诱导痰液细胞学分析在儿童支气管哮喘临床分型中的应用

Application of Induced Sputum Cytology Analysis for Childhood Asthma Subtype

目的拟通过痰液细胞学分析探讨儿童哮喘的临床亚型。方法选择急性发作期哮喘患儿46例,缓解期哮喘患儿33例。其中轻度至中度哮喘56例,重度哮喘23例。将急性发作期哮喘分为未规则治疗组(33例)和规则治疗组(13例)。健康对照组18例。常规检测肺功能、外周血嗜酸性粒细胞(EOS)计数(%)、诱导痰液细胞百分比(%),并行皮肤过敏原试验。结果1.以痰液EOS%≥2%为准将哮喘患儿分为嗜酸细胞性哮喘(EA)和非嗜酸细胞性哮喘(NEA)2个亚型,79例患儿中EA和NEA分别为40例(50.63%)和39例(49.37%)。2.EOS%≥2%在急性发作期未规则治疗组和急性发作期规则治疗组分别为21例(63.6%)、9例(69.2%),2组比较差异无统计学意义(P>0.05),但显著高于缓解期[10例(30.3%)](Pa<0.05)。3.轻度发作未规则治疗组患儿中性粒细胞百分比(NEU%)≥61%、EOS%≥2%、NEU%<61%+EOS%<2%的例数分别为7例(38.9%)、10例(55.6%)、4例(22.2%),轻度发作期规则治疗组分别为2例(22.2%)、6例(66.6%)、3例(33.3%),2组比较差异无统计学意义(Pa>0.05);重度发作未规则治疗组中NEU%≥61%、EOS%≥2%、NEU%<61%+EOS%<2%的例数分别为3例(20.0%)、12例(80.0%)、2例(13.3%),重度发作规则治疗组分别为1例(25.0%)、3例(75.0%)、1例(25.0%),2组比较差异无统计学意义(Pa>0.05)。4.按痰液细胞学分类,各亚型哮喘患儿一级亲属及个人过敏史阳性率、皮肤点刺试验阳性率、血EOS>0.5×109L-1者的百分比、被动吸烟率的差异均无统计学意义(Pa>0.05)。结论儿童哮喘存在EA、NEA2个亚型,NEA以中性粒细胞炎症为主,哮喘急性发作期EA比例高于临床缓解期。本研究未能证实EA与过敏相关。

Objective To explore the clinical subtype of asthma in children according to induced sputum cytology analysis.Methods Forty-six children with exacerbated asthma and 33 with remission asthma were selected.Among them,56 cases had mild to moderate asthma,while the other 23 had severe asthma.The patients with exacerbated asthma were again divided into 2 groups,one group received irregular treatment （33 cases） and the other regular treatment （13 cases）,and there was also a control group of 18 healthy children. Lung function,peripheral blood eosinophill（EOS） count（EOS%）,the percentage of sputum cell count and skin prick tests were done in all patients.Results 1.Based on EOS%≥2%,the children of asthma subtype were divided into the EOS asthma（EA） subtype and the non EOS asthma（NEA） subtype. Of the 79 asthmatic subjects,40 cases were EA （50.63%） and 39 cases were NEA （49.37%）.2.The percentages of EOS%≥2% in the sputum were found in 21 cases（63.6%） in exacerbated asthma with irregular treatment group and 9 cases（69.2%） in the regular treatment group,which were much higher than those in remission asthma group [10 cases（30.3%）]（Pa〉0.05）,but there was no significant difference between the exacerbated asthma with irregular treatment group and the with regular treatment group（P〉0.05）.3.The percentages of noutrophil（NEU）%≥61%,EOS%≥2%,NEU%61%＋EOS%2% in the sputum of mild asthma with irregular treatment group were 7 cases（38.9%）,10 cases（55.6%）,and 4 cases（22.2%）,while the percentages of NEU%≥61%,EOS%≥2%,NEU%61%＋EOS%2% in the sputum of mild asthma with regular treatment group were 2 cases（22.2%）,6 cases（66.6%） and 3 cases（33.3%）. There was no significant difference between mild asthma with irregular treatment group and mild asthma with irregular treatment group（P〉0.05）. The percentages of NEU%≥61%,EOS%≥2%,NEU%61%＋EOS%2% in the sputum of exacerbated asthma with irregular treatment group were 3 cases（20.0%）,12 cases（80.0%） and 2 cases（13.3%）,whereas the percentages of NEU%≥61%,EOS%≥2%,NEU%61%＋EOS%2% in the sputum induced（SI） of the regular treatment group were of 1 case（25.0%）,3 cases（75.0%） and 1 case（25.0%）.There was no significant difference between the exacerbated asthma with irregular treatment group and the exacerbated asthmatics with regular treatment group（P〉0.05）.4.There was no significant difference in atopic family history,the percen-tages of skin prick test positive children,the percentages of peripheral blood EOS count 0.5× 109 L-1,and passive smoking rate among groups of various subtypes of asthmatic children（Pa〉0.05）.Conclusions Asthmatic children exhibit 2 subtypes named EA and NEA,NEU inflammation is the major subtype of the NEA group,and the percentage of EA in the exacerbated asthma group was higher than that in the chinical remission asthma group.This study failed to establish the relationship between EA and allergy.