诱导痰分析对预测毛细支气管炎转归的意义

A study of induced sputum on detecting the development of bronchiolitis

目的观察首次喘息的毛细支气管炎(毛支)患儿诱导痰组分的变化,探讨诱导痰液炎性细胞及细胞因子在预测其转归的价值。方法用4.5%高渗盐水超声雾化法留取70例毛细支气管炎婴儿的诱导痰液,用荧光酶标法、ELISA方法检测诱导痰液中的嗜伊红阳离子蛋白质(ECP)、白介素(IL)-4、干扰素(IFN)-γ水平,台盼蓝染色和瑞氏染色计数嗜酸性粒细胞,随访观察3年。结果毛支发作3年后有24.3%(17/70)患儿发展为哮喘,其初发阶段诱导痰液中的嗜酸性粒细胞(EOS)、ECP、IL-4明显高于未发展为哮喘的单纯毛支患儿(P<0.01),而IFNγ-则明显低于单纯毛支患儿(P<0.01),差异具有显著性。结论对于诱导痰中存在ECP、IL-4、EOS显著增高的毛支患儿有发展为哮喘的可能,在其初发阶段应进行哮喘的早期干预治疗。

Objective To explore the value of induced sputum inflammatory cells and cytokines on asthma predicting of bronchiolitis. Methods A method to induce sputum with inhaled 4.5 % hypertonic salinel was used in 70 infants with bronchiolitis. Levels of eosinophi cationic protein（ECP）, and interleukin-4 （IL-4）, IFN-r in sputum were determined by fluoresent enzyme immunoassay and ELISA respectively. Sputum smear was stained by Wright＇s and toluidine blue, diffential inflammatory cells counts were performed by counting 500 cells under the light microscope. A 3-year follow-up was made for those infants. Results 17 of 23 （24.3%） had developed asthma after bronchiolitis, There were significant increase in the EOS cell tout （5.6 ± 1.6 vs 2.2 ±1.5, P〈0.01）and the ECP contant（6.19 ± 2.76 vs 3.53± 2.04, P 〈0.01 and the IL - 4 levels（11.14 ± 2.35vs7.99 ± 3.95, P 〈0.01）. Levels of IFN -γ was siginifieantly lower than that of bronchiolitis group（4.47 ± 2.35vs7.08 ± 3.05, P〈0.01）. Conclusion Infants who had siginifieantly high levels of ECP, IL-4, EOS counts in induced sputum during first bronehiolitis have high risk to develop asthma.