嗜酸细胞支气管炎

1　概念在慢性咳嗽的原因研究中 ,嗜酸细胞支气管炎是咳嗽的一个原因。嗜酸细胞性支气管炎首先由 Gibson等在 1989年L ancet杂志上提出 [1 ] 。近几年来有大量的相关论文。Brighting等强调了在治疗慢性咳嗽病人中嗜酸细胞支气管炎的重要性。嗜酸细胞支气管炎的定义是有一个像哮喘一样的嗜酸细胞气道炎咳嗽的特点 ,肺功能正常。甲基胆碱激发试验阴性 ,没有可变性气道阻塞的证据。吸入皮质类固醇有良好的作用。而“纯粹的嗜酸细胞支气管炎”将不属于“标准的哮喘概念”之内 ,它好像有理由认为是一个症状差异 ,如同咳嗽变异性哮喘一样。Brigh…     

嗜酸细胞趋化因子在哮喘、嗜酸细胞性支气管炎患者诱导痰中的表达及其与气道炎症的关系

目的探讨嗜酸细胞趋化因子（eotaxin）在支气管哮喘、嗜酸细胞性支气管炎患者气道炎症发生中的作用以及在两者间的区别。方法分别收集支气管哮喘（A组）、嗜酸细胞性支气管炎（EB组）、单纯慢性支气管炎（CB组）缓解期/稳定期患者13例、11例、12例和健康对照者（C组）9例。诱导痰并经处理后进行分类细胞记数,并用夹心法酶联免疫吸附测定（ELISA）其诱导痰上清液中eotaxin浓度。结果诱导痰嗜酸细胞占白细胞百分比（Eos/Leu%）、eotaxin浓度A组[（19.2±9.7）%;（0.251±0.118）g/L]、EB组[（11.4±6.1）%;（0.146±0.079）g/L]分别与CB组[（0.9±0.6）%;（0.043±0.036）g/L]、C组[（0.8±0.4）%;（0.031±0.013）g/L]比较,差异有显著性（P均〈0.05）;A组Eos/Leu%、eotaxin浓度与EB组比较,差异也有显著性（P均〈0.05）。结论 eotaxin可能通过对Eos的选择性趋化作用参与了支气管哮喘和嗜酸细胞性支气管炎患者气道炎症的发生机制,这种作用机制对于支气管哮喘和嗜酸细胞性支气管炎在程度上可能是不同的。     

慢性支气管炎还是嗜酸细胞性支气管炎?

编辑同志 :我们怀着极大的兴趣拜读了付杰伟等的论文“嗜酸细胞趋化因子在哮喘、慢性支气管炎患者诱导痰中的表达及其与气道炎症的关系”[1 ] ,受益匪浅。现提出一些看法供商榷。随着诱导痰细胞分析等无创性气道炎症检查技术在临床上的应用 ,对包括慢性支气管炎 (简称慢支 )在内的慢性气道炎症性疾病的认识更加深入。从发表的研究结果来看 ,大部分单纯慢支患者急性发作期的诱导痰细胞分析均显示中性粒细胞升高为主 ,仅少数患者出现嗜酸细胞增多。诱导痰嗜酸细胞增多的患者可诊断为非哮喘性嗜酸细胞性支气管炎 (简称为嗜酸细胞性支气管炎 )。…     

嗜酸粒细胞性支气管炎的气道炎症和临床特点

目的　探讨嗜酸粒细胞性支气管炎 (eosinophilicbronchitis,EB)的诊断、治疗及其气道炎症特点。方法　采用Irwin慢性咳嗽解剖学诊断程序 ,对 86例慢性咳嗽患者进行病因诊断 ;通过诱导痰 ,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嗜酸粒细胞阳离子蛋白 (ECP)、白细胞介素 8(IL 8)的浓度 ,并以 9例正常人和 9例典型哮喘患者作对照组 ;吸入布地奈德干粉剂 2 0 0～ 4 0 0 μg ,每天 2次 ,治疗 4周 ,部分患者同时口服泼尼松 10～ 15mg/d或甲泼尼龙 8～ 12mg/d ,1周。结果　本组有 13例符合EB诊断 ,占慢性咳嗽的 15 % ,多表现为慢性干咳 ,肺功能正常 ,组胺激发试验阴性。EB诱导痰嗜酸粒细胞 (Eos)为 0 186 2± 0 16 32 ,ECP浓度为(2 5 3± 2 0 7)mg/L ,均较正常人升高 (P <0 0 1) ;糖皮质激素治疗 1周后 ,13例患者的咳嗽均消失。结论　EB是引起慢性咳嗽的一个重要原因 ,气道具有以Eos为主的炎症 ,糖皮质激素治疗效果良好。     

