胃食管反流性咳嗽的诱导痰细胞及介质特征分析

目的探讨胃食管反流性咳嗽(gastro-esophageal reflux induced cough,GERC)的气道炎症特点。方法根据Irwin’s解剖学诊断程序结合诱导痰方法,筛选出20例GERC患者(GERC组),并以10例健康人(健康对照组)和8例其他病因的咳嗽伴有胃食管反流(GER)患者(GER组)分别作对照组。HE染色分析痰液中细胞分类,分别采用荧光酶免疫法、酶联免疫吸附法测定诱导痰上清液中总IgE、嗜酸细胞阳离子蛋白(ECP)及白细胞介素8(IL-8)的浓度。结果GERC患者中性粒细胞百分率为(63.43±30.89)%较健康对照组(35.53±20.19)%明显增高(P<0.01);巨噬细胞百分率为(32.50±31.02)%较健康对照组(62.91±20.51)%明显降低(P<0.01);而嗜酸细胞百分率为(0.19±0.33)%和淋巴细胞百分率(4.88±10.39)%与健康对照组相比差异无显著性。除嗜酸细胞外,GERC和GERD组的诱导痰细胞总数及细胞学分类指标差异无统计学意义(P>0.05)。GERC组患者诱导痰上清液中IgE,ECP,IL-8的浓度分别为[(3.21±3.26)、(29.28±57.46)、(6.63±5.41)mg/L]与健康对照组[(2.48±0.52)、(8.02±8.39)、(7.02±10.79)mg/L]相比,差异无显著性。结论GERC患者气道存在明显的中性粒细胞性炎症。

Characteristics of airway inflammatory cells and mediators in patients of gastro-esophageal reflux induced cough

Objective To observe the airway inflammation feature in patients of gastro-esophageal reflux-induced cough.Methods Sputum was induced by hypertonic saline aerosol inhalation in 20 cases with GERC,10 healthy subjects and 8 cases with chronic cough due to other causes but accompanying with gastro-esophageal reflux diseases (GERD).The sputum differential cell counts were determined by HE staining.The concentration of total IgE,ECP and IL-8 in the supernatant of induced sputum was measured with fluoroenzyme immunoassay(FEIA) and enzyme linked immunosorbent assay(ELISA),respectively.Results The sputum neutrophil percentage in GERC and GERD patients showed significantly increase compared with those in healthy control(P<0.01).The macrophage percentage in GERC patients showed significant decrease compared with those in healthy subjects(P<0.01).The total cell and differential cell count were not significantly different between GERC and GERD groups(P>0.05),and concentration of IL-8,IgE,and ECP in sputum supernatant showed no significant difference among the GERC,GERD and healthy subjects.Conclusion There is neutrophilic airway inflammation in GERC patients.