咳嗽变异型哮喘患者气道阻力和肺泡灌洗液变化的研究

Study of airway resistance and bronchoalveolar lavage fluid changes in cough variant asthma

目的探讨咳嗽变异型哮喘(CVA)肺功能气道弹性阻力和肺泡灌洗液(BALF)细胞学以及细胞因子变化的特征。方法 对28例CVA、26例慢性阻塞性肺疾病(COPD)稳定期患者和26例健康非吸烟者行最大呼气流量客积曲线(MEFV)、气道弹性阻力、BALF中细胞分类计数、T淋巴细胞亚群、肿瘤坏死因子(TNF-α)和白细胞介素-8(IL-8)测定。结果(1)CVA患者呼气流量指标[最大呼气流量(PEF),最大呼气中段流量(MMEF),一秒用力呼气容积(FEV1)]与健康对照组比较差异无显著性(P>0.05)。气道弹性阻力增高,与COPD组比较差异无显著性(P>0.05)。(2)CVA患者BALF嗜酸性粒细胞百分率显著高于正常对照组和COPD组(P<0.001和P<0.01)。(3)CVA患者队LF中CD+4和CD+8显著高于正常对照组(P<0.001),但低于COPD组(P<0.001)。(4)CVA患者BALF中TNF-α值显著高于COPD组和正常对照组(P<0.01);CVA组中IL-8值和COPD组IL-8值显著高于正常对照组(P<0.01)。结论 气道弹性阻力、BALF细胞分类计数、T细胞亚群及TNF-α、lL-8值测栓有助于CVA与COPD的鉴别诊断,可作为诊断CVA的参考指标。

Objective To study the characteristics of airway elastic resistance and changes of cyto-logicals, cytokines in bronchoalveolar lavage fluid (BALF) in patients with cough variant asthma (CVA). Methods MMEV、airway elastic resistance、differential cell count and T-cell subpopulation of the BALF obtained, the level of TNF-α and IL-8 of the BALF were measured in 28 cases with CVA, 26 cases with chronic obstructive pulmonary disease (COPD) in stability and 26 cases normal controls (no-smokers). Results (l)Airway elastic resistance have increased, characteristics similar with COPD group. (2) The percentage of eosinophils of BALF in the CVA were significantly higher than these in control group and these COPD group (P<0. 001 and P<0. 01). (3) The Percentage of CD+4 and CD+8 of BALF in the CVA were significantly higher than these in control group CD+4 and CD+8 (P<0. 001); but were significantly lower than these in COPD group CD+4 and CD+8 (P<0. 001). (4) The levels of TNF-α in the CVA were significantly higher thon these COPD group TNF-α and these control group TNF-α(P<0. 01). The levels of IL-8 of BALF in the CAV and the levels of IL-8 of BALF in the COPD were significantly higher than these control group (P<0. 01). Conclusion It is indicated that measurement of airway elastic resitance, differential cell count, T-cell subpopulation, TNF-α and IL-8 were helpful in differential diagnosis of CAV from COPD, and were sensitive index as candidate for CVA.