嗜酸细胞性胃肠炎的诊断和治疗

目的探讨嗜酸细胞性胃肠炎(EG)的诊断要点和治疗预后。方法对7例EG患者的临床特点、实验室检查、内镜表现和治疗随诊情况进行分析。结果(1)粘膜型EG患者常以腹痛和腹泻为首发症状,而浆膜型以腹痛和腹胀为首发症状,可伴恶心呕吐、低热等。(2)外周血和骨髓中嗜酸细胞计数明显增高(45.0%±22.4%和35.5%±2.6%),以成熟型为主,并随症状的有无而增减。(3)血沉、C反应蛋白、纤维蛋白原等指标正常,IgG可下降。(4)腹水为渗出液,可见嗜酸细胞。(5)内镜表现多为粘膜片状糜烂和水肿,以胃窦和回盲部明显,活检可证实大量嗜酸细胞浸润。(6)激素可在1周内迅速缓解症状,并使嗜酸细胞恢复正常。(7)病情可有反复,但预后良好。结论EG临床和内镜表现无特异性,外周血嗜酸细胞、腹水嗜酸细胞,尤其是胃肠粘膜组织中嗜酸细胞增多是诊断的关键。     

嗜酸粒细胞性支气管炎

嗜酸粒细胞性支气管炎(eosinophilic bronchitis,EB)是近年提出的疾病诊断,突出特征是慢性咳嗽,无痰或晨咳少许粘痰,肺功能正常,乙酰甲胆碱(或组胺)激发试验阴性,没有可逆性气流阻塞的证据,糖皮质激素治疗反应良好。本文拟对其与有关疾病的关系、病因、病理、发病机制、治疗等方面的进展及进一步研究的方向做简要综述。     

嗜酸细胞性支气管炎38例临床分析

嗜酸细胞性支气管炎（NAEB）是一种以气道嗜酸细胞浸润为特征的非哮喘性支气管炎，是慢性咳嗽的重要病因，临床易被误诊为慢性支气管炎。2002年1月-2008年6月，我院收治NAEB患者38例。现回顾性分析如下。     

069 嗜酸粒细胞性支气管炎

嗜酸粒细胞性支气管炎(eosinophilic bronchitis,EB)是近年提出的疾病诊断,突出特征是慢性咳嗽,无痰或晨咳少许粘痰,肺功能正常,乙酰甲胆碱(或组胺)激发试验阴性,没有可逆性气流阻塞的证据,糖皮质激素治疗反应良好.本文拟对其与有关疾病的关系、病因、病理、发病机制、治疗等方面的进展及进～步研究的方向做简要综述.     

069 嗜酸粒细胞性支气管炎

嗜酸粒细胞性支气管炎（eosinophilic bronchitis,EB）是近年提出的疾病诊断,突出特征是慢性咳嗽,无痰或晨咳少许粘痰,肺功能正常,乙酰甲胆碱（或组胺）激发试验阴性,没有可逆性气流阻塞的证据,糖皮质激素治疗反应良好。本文拟对其与有关疾病的关系、病因、病理、发病机制、治疗等方面的进展及进一步研究的方向做简要综述。     

支气管刷检嗜酸粒细胞计数在嗜酸粒细胞性支气管炎诊断中的价值

目的探讨支气管刷检嗜酸粒细胞（EOS）计数在嗜酸粒细胞性支气管炎（EB）诊断中的价值。方法选择32例EB患者（EB组）,18例咳嗽变异性哮喘患者（CVA组）,26例其它病因咳嗽患者（其它病因组）和13名健康人（健康对照组）,分别进行诱导痰、支气管刷检洗涤液和支气管肺泡灌洗液（BALF）中EOS的检测。结果EB及CVA组各标本中EOS的比例较其它病因及健康对照组明显增高（P〈0．001）;在EB及CVA组,支气管刷检洗涤液中EOS的比例显著高于诱导痰和BALF（P均〈0．叭）;支气管刷检EOS计数诊断EB的敏感性、特异性、阳性预测值和阴性预测值分别为100％、71．9％、66．7％和100％。结论经纤支镜支气管刷检EOS计数在EB的诊断中具有较重要的价值。     

