难治性哮喘不同表型的临床特征与外周血细胞的关系

Relationship between clinical features of different phenotypes of refractory asthma and peripheral blood cells

目的探究与分析难治性哮喘不同表型的临床特征与外周血细胞的相关性。方法选取新疆维吾尔自治区人民医院自2016年5月~2018年5月收治的难治性哮喘(88例)作为研究对象,实施诱导痰细胞学检查。按照不同的气道炎症表型分为嗜酸性粒细胞型、中性粒细胞型、混合细胞型及寡细胞型。比较不同气道炎症表型患者肺功能指标、外周血计数。结果嗜酸性粒细胞型、混合细胞型患者第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、呼出气一氧化氮(FeNo)明显高于中性粒细胞型患者,差异有统计学意义(P<0.05)。寡细胞型患者FEV1、FEV1/FVC明显高于中性粒细胞型,FeNo明显低于中性粒细胞型,差异有统计学意义(P<0.05)。嗜酸性粒细胞型和混合细胞型患者中性粒细胞明显低于中性粒细胞型,嗜酸性粒细胞明显高于中性粒细胞型,差异有统计学意义(P<0.05)。寡细胞型患者中性粒细胞明显低于中性粒细胞型,淋巴细胞明显高于中性粒细胞型,差异有统计学意义(P<0.05)。结论难治性哮喘气道炎症表型有4种,中性粒细胞型患者肺功能较差,外周血细胞中嗜酸粒细胞及中性粒细胞的水平进行判断在评估哮喘炎症表型方面具有相关性。

Objective To explore and analyze the correlation between different phenotypes of refractory asthma and peripheral blood cells.Methods Eighty-eight patients with refractory asthma admitted to Xinjiang Uygur Autonomous Region People′s Hospital from May 2016 to May 2018 were selected as subjects,while they were enrolled in the sputum cytology.According to different airway inflammation phenotypes,the patients were classified in acidic granulocyte type,neutrophil type,mixed cell type and oligocytic type.The lung function indexes and the peripheral blood counts of patients with different airway inflammation phenotypes were compared.Results Forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FVC),fractional exhaled nitirc oxide(FeNO)in acidic granulocyte type and mixed cell type patients were significantly higher than those in neutrophil type,and the differences were statistically significant(P<0.05).FEV1、FEV1/FVC in oligocytic type patients were significantly higher than those in neutrophil type,while FeNo was lower than that in neutrophil type,and the differences were statistically significant(P<0.05).Neutrophils in acidic granulocyte type and mix cell type patients were significantly lower than those in neutrophil type,while eosinophils were significantly higher than those in neutrophil type,and the differences were statistically significant(P<0.05).Neutrophils in oligocytic type patients were lower than that in neutrophil type,while lymphocytes were significantly higher than those in neutrophil type,and the differences were statistically significant(P<0.05).Conclusion There are four phenotypes of airway inflammation in refractory asthma.Among them,the pulmonary function of neutrophil type is poor,and the levels of eosinophils and neutrophils in peripheral blood cells are correlated in assessing the inflammatory phenotype of asthma.