慢性咳嗽患者自然咳痰与诱导咳痰细胞学分析结果比较

Influence of the Use of Spontaneous and Induced of Sputum on Sputum Cell Analysis in Patients with Chronic Cough

目的:探讨自然咳痰与诱导咳痰法对痰细胞学分析结果的影响。方法:60 例能自然咳痰的慢性咳嗽患者先自然咳痰获得痰液样本,然后及经 3%高渗盐水雾化吸入 10 min 后获得诱导痰样本,比较两种方式获得痰样本的细胞总数、细胞分类计数和细胞存活率。通过计算组内相关系数检验两种获得痰样本方法的一致性。结果:60 例患者中男 21 例,女 39 例,平均年龄 41.8±14.2 岁。自然咳痰与诱导咳痰的痰液嗜酸粒细胞比例分别为 2.0%、1.5%、淋巴细胞比例分别为 2.0%、1.5%,两组间无统计学差异(P>0.05)。自然咳痰法痰细胞总数、中性粒细胞比例分别为 4.1×10^6/g、76.5%,均高于诱导咳痰法痰细胞总数(2.4×10^6/g)及中性粒细胞比例(53.5%)(P<0.01)。自然咳痰法细胞存活率、巨噬细胞比例分别为 87.9%、13.8%,较诱导咳痰法细胞存活率(91.6%)、巨噬细胞比例(31.4%)低(P<0.01)。两种痰样本分析所得的嗜酸粒细胞、中性粒细胞、巨噬细胞及淋巴细胞比例的组内相关系数分别为 0.890、0.809、0.709、0.245。结论:自然咳痰与诱导咳痰法均可用于痰液细胞学分析,两种方法对痰液嗜酸粒细胞比例评价无明显影响,但对中性粒细胞及巨噬细胞比例有影响。

Objective:To investigate the influence of the use of spontaneous and induced sputum on sputum cell analysis in patients with chronic cough. Methods:60 patients with chronic cough who could produce spontaneous sputum were included in this study. Spontaneous sputum samples and sputum induced with 3% hypertonic saline for 10 minutes were consequently collected from the same patient. The total and differential cell counts,and cell viability were analyzed and compared. Agreements between the sputum cell analysis results with two methods were determined by calculating the intracalass correlation ecoefficiency(ICC). Results:Of 60 patents,there were 21 females and 39 males, with a mean age of 41.8±14.2 years. The median percentages of eosinophil and lymphocyte in spontaneous sputum and induced sputum were 2.0% vs 1.5%,and 2.0% vs 1.5%,respectively. There were no statistically significant differences between them(all P>0.05). The total cell count,median percentage of neutrophil in spontaneous sputum were 4.1×10^6 /g and 76.5% respectively,which were significantly higher than their counterparts in induced sputum(2.4×10^6 /g,53.5%,P< 0.01). The percentages of viable cells and macrophages in induced sputum were 87.9% and 13.8%,respectively,which were significantly lower than their counterparts in spontaneous sputum (91.6%,31.4%,P<0.01). The ICCs of the percentages of eosinophil,neurophil,macrophage and lymphocyte between spontaneous sputum and induced sputum were 0.890,0.809,0.709,and 0.245,respectively. Conclusion:Both spontaneous sputum and induced sputum can be used for sputum cell analysis. The two methods do not affect the evaluation of sputum eosinophil ratio,but affect on the percentages of neutrophils and macrophages. Induced sputum contains a higher cell viability than spontaneous sputum.