系统性痰液分析技术在评估COPD病情进展中的意义

Value of sputum physico-chemical properties analysis in clinical assessment of chronic obstructive pulmonary disease

目的了解慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病情不同阶段痰液理化特性及炎性因子弹性蛋白酶(neutrophile elastase,NE)、人白细胞弹性蛋白酶抑制因子(elafin)含量的演变,探究其在COPD病情评估中的价值。方法收集20例COPD患者临床缓解期及急性加重期的痰液标本,观察痰液外观性状的差异;采用常规理化分析和免疫荧光定量方法,检测并分析痰液的粘度,痰液中粘蛋白、多糖、硫酸基、NE以及elafin的含量,同时计算痰液炎性损伤因素水平、抗损伤因素水平及损伤指数。结果COPD组痰液理化指标及NE含量均较正常人明显增高(P<0.01),elafin含量均较正常人降低。COPD组急性加重期与临床缓解期相比,痰液外观呈粘液脓性改变,痰液理化指标及NE含量升高(P<0.05),elafin含量降低(P<0.05)。COPD组痰液粘度与粘蛋白、多糖、硫酸基、NE呈正相关,与elafin呈负相关,急性加重期相关度更高。结论COPD病情的进展伴随痰液理化性质的恶化及炎性损伤因素/抗损伤因素水平的失衡,痰液分析在COPD患者病情评估中起重要作用。

Objective To investigate the changes of physico-chemical properites and inflammatory factors of sputum in different clinical periods of chronic obstructive pulmonary disease(COPD),and to assess the clinical value of sputum physico-chemical analysis.Methods The levels of viscosity,mucin,polysaccharose,sulphate esters,neutropil elastase(NE)and elafin consistence expression in sputum were detected in 20 patients with COPD during acute exacerbation period and clinical remission period by routine physiochemical analysis and enzyme-linked immunosorbent assay,and the inflammatory injury factors,anti-inflammatory injury level and injury indexes were calculated.Results All physico-chemical properties and NE in the sputum of patients with COPD were obviously higher than normal(P<0.01),and elafin was lower.These data in acute exacerbation period of COPD were increased more significantly than in clinical remission period(P<0.05).Mucopurulent sputum,as well as elafin,was decreased(P<0.05).The viscosity in the sputum of COPD was positively correlated with mucin,polysaccharose,sulphate esters and NE,and negatively correlated with elafin,espesially in acute exacabation period.Conclusion The clinical progression of COPD is accompanied with the alteration of sputum physico-chemical properites and severe unbalance between inflammatory injury and anti-inflammatory injury factors,and sputum analysis is an important role in assessing the clinical seriousness of COPD.