嗜酸细胞趋化因子在哮喘、慢性支气管炎患者诱导痰中的表达及其与气道炎症的关系

目的　探讨嗜酸细胞趋化因子 (eotaxin)在嗜酸细胞性气道炎症和气流阻塞发生中的作用。方法　收集单纯型慢性支气管炎 (A组 )、慢性喘息性支气管炎 (B组 )、支气管哮喘 (C组 )急性发作期患者各 11例和健康对照者 (D组 ) 7名。用夹心法酶联免疫吸附测定 (ELISA)诱导痰上清液中eotaxin浓度。结果　B组 [(2 3 4± 5 8) % ]、C组 [(2 0 7± 3 1) % ]诱导痰嗜酸细胞占白细胞百分比(EOS/Leu % )分别与A组 [(11 6± 2 6 ) % ]、D组 [(1 2± 0 3) % ]比较 ,差异有显著性 (P均 <0 0 0 1) ;B组eotaxin浓度 [(0 2 90± 0 170 )g/L]与A组 [(0 12 0± 0 0 2 0 )g/L]比较 ,差异有显著性 (P =0 0 0 7) ;B组与D组 [(0 0 30± 0 0 5 0 )g/L]比较 ,差异也有显著性 (P <0 0 0 1) ,C组 [(0 2 40± 0 140 )g/L]与A组比较 ,差异有显著性 (P =0 0 18) ;C组与D组比较差异也有显著性 (P =0 0 0 1) ,但B组EOS/Leu %和eotaxin浓度与C组比较差异均无显著性 (P =0 196、0 490 )。B、C组EOS/Leu %与一秒钟用力呼气容积占预计值百分比 (FEV1占预计值 % )呈负相关 (r分别 =- 0 92 1、- 0 6 6 3,P <0 0 0 1或 0 0 2 6 ) ;C组eotaxin浓度与FEV1占预计值 %呈负相关 (r =- 0 6 43,P =0 0 33)。B、C组eotaxin浓度与E     

嗜酸粒细胞性支气管炎的研究进展

嗜酸粒细胞性支气管炎（eosinophilicbronchitis,EB）是慢性咳嗽的主要病因之一,近年来其发病率呈上升趋势,国内其发病率为17．2％。EB是以慢性咳嗽为主要症状,其特点是肺部影像学、肺功能、气道反应性、PEF日间变异率均正常,而诱导痰嗜酸粒细胞比例增高,糖皮质激素治疗有效。病因尚不清楚,发病机制有待进一步研究。本文对EB的流行病学、病因、病理表现、发病机制、诊断、治疗和预后作一综述。     

Sputum neutrophilia can mask eosinophilic bronchitis during exacerbations

BACKGROUND:

Exacerbations of airway disease are eosinophilic, neutrophilic, both or neither. The primary objective of the present study was to identify whether the treatment of a neutrophilic bronchitis can unmask an associated eosinophilia.

METHODS:

A retrospective survey of 2160 consecutive sputum cell counts from 1343 patients with airway disease was conducted to identify patients with an isolated neutrophilic bronchitis, which was defined as a sputum total cell count of greater than or equal to 12×10⁶ cells/g of sputum and a proportion of neutrophils of 80% or greater. The characteristics of the patients who subsequently demonstrated sputum eosinophilia (3% or greater) within eight weeks of resolving the neutrophilia were compared with the patients who subsequently did not have sputum eosinophilia.

RESULTS:

Two hundred thirty-seven patients had 273 neutrophilic exacerbations. The sputum was re-examined within eight weeks in 65 patients (27.4%), of whom 38 (58.5%) had resolution of the neutrophilic bronchitis after treatment with an antibiotic. Of these 38 patients, 13 (34%) showed eosinophilia.

CONCLUSIONS:

A neutrophilic exacerbation of airway disease was observed to mask sputum eosinophilia in one-third of patients who had sputum cell counts available before and after antibiotic therapy. Hence, the absence of sputum eosinophilia during an infective exacerbation should not be used as an indication to reduce the dose of corticosteroids. To optimize therapy, repeat sputum cell count measurements are recommended after antibiotic treatment before changing corticosteroid treatment.     

非支气管哮喘嗜酸粒细胞性支气管炎的最新进展

非支气管哮喘(简称哮喘)嗜酸粒细胞性支气管炎(nonasthmatic eosinophilie bronchitis,NAEB)以慢性咳嗽为主要症状,无明显临床体征,肺影像学与肺功能正常,无气道高反应性,应用抗生素治疗无效,而应用糖皮质激素治疗有效,由于诱导痰液中嗜酸粒细胞≥3%而称为NAEB.其病因与发病机制尚不清楚,近年在病机、诊断程序及治疗方面取得较大进展.本文就近年对该病的认识作一综述.     

