咳嗽变异型哮喘患者诱导痰嗜酸粒细胞计数与气道高反应性的相关性分析及诱导痰细胞学检查的诊断价值

Correlation analysis of induced sputum eosinophiis count, airway hyperresponsiveness and the diagnostic value of induced sputum eosinophils count in cough variant asthma

目的探讨咳嗽变异型哮喘（CVA）患者中诱导痰嗜酸粒细胞计数与气道高反应性的相关性及诱导痰细胞学检查在CVA中的诊断价值。方法收集2016年7月至2017年7月就诊于山西医科大学第一医院呼吸科门诊疑似为CVA患者130例（最终诊断CVA96例，非CVA34例），行诱导痰细胞学检查、肺通气功能检查、支气管激发试验（Astograph法），并比较96例CVA患者的临床基本资料、咳嗽症状积分、痰细胞学计数、最小诱发累积剂量Dmin等。结果在本研究中，CVA患者诱导痰嗜酸粒细胞计数与Astograph法激发定量试验（Drain）值呈负相关（r=-0．682，P〈O．001），诱导痰嗜酸粒细胞计数与咳嗽症状积分呈正相关（r=0．750，P〈0．001）。通过受试者工作特征曲线评价诱导痰嗜酸粒细胞计数诊断CVA的价值，其约登指数为58．8％，最佳截断值为3．105％，敏感度为82．3％，特异度为76．5％，曲线下面积为0．793（P〈0．001）。结论CVA患者中，诱导痰嗜酸粒细胞计数与气道高反应程度Dmin值、患者咳嗽症状的严重程度间有显著相关性。诱导痰细胞学检查可作为CVA诊断的重要辅助手段。

Objective To explore the correlation of induced sputum eosinophils count and bronchial provocation test and the diagnostic value of induced sputum eosinophils count in cough variant asthma （CVA）. Methods One hundred and thirty patients with suspected CVA were selected from in July 2016 to July 2017 in the first hospital of Shanxi medical university, finally 96 patients were diagnosed with CVA and 34 patients were diagnosed without CVA. All the patients accepted the measurement of induced sputum, pulmonary ventilation function, and bronchial provocation test （Astograph method）. The demographic data, cough symptoms integration, induced sputumcounts, minimum dose （Drain） in 96 patients with CVA were collected. Results In this study, induced sputum eosinophils count in CVA patients was negatively correlated with bronchial stimulates the quantitative test Drain value （r =-0. 682, p〈0.001）, and positively correlated with cough symptoms integration （r = 0. 751, P〈0.001）.The value of diagnosis to CVA with induced sputum eosinophils count was determined by the receiver operating characteristic curves （ROC）. The Youden＇s index was 58.8%, and the optimal cut-off value was 3. 105%, the sensitivity was 82.3% and the specificity was 76.5%. The areas under the ROC curve was 0. 793 （P〈0. 001）. Conclusions In patients with CVA, there is a significant correlation between induced sputum eosinophils level and airway hyperresponsiveness, and severity of cough symptoms. The induced sputum can be used as an auxiliary and important means for the diagnosis of CVA.