不同气道炎症表型哮喘278例的临床特征分析

Clinical characteristics of different airway inflammatory phenotypes in patients with asthma

目的研究哮喘不同炎症表型的临床特征。方法采用回顾性分析的方法,收集2011年1月至2012年3月期间在本院就诊哮喘患者的病史,共纳入资料完整的患者287例,根据诱导痰炎症细胞分类不同将患者分为4组:嗜酸性粒细胞性哮喘(Eos)组(41.5%,119/287),中性粒细胞性哮喘(Neu)组(27.5%,79/287),寡细胞性哮喘(Pau)组(11.1%,32/287),混合细胞性哮喘(Mix)组(19.9%,57/287)。对诱导痰细胞学检查和肺功能等结果进行分析。结果各组患者在性别、病程、发病年龄、特应性、吸烟、体质指数、ACT评分、规律使用吸入激素方面无统计学差异(P>0.05)。在诱导痰炎症细胞方面,Mix组炎症细胞总数显著高于其余3组(P<0.01)。在Neu组和Mix组中,存在气流受限患者(FEV1占预计值<80%)的诱导痰中性粒细胞比例与FEV1占预计值百分率呈显著的负相关(r=-0.386 6,P=0.032)。结论哮喘患者存在不同的气道炎症表型,但其临床特征无显著差异。中性粒细胞炎症可能在哮喘气道阻塞中起重要作用。

Objective To investigate the clinical characteristics of different airway inflammatory phenotypes in patients with asthma.Methods A total of 287 patients with asthma were recruited from the out-patient of Xinqiao Hospital from January 2011 to March 2012,and were divided into four groups according to different counts of sputum cells including an eosinophilic group（Eos group;41.5%,119/287）,a neutrophilic group（Neu group;27.5%,79/287）,a pauci-granulocytic group（Pau group;11.1%,32/287） and a mixed granulocytic group（Mix group;19.9%,57/287）.The medical records,demographic information,results of the induced sputum cytology and pulmonary function were analyzed retrospectively.Results There were no significant difference in sex,onset age,smoking,atopy,duration of asthma,body mass index,ACT score and regular use of inhaled corticosteroids among the four groups（P0.05）.However,the total inflammatory cell count in the Mix group was significantly higher than that in other groups（P0.01）.In the Neu group and Mix group,there was significantly negative correlation between the neutrophil ratio in induced sputum and FEV1%pred in the patients with airflow limitation（FEV1%pred80%）（r=-0.386 6,P=0.032）.Conclusion Though there are four inflammatory phenotypes of asthma,the clinical characteristics are not significantly different.The neutrophilic airway inflammation may play an important role in airway obstruction of asthma.