各期慢性阻塞性肺疾病患者诱导痰细胞成分与肺功能的关系

Relationship between Lung Function and Induced Sputum Cell Characteristics in Patients with Chronic Obstructive Pulmonary Disease in Different Stages

【目的】比较不同时期慢性阻塞性肺病(COPD)患者诱导痰中细胞组成的变化,及其诱导痰中细胞成分尤其中性粒细胞百分比与气流受限的关系。【方法】对110例COPD患者[急性加重期COPD(AECOPD)患者(A1组)62例、稳定期COPD患者(B组)48例]及30例健康对照者(C组)进行肺功能测定及痰诱导,痰液处理后沉渣作细胞学分析。其中AECOPD组在治疗1周后(A2组)再次进行上述指标的测定。【结果】140例受试者中有21例因不能耐受痰诱导过程或痰标本不合格而退出研究,最终有119例受试者完成本研究(A1,2组48例,B组43例,C组28例)。A1组、A2组、B组、C组诱导痰中细胞总数(106/mL)分别为(8.8±3.7)、(6.5±2.6)、(5.0±2.8)、(2.8±1.3),细胞分类中A1组、A2组、B组以中性粒细胞为主,分别为66%±15%、60%±10%、55%±11%,而在C组中则以巨噬细胞、中性粒细胞为主,分别为37%±10%、32%±8%;AECOPD患者(A1组、A2组)诱导痰中性粒细胞百分比与肺功能指标(FEV1、FEV1%pre、FVC、FEV1/FVC)呈负相关(r分别为-0.860、-0.682、-0.662、-0.300,P<0.001);稳定期组(B组)中性粒细胞与FEV1、FEV1%pre负相关(r分别为-0.346、-0.421,P<0.05),对照组中性粒细胞与肺功能无相关性(P>0.05)。【结论】AECOPD、缓解期、稳定期患者诱导痰细胞以中性粒细胞为主,健康者诱导痰细胞以巨噬细胞为主;气道局部中性粒细胞增多与各期COPD患者气流受限存在密切的关系。

[Objective] To compare the induced sputum characteristics of COPD （chronic obstructive pulmonary disease） patients in different stages with that of normal subjects, and eximine the relationship between the airflow limitation and the induced sputum characteristics especially the number of sputum neutrophils of COPD patients. [Methods] Sputum induction and the lung function were performed in 110 COPD patients （62 acute exacerbation of COPD（AECOPD）（Group A1）, 48 stable COPD patients （Group B）, and 30 healthy volunteers （Group C）. And the same measurements were repeated in the patients with AECOPD after a short-term （1 week ） treatment. We called them catabatic AECOPD patients （group A2）. Cell components of induced sputum of the 4 groups were analyzed. [ Results ] Of the 140 subjects enrolled, 119 finally finished the study （48 in group A1, 43 in group B, and 28 in group C）. Total cell counts（10 6/ml ）in group Al, group A2, and group B were （8.8 ± 3.7）,（6.5 ± 2.6）,（5.0 ± 2.8）, and （2.8 ±1.3）, respectively. The main cell differential （%） of group A1, group A2, and group B were neutrophils：66% ± 15%,60% ± 10%, and 55% ± 11%, respectively. While in group C, the main cell differentials （%） were macrophages and neutrophils, and their percentage were 37% ± 10% and 32% ± 8%, respectively. The percentage of neutrophils was negatively correlated with lung function （FEV1, FEV1%pre, FVC, FEV1/FVC ）in the patients with AECOPD groups（group A1, A2）（r= -0.860, -0.682, -0.662, and -0.300, respectively,P〈 0.001 ）. And the percentage of neutrophils in group B was also negatively correlated with FEV1 and FEV1%pre （r was -0.346 and -0.421, respectively, P〈 0.05）,while there was no relationship between neutrohpils and lung function in group C （P 〉 0.05）. [Conclusions] The main cell differential in induced sputum was neutrophils in the patients with acute exacerbation COPD, catabatic AECOPD and stable COPD, while in healthy volunteers were macrophages.The increased number of neutrophils in the local airway was closely related to the airflow limitation in COPD patients.