支气管肺泡灌洗术在难治性哮喘诊治中的应用价值

The application value of the bronchoalveolar lavage in diagnosis and treatment of refractory asthma

目的了解难治性哮喘气道炎症的粒细胞表型,初步探讨支气管肺泡灌洗术(broncho-avleolar lavage,BAL)在难治性哮喘诊治中的应用价值。方法 31例难治性哮喘患者选择右肺中叶或左肺舌段进行BAL,回收支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)进行细胞分类和细菌培养。结果 31例患者的BALF中中性粒细胞比例均呈不同程度升高,范围分布于8%～97%,其中中性粒细胞比例大于40%者占64.5%,而嗜酸粒细胞比例升高者只有6例,其中3%～6%的5例,54%的1例。BALF培养结果发现,烟曲霉(+)4例,铜绿假单胞菌(+)1例,大肠杆菌(+)1例。结论以中性粒细胞浸润为主的气道炎症表型可能是难治性哮喘的一种特征,通过BALF检查有助于难治性哮喘的诊断和制定个体化的治疗。

Objective To know about granulocyte phenotype of the refractory asthma airway inflammation,and preliminarily discuss the application value of bronchoalveolar lavage(BAL) in refractory asthma.Methods The 31 cases of patients with refractory asthma undergo the BAL in the middle lobe of right lung or lingual segment of left lobe.And recycle the bronchoalveolar lavage fluid(BALF) to process cell classification and cell culture.Results In the BALF of the 31 patients,the neutrophils ratio rise in varying degrees,the range is distributed in 8% to 97%,of which the neutrophils ratio more than 40% account for 64.5%,and the proportion of eosinophilic granulocyte rise only six cases,3%~6% in 5 patients,and 54% in 1 patient.The BALF culture results have found,aspergillus fumigatus(+) 4 cases,pseudomonas aeruginosa(+) 1 case,and escherichia coli(+) 1 case.Conclusions Mainly neutrophils infiltrating in the airway inflammation phenotype may be a way of refractory asthma.It is helpful to the diagnosis of refractory asthma and draw out individuation treatments through the BAL examination.