痰诱导方法研究哮喘儿童气道炎症的安全性和可重复性

Safety and Repeatability of Sputum Induction in Asthmatic Children

目的 探讨高渗盐水痰诱导方法研究哮喘儿童气道炎症的安全性和可重复性。方法 ２８例哮喘儿童（轻度１２例、中度１０例、重度６例）进行痰诱导，测定诱导前后最大呼气流量（ＰＥＦ）变化；对轻度和中度哮喘组于４ｈ和８ｈ后再重复诱导两次，集痰液涂片，进行总细胞计数和分类计数５００个细胞中的各类细胞的百分比。结果 轻度和中度哮喘发作组诱导前后ＰＥＦ值相比无显著差异（Ｐ＞０．０５）。重度哮喘发作组诱导前ＰＥＦ值为１５３．２±１８．０ｍｌ／ｍｉｎ，诱导后为１２１．４±１２．３ｍｌ／ｍｉｎ，两者有显著差异（Ｐ＜０．０５）。轻度哮喘发作组４ｈ和８ｈ以及中度哮喘发作组４ｈ的细胞计数与第１次相比，细胞总数和细胞分类均无显著性差异（Ｐ＞０．０５）。中度哮喘发作８ｈ的细胞计数与第１次相比，细胞总数和上皮细胞分类有显著性差异（Ｐ＜０．０５），而其它细胞则无显著性差异。结论 对哮喘轻度和中度发作的儿童进行痰诱导是安全的，而对重度哮喘发作的儿童进行痰诱导会引起ＰＥＦ显著下降，具有一定的危险；轻度和中度发作儿童８ｈ内重复诱导细胞计数具有可重复性。

Objective To explore the safety and repeatability of hypertonic salineinduced sputum in asthmatic children. Methods 28 asthmatic children (including 12 mild, 10 moderate and 6 severe) were selected to apply the technique of sputum induction by hypertonic saline and to measure the peak expirtory now(PEF) before and after induction. To mild and moderate exacerbation subjects, inductions were repeated at 4h and 8h. Absolute and differential counts of inflammatory cells of the sputum were performed. Results At the first process, before and after induction, the PEF values had no significantly difference between mild and moderate exacerbation subjects (188.0±23.5 υs 168.3±28.5 ml/min, 175.4 ± 43.5 υs 149.7± 30.lml/min, P>0.05), but the severe subjects showed significant decrease in PEF values (153.2± 18.0 υs 121.4± 12.3ml/min, P<0.05). There was no significant change in the total and differential counts of the inflammatory cells in the 4h sample compared with the baseline (P>0.05). The total and percentage of epithelia cells had significant difference in the 8h sample compared with the baseline, but there was no significant difference between the differential counts of others. Conclusion Hypertonic saline -- induced sputum is a safe technique in patients with mild and moderate asthma, but somewhat dangerous in patients with severe asthma. It had fine repeatability to assess airway inflammation in children with mild and moderate exacerbation of asthma within a 8h period.