支气管哮喘患者气道炎症表型研究

Airway inflammatory phenotypes of asthmatic patients

目的 研究不同严重程度支气管哮喘（哮喘）患者的气道炎症表型分布,分析不同气道炎症表型的炎症标志物与肺功能特征.方法 回顾性分析中日友好医院呼吸内科2013年1月至2014年12月完成诱导痰细胞学检查的946例哮喘患者的临床资料,按照严重程度分为重症组（61例）和普通组（885例）.分析重症哮喘和普通哮喘患者的气道炎症表型分布,痰细胞、呼出气一氧化氮和肺功能特征.结果 哮喘患者的气道炎症表型分布为嗜酸粒细胞型占46.6％（441/946）,混合细胞型占27.5％（260/946）,中性粒细胞型占21.5％（203/946）,寡细胞型占4.4％（42/946）,重症组与普通组的炎症表型构成比分别为44.3％、29.5％、21.3％和4.9％以及46.7％、27.4％、21.5％和4.4％,差异无统计学意义（均P＞0.05）.重症组患者痰嗜酸粒细胞水平为（29.1±28.5）％,高于普通组的（22.2±25.2）％,差异有统计学意义（=1.98,P＜0.05）;呼出气一氧化氮水平为（66.4±64.1）ppb,高于普通组的（48.0±43.7）ppb,差异有统计学意义（t=3.23,P＜0.01）;FEV1占预计值％为（63.7±24.1）％、FEV1/FVC为（56.4±15.1）％,均低于普通组[分别为（84.7±23.7）％和（69.1±14.5）％）],差异有统计学意义（均P＜0.01）.重症组气道炎症表型中,中性粒细胞型的FEV1占预计值％[（46.6±16.1）％]和FEV1/FVC比值[（45.2± 16.1）％]最低（均P＜0.01）.结论 哮喘患者气道炎症表型常见为嗜酸粒细胞型、混合细胞型、中性粒细胞型,中性粒细胞型重症哮喘患者肺功能损害更显著.

Objective To analyze the airway inflammatory phenotypes and clinical features of severe asthma compared to mild-moderate （＂common＂） asthma.Methods A total of 946 cases of asthma were retrospectively analyzed in our hospital from January 2013 to December 2014.Sixty-one patients were classified to the severe asthma group,and 885 patients to the common asthma group.Severe asthma was diagnosed based on the protocol from ATS/ERS guidelines.All patients received induced sputum cell counts and pulmonary function tests,and 543 of them received fractional exhaled nitric oxide （FeNO） tests.The airway inflammatory phenotypes were defined and the clinical features of patients of severe asthma were studied.Results The distribution of airway inflammatory phenotypes of asthma was as follows：eosinophilic subtype （46.6%,441/946）,mixed granulocytic subtype （27.5%,260/946）,neutrophilic subtype （21.5 %,203/946）,and paucigranulocytic subtype （4.4%,42/946）.There were no differences between the severe asthma group and the common asthma group in the distributions.Compared with common asthma patients,severe asthma patients had higher sputum eosinophil percentages （29.1% ± 28.5% vs 22.2% ± 25.2%,t =1.98,P 〈 0.05）,higher FeNO values [（66.4 ± 64.1） ppb vs （48.0 ± 43.7） ppb,P 〈 0.01],lower percentages of FEV1 % pred [（63.7 ± 24.1） % vs （84.7 ± 23.7） %,P 〈 0.01],and lower ratios of FEV1/FVC [（56.4 ± 15.1） % vs （69.1 ± 14.5） % P 〈 0.01].In severe asthma patients,FeNO values were higher in the eosinophilic subtype and mixed granulocytic subtype （P 〈 0.05）.Neutrophilic subtype patients had the lowest sputum eosinophil percentage [（1.8 ±0.8）%,P 〈 0.01],the lowest percentage of FEV1 % pred [（46.6 ± 16.1） %,P 〈 0.01],and the lowest ratios of FEV1/FVC [（45.2 ± 16.1） %,P 〈 0.01].Conclusions The common airway inflammatory phenotypes included eosinophilic subtype,mixed granulocytic subtype and neutrophilic subtype,in both severe and common asthma patients.Severe asthma patients had more severe eosinophilic airway inflammation and poorer lung function.Neutrophilic subtype might be the most intractable subtype with severely damaged pulmonary function in severe asthma.