慢性阻塞性肺疾病诱导痰细胞分类特点及其与治疗反应性的相关性分析

Cytologic Profile of Induced Sputum and Its Relationship with Treatment Response in Patients with Chronic Obstructive Pulmonary Disease

目的探讨慢性阻塞性肺疾病(简称慢阻肺)诱导痰细胞分类特点及其与治疗反应性的相关性。方法检测65例初诊慢阻肺患者诱导痰细胞分类特点,分析其与肺功能、功能性呼吸困难评分、圣乔治呼吸问卷评分(SGRQ)的相关性,并分析嗜酸粒细胞(Eos)百分比与慢阻肺治疗反应性的相关性。结果慢阻肺稳定期患者诱导痰中性粒细胞(Neu)、巨噬细胞、Eos、淋巴细胞百分比分别为(86.24±15.04)%、(5.75±6.96)%、(4.71±4.79)%、(1.30±1.09)%,其中Eos百分比≥3%者31例(60.78%)。Neu百分比与FEV_1、FEV_1%pred、FVC、FVC%pred呈负相关(P均<0.01),与SGRQ症状评分呈正相关(r=0.304,P=0.034)。Eos百分比与FEV_1/FVC呈负相关(r=-0.399,P=0.004)。给予丙酸氟替卡松+沙美特罗治疗后,Eos百分比≥3%者肺功能及症状改善较Eos百分比<3%者更加显著(P均<0.05)。结论部分稳定期慢阻肺可表现为嗜酸粒细胞性炎症,诱导痰Eos百分比与慢阻肺气流受限呈负相关,对长效型糖皮质激素联合β2受体激动剂治疗反应较好。

Objective To explore the cytologic profile of induced sputum and its relationship with the treatment response in patients with chronic obstructive pulmonary disease（ COPD）. Methods Sixtyfive treatment-naive patients with COPD and 26 normal subjects were recruited for the study. Sputums induced by the inhalation of hypertonic saline were collected,and the associations of differential cell counting were analyzed with pulmonary function,modified Medical Research Council dyspnea scale,St. George＇s Respiratory Questionnaire score（ SGRQ） before and after the treatment with inhaled corticosteroid and longacting β2-agonist. Results The cell percentages of neutrophil（ Neu）,macrophage,eosinophil（ Eos） and lymphocyte in induced sputum of the COPD patients were（ 86. 24 ± 15. 04） %,（ 5. 75 ± 6. 96） %,（ 4. 71 ±4. 79） %,and（ 1. 30 ± 1. 09） %,respectively. The eosinophil percentage（ Eos%） was ≥ 3% in 31patients（ 60. 78%）. The neutrophil percentage（ Neu%） was inversely correlated with forced expiratory volume in 1 second（ FEV1）,percent of predicted value of FEV1（ FEV1% pred）,forced vital capacity（ FVC）,and percent of predicted value of FVC（ FVC% pred）（ P 〈0. 01,respectively）,and positively correlated with the SGRQ symptom score（ r = 0. 304,P = 0. 034）. The Eos% was inversely correlated with FEV1/ FVC ratio（ r =- 0. 399,P = 0. 004）. The patients with Eos% ≥3% improved significantly in FEV1 and symptom score（ P 〈0. 05,respectively） than the patients with Eos% 3%. Conclusions An eosinophilic airway inflammation is present in a subgroup of COPD. The Eos% is inversely correlated with pulmonary function and may be a predictive indicator of response to treatment with inhaled corticosteroids and long-acting β2-agonists.