老年哮喘患者支气管肺泡灌洗液中粒细胞巨噬细胞集落刺激因子水平变化及意义

Level of Granulocyte Macrophage Colony Stimulating Factor in Bronchoalveolar Lavage Fluid from Elderly Patients with Asthma Bronchial and Their Significance

目的：探讨老年哮喘患者支气管肺泡灌洗液（BALF）中粒细胞巨噬细胞集落刺激因子（GM-CSF）水平变化及其临床意义。方法通过支气管镜肺泡灌洗，收集2015年1月～12月确诊的39例老年哮喘患者急性发作期和缓解期以及35例对照者的BALF标本。显微镜下计数BALF中中性粒细胞（NEU）占白细胞百分比，采用酶联免疫吸附试验检测 BALF中 GM-CSF和髓过氧化物酶（MPO）水平。统计学处理采用 LSD-t检验和Pearson相关分析。结果老年哮喘患者BALF中GM-CSF水平急性发作期（184.6±35.0 ng／L）显著高于缓解期（132.9±31.4 ng／L）及对照组（125.0±26.1 ng／L ），差异有统计学意义（t＝6.778，8.115，P 均＜0.01）；MPO水平急性发作期（43.9±11.7 ng／L）显著高于缓解期（24.5±9.9 ng／L）及对照组（21.8±8.5 ng／L ），差异有统计学意义（t＝7.804，9.080，P均＜0.01）；NEU百分比急性发作期（42.1％±9.6％）显著高于缓解期（31.6％±8.2％）及对照组（28.8％±7.5％），差异有统计学意义（t＝5.127，6.497，P 均＜0.01）。老年哮喘患者缓解期BALF中 GM-CSF和 MPO水平及 NEU百分比与对照组比较，差异均无统计学意义（t＝1.153～1.840，P均＞0.05）。老年哮喘患者急性发作期 BALF中 GM-CSF和 NEU百分比及 MPO水平均呈正相关（r＝0.554，0.725，P均＜0.01），NEU百分比与MPO呈正相关（r＝0.569，P＜0.01）。结论老年哮喘患者急性期BALF中GM-CSF水平升高，与疾病的发生发展关系密切，可作为病情的有效监测指标。

Objective To elucidate clinical significance of the varied level of granulocyte macrophage colony stimulating factor （GM-CSF）in bronchoalveolar lavage fluid （BALF）from elderly patients with asthma bronchial.Methods From January to December 2015,39 asthma bronchial patients and 35 controls were enrolled into the current study.BALF were obtained through the bronchoscope alveolar lavage.Cells were counted under the microscope.GM-CSF and myeloperoxidase （MPO） were detected by ELISAs.LSD-t test and Pearson correlation were used for statistical analysis.Results There was signifi-cant difference in GM-CSF levels of asthma bronchial patients in attack stage （184.6±35.0 ng/L）,remission stage （132.9 ±31.4 ng/L）and control groups （125.0±26.1 ng/L）.Through pairwise comparison,the GM-CSF levels in asthma bron-chial patients in attack stage were significantly higher than that in remission stage （t=6.778,P〈0.01）and control groups （t=8.115,P〈0.01）.The levels of MPO in the 3 groups were 43.9±11.7 ng/L,24.5±9.9 ng/L,21.8±8.5 ng/L,re-spectively.Comparison to remission and normal control groups,the MPO levels were markedly higher in attack stage （t=7.804,9.080,both P〈0.01）.The percentages of neutrophils were 42.1%±9.6%,31.6%±8.2% and 28.8%±7.5% re-spectively in the 3 groups,respectively.The percentages of neutrophils in attack stage were markedly higher than that in re-mission stage （t=5.127,P〈0.01）as well as normal control groups （t=6.497,P〈0.01）.The levels of GM-CSF and MPO and the percentages of neutrophils were no significant differences between asthma bronchial patients in remission stage and in control groups （t=1.153~1.840,all P〉0.05）.Furthermore,the result of this study showed a positively correlated be-tween the GM-CSF and the percentages of neutrophils （r=0.554,P〈0.01）as well as the MPO （r= 0.725,P〈0.01）and a positive correlation between the percentages of neutrophils and the MPO （r= 0.569,P〈0.01）in elderly patients with asthma bronchial in attack stage.Conclusion These results indicated that GM-CSF was higher in asthma bronchial patients in attack stage,and suggesting that GM-CSF might be involved in the pathological process of asthma.GM-CSF may be used as an effective index to monitor the condition of elderly patients with asthma.