度は,若青年症例で,老年症例に比べて高く,特に好塩基性細胞の頻度には両症例群間に有意の差が見られ(P<0.05)｡ 2.BAL細胞からのヒスタミン遊離は,若青年症例で,老年症例に比べ有意に多い傾向が見られた(P<0.001)｡一方,BAL細胞からのロイコトリエンC(4)遊離は,若青年症例に比べ,老年症例で多い傾向が見られたが,両症例群間に有意の差は見られなかった｡3.メサコリンに対する気道の反応性は,全般的に若青年症例で,老年症例に比べより強い傾向を示した｡そして,390μg/mℓまたはそれ以下の低濃度のメサコリンに反応を示す症例は,若青年症例では16例中12例(75.0%),老年症例では14例中5例(35.7%)であった｡以上の結果より,気道過敏性は,BAL細胞からの化学伝達物質遊離の変化やBAL細胞の頻度の変化とともに,加齢の影響を受けることが明らかとなった

気管支喘息におけるハウスダストアレルギー. 血清IgE値とIgE抗体価と年齢との関連

Serum IgE levels and IgE antibody values in relation to patient age were examined in 50 patients with house dust mite (HDm) sensitive asthma, 1. IgE antibody values to HDm were highest in patients between the ages of 10 and 19, and the　values generally low in those over the age of 40. 2. High IgE antibody values to HDm　were accompanied by high serum IgE levels in patients between 10 and 19. IgE antibody values and serum IgE levels were in general low in patients over age 40. In patient under　age 9, serum IgE levels were less than 500 IU/ml in 5 of the 10 subjects despite an increased value of IgE antibodies to HDm. These results suggest that an increased　production of IgE antibodies to HDm is usually accompanied by an increased production of total IgE in younger subjects. However, an increase in production of IgE antibodies is not always related to an increase in production of total IgE in patients under age 9. The results also show that production of IgE antibodies to HDm and total IgE is in general low in older patients despite the hyperreactivity to HDm.ハウスダストが原因抗原であるアトピー型気管支喘息50例を対象に,血清IgE値とIgE抗体価を年齢との関連のもとに検討した｡1.IgE抗体価は10-19才の年齢層の症例において最も高く,一方40才以上の症例では全般的に低い傾向が見られた｡2.10-19才の年齢層の症例では,IgE抗体価の高値と同時に血清IgE値も高い値を示したが,40才以上の症例では,IgE抗休価および血清IgE値いずれも10-19才の症例に比べ全般的に低い値を示した｡9才以下の症例では,IgE抗体価の高値にもかかわらず,血清IgE値は比較的低く,500IU/ml以下を示した症例が10例中5例に観察された｡これらの結果は,若年症例では,IgE抗体の産生亢進と総IgEの産生亢進が同時に見られること が多いが,9才以下ではIgE抗体産生亢進に総IgE産生亢進が必ずしもともなわない場合があることを示している｡また,40才以上の症例では,ハウスダストに対する過敏性は有しているものの,IgE抗体価および血清IgEは全般的に低い値を示す傾向が示唆された

気管支喘息における気道炎症反応の臨床的意義｡慢性閉塞性細気管支炎との比較検討

Clinical significanoce of airway inflammation was assessed in 28 patients with bronchial asthma, and the results were compared with those in 9 patients with chronic obstructive bronchiolitis (COB). 1. Total cell number in bronchoalveolar lavage(BAL) fluid was markedly increased in patients with COB (51.0×10(6)), which was significantly greater than that in those with bronchial asthma (9.6×10(6) ). 2. The proportion of BAL macrophages was significantly higher in patients with bronchial asthma than in those with COB. However, the, absolute number of BAL macrophages was not significantly different between them. 3. The proportion of BAL lymphocytes was higher in patients with bronchial asthma than in those with COB, but this difference was not signifcant. In contrast, the absolute number of BAL lymphocytes was significantly greater in patients with COB than in those with bronchial asthma. 4. The proportion and the number of BAL neutrophils were markedly increased in patients with COB compared to those with bronchial asthma. 5. The proportion and the number of BAL eosinophils were higher in patients with bronchial asthma than in those with COB, although these defferences were not significant. The results suggest that airway inflammation in bronchial asthma is not so intensive as that in COB.気管支喘息28例および慢性閉塞性細気管支炎9例を対象に,気道炎症反応の臨床的意義について検討を加えた｡1.気管支肺胞洗浄(BAL)液中の総細胞数は,慢性閉塞性細気管支炎において著明に増加しており(51.0×10(6)),気管支喘息(9.6×10(6))との間に有意の差が見られた｡2.BAL液中マクロファージの頻度は気管支喘息において,慢性閉塞性細気管支炎に比べ有意に高い値を示したが,絶対数での比較では両疾患群間に有意の差は見られなかった｡ 3.BAL液中リンパ球の頻度は,気管支喘息においてやや高い傾向が見られたが,絶対数の比較では慢性閉塞性細気管支炎において有意に高い値であった｡ 4.BAL液中の好中球は,その頻度および絶対数とも慢性閉塞性細気管支炎において著明に増加しており,これは気管支喘息と比べ有意に高い値であった｡ 5.BAL液中好酸球の頻度および絶対数は,気管支喘息においてやや高い値であったが,両疾患群間に有意の差は見られなかった｡以上の結果より,気管支喘息における気道炎症反応は,慢性閉塞性細気管支炎ほど高度ではない ことが明らかにされた

