痰液分析对慢性阻塞性肺疾病病情进展的评估价值

The value of sputum analysis to assess clinical progression of chronic obstructive pulmonary disease

目的 了解慢性阻塞性肺疾病(COPD)病情进展各阶段痰液特性的改变规律,考察其评估病情进展的价值。方法 采用常规理化分析和免疫荧光的方法,分析39例COPD患者临床缓解期、急性发作期及临终前痰液的粘度、粘蛋白含量、多糖含量、硫酸基含量以及中性粒细胞(PMN)膜结合弹力酶(HLE)表达强度与分泌型白细胞弹力酶抑制因子(SPIL)表达强度之比;观察痰液外观性状的变化情况。结果 临床缓解期COPD患者痰液的上述指标均较正常人明显增高,随病情进展,上述指标呈同步进行性升高。痰液外观也随之呈稀薄泡沫样痰→粘液痰→粘液脓性痰改变。痰液成份性指标粘蛋白、多糖、硫酸基含量及HLE/SPIL与痰液粘度的相关性呈明显正相关,相关系数分别为0.63、0.66、0.58及0.55。结论 COPD病情的进展伴随有痰液理化特性的恶化和炎性损伤/抗损伤因素失衡程度的加大,痰液分析有助于COPD病情进展的评估。

Objective To investigate the changes of the sputum in physiocheiuical properties with the progressive procedure of clinical feature in chronic obstructive pulmonary disease (COPD), and to elucidate its value to assess clinical condition.Methods The mucusity, mucins, polysaccharose and sulphate esters consistence, polymorphonuclear neutrophils (PMNs) membrane-bound leukocyte elastase (HLE) and secretory leukoprotease inhibitor (SLPI) expression in the sputum were detected by routine physio-chemical analysis, immunofluorescence and enzyme-linked immunosorbent assay in 39 cases of patients with OOPD in clinical remission, acute attack and agonal stage while the appearance of sputum was observed. Results All parameters measured in the sputum in COPD patients at all stages of clinical condition had changed obviously. With clinical feature progressing, the mucusity, mucins, polysaccharose and sulphate esters consistence of the sputum increased persistantly, the ratio of PMN membrane-bound HLE to SLPI elevated too. The appearance of sputum also showed the process from watery frothy sputum to mucus sputum to mucopuraleat sputum. Positive correlation between the mucusity and mucins, polysaccharose esters, sulphate esters consistence of the sputum were demonstrated with correlation coefficient of 0.63,0.66,0.58,0.55, respectively .Conclusions The progression of COPD in clinical feature was accompanied with more markedly alteration of the sputum in physiochemical properties and severer imbalance between inflammatory injury and anti-inflammatory factors. Sputum analysis is of helpful to assess clinical features of COPD.