哮喘-慢阻肺重叠综合症患者诱导痰细胞计数及血清降钙素原检测的意义

Significance of differential cell counts in induced Sputum and serum procalcitonin detection in asthma-chronic obstructive pulmonary disease overlap syndrome

目的探讨不同时期哮喘-慢阻肺重叠综合症(ACOS)患者诱导痰细胞分类计数及血清PCT的变化,了解不同时期ACOS患者气道炎症的类型。方法随机选择2016年6月-9月在我院住院诊治的急性加重期ACOS患者30例作为观察组,分别于急性加重期及稳定期检测诱导痰细胞分类计数及血清PCT,同时期健康体检者30人作为对照组,测定诱导痰细胞计数及血清PCT,比较不同时期ACOS患者诱导痰炎性细胞分类计数及血清PCT的变化。结果急性加重期ACOS患者诱导痰炎症细胞总数、嗜中性粒细胞、嗜酸性粒细胞及血清PCT较稳定期明显升高(P<0.05);稳定期ACOS患者诱导痰炎症细胞总数、嗜中性粒细胞、嗜酸性粒细胞较健康成人明显升高(P<0.05),但两组间血清PCT差异无统计学意义(P>0.05)。结论稳定期ACOS患者气道炎症以慢性炎症为主,主要浸润细胞为嗜酸性粒细胞与中性粒细胞并存,ACOS患者急性加重期多由细菌感染引起,气道急性炎症与慢性炎症共同作用,炎症水平明显高于稳定期。

Objective To investigate the changes and significance of differential cell counts in induced sputum and serum PCT at different stages of asthma-chronic obstructive pulmonary disease overlap syndrome( ACOS),so as to approach the airway inflammatory state in ACOS at different stages. Methods 30 patients with acute exacerbation of ACOS admitted to our hospital from June 2016 to August 2016 were assigned to the observation group to detect differential cell counts in induced sputum and serum PCT separately during acute exacerbation and stable stage.30 healthy subjects receiving physical examination at the same period were assigned to the control group to detect differential cell counts in induced sputum and serum PCT. For patients with ACOS,changes in differential cell counts in induced sputum and serum PCT were compared across different stages. Results In patients with acute exacerbation of ACOS,there were significant increases in total count of inflammatory cells,neutrophil count,eosinophil count and serum PCT compared to those in stable ACOS( P < 0. 05). The total count of inflammatory cells,neutrophil count and eosinophil count were significantly higher in stable ACOS than in healthy population( P < 0. 05). However,there was no statistically significant difference between the two groups in serum PCT( P > 0. 05). Conclusion In stable ACOS,chronic inflammation is the predominant airway inflammation,and eosinophils and neutrophils are the primary co-existing infiltrating cells. Acute exacerbation of ACOS is predominantly caused by bacterial infection under the combined action of acute and chronic airway inflammation,resulting in significantly higher inflammation level than that in stable ACOS.