Interleukin-8 in bronchoalveolar lavage fluid of patients with diffuse panbronchiolitis or idiopathic pulmonary fibrosis

This study was designed to clarify the contribution of IL-8 as a specific neutrophil chemotactic factor in the human respiratory tract in various pulmonary diseases. The neutrophil chemotactic activity(NCA), neutrophil counts and IL-8 concentration in the bronchoalveolar lavage fluid (BALF) obtained from normal volunteers (NV), control patients (CP), patients with diffuse panbronchiolitis (DPB) and patients with idiopathic pulmonary fibrosis (IPF) were examined. Neutrophil counts, NCA and IL-8 concentration in BALF obtained from patients with DPB or IPF was significantly higher than that from NV or CP. The IL-8 concentration correlated with neutrophil count and also correlated with NCA in BALF from patients with IPF, whereas there was no correlation between these factors in BALF from DPB. These results suggest that the contribution of IL-8 to neutrophil accumulation of the lower respiratory tract is different between IPF and DPB

老年者気管支喘息における液性および細胞性免疫反応について

Humoral and cellular immune responses in bronchial asthma were examined by comparing the results of older asthmatics (group OA) with those of older healthy subjects (group OH) and of younger asthmatics (group YA). In humoral immune response, IgE-mediated immune system expressed by elevated serum IgE levels and IgE antibodies for house dust mite (HDm) and/or Candida albicans was clearly found in older asthmatics, while there was no finding showing the presence of IgE-mediated immune response in older healthy subjects. There was no significant difference in levels of serum IgG and IgA among the three groups. However, the serum IgM level was significantly lower in older asthmatics than in younger asthmatics. IgE antibodies to HDm and/or Candida albicans were more frequently found in older asthmatics compared with older healthy subjects. In contrast, IgG(4) antibodies to HDm were not different among the three groups. IgG(4) antibodies to Candida albicans were significantly higher in both older groups than in younger group. However, there was no significant difference between asthmatic and healthy subjects in the elderly. Delayed skin reaction to PPD was significantly more decreased in older asthmatics. These results show that bronchial asthma in the elderly is characterized by the presence of IgE-mediated immune response and by the changes of immune response with aging.気管支喘息における液性および細胞性免疫反応について,老年者気管支喘息,老年者健常人,および若年者気管支喘息の間で比較検討を行った｡1.まず,液性免疫では,血清IgE値高値,ハウスダストやカンジダに対するIgE抗体陽性などのIgE系反応は,老年者気管支喘息においては明らかに観察されたが,老年者健常人では全く観察されなかった｡血清IgGおよびIgA値には3者間に有意の差は見られなかったが,血清IgMは,若年者喘息に比べ老年者喘息で有意に低い値を示した｡2.ハウスダストやカンジダに対するIgE抗体は老年者喘息において老年者健常人に比べより高い頻度で陽性であったが,一方,ハウスダストに対するIgG(4)抗体は3者聞に有意の差は見られなかった｡また,カンジダに対するIgG(4)抗体は,老年者喘息および健常人において,若年者喘息に比べ有意の高値を示した｡しかし,老年者の喘息と健常人との間には有意の差は見られなかった｡3.PPDによる遅延型皮膚反応は,若年者喘息に比べ老年者喘息において有意の減弱傾向を示した｡これらの結果は,老年者喘息はIgE系反応を有していること,そして,加齢による免疫反応の変化の影響を受けること,を示している