嗜酸粒细胞性支气管炎在慢性咳嗽病因分布情况及治疗对策

目的 了解嗜酸粒细胞性支气管炎(EB)的发病率,评价孟鲁司特与吸入激素(布地奈德)治疗EB的疗效与安全性.方法 对慢性咳嗽患者,遵循我国咳嗽指南慢性咳嗽诊断流程进行诊断.确诊EB患者随机分成3组,甲组为孟鲁司特治疗组,乙组为布地奈德治疗组,丙组为孟鲁司特联合布地奈德治疗组,疗程4周.比较其疗效与安全性.结果 慢性咳嗽患者467例,其中56例确诊EB患者(占12％),治疗前三组患者性别、年龄、咳嗽病史、咳嗽症状评分、诱导痰嗜酸粒细胞(Eos)比例及嗜酸粒细胞阳离子蛋白(ECP)、白三烯C4( LTC4)相比较,差异均无统计学意义(P＞0.05),三组治疗后改善咳嗽症状有效率、治疗前后外周血Eos计数差异无统计学意义(P＞0.05),三组治疗后诱导痰Eos分类、ECP、LTC4较治疗前明显降低(P＜0.01),治疗后丙组诱导痰Eos分类、ECP、LTC4较甲组、乙组降低(P＜0.05),三组间不良反应发生率差异无统计学意义(P＞0.05).结论 EB发病率较高,是慢性咳嗽的常见原因.孟鲁司特单独或联合布地奈德能改善EB咳嗽症状及降低气道嗜酸粒细胞性炎症.     

The role of induced sputum in the diagnosis of pulmonary tuberculosis

OBJECTIVES: To determine the sensitivity of referral guidelines for induced sputum in pulmonary tuberculosis (PTB) case detection and determine the diagnostic yield of the test. METHODS: A retrospective analysis of case notes of adult patients referred for induced sputum was carried out at the North Trent Regional Department of Infection and Tropical Medicine, the Royal Hallamshire Hospital, Sheffield, UK. Clinical characteristics were noted on patients referred during a 12-month period in 2001-2002, and of all patients with positive induced sputum results from April 1998 to March 2002. RESULTS: Over a 12-month period 114 patients were referred in our unit for induced sputum sampling. Twelve of the 114 patients had positive sputum cultures giving a positive yield for the test of 10.5%. With strict adherence to our referral guidelines, 10 of the 12 positive cases (83.3%) would have been detected. With modification to the referral guidelines, all 12 microbiologically positive cases would have been detected making the guidelines 100% sensitive in detecting microbiologically positive cases among patients referred with a clinical suspicion of PTB who are unable to self-expectorate. The positive yield for the test would have been increased to 13.2%. In the past 4 years 29 patients had positive induced sputum results. Of these, 11 patients (37.9%) had concurrent microbiological proven extra-pulmonary TB (EPTB) and 10 (34.5%) had past histories of TB infection. Seven patients had chest X-rays reported as normal. CONCLUSIONS: Induced sputum offers a relatively non-invasive investigation for patients with suspected PTB who are unable to bring up sputum. Induced sputum also offers a means of establishing a microbiological diagnosis in some cases of EPTB. An investigative algorithm is suggested.Summary. In an era of increasing drug resistant disease, establishing a microbiological diagnosis of TB is paramount. Sputum induction can be used as an alternative investigation to bronchoscopy in suspected PTB patients who are able to self-expectorate. Induced sputum is a sensitive investigation for suspected PTB patients but with a low diagnostic yield. Referral guidelines are suggested.     

嗜酸粒细胞性胃肠炎临床特点分析

目的探讨嗜酸粒细胞性胃肠炎(eosinophilic gastroenterirtis,EG)患者的临床特点,以提高临床医师对此病的认识,减少误诊和漏诊率。方法回顾性分析确诊的20例EG患者的临床表现、实验室检查、影像学检查、胃肠镜检查、病理学结果及治疗方法和效果等。结果本研究中40.0%的患者有过敏史,25.0%伴支气管哮喘。临床症状主要表现为腹痛、腹泻、腹胀、恶心、呕吐等。85.0%患者伴外周血嗜酸粒细胞增多,100%患者胃肠道黏膜组织的病理学检查见嗜酸性粒细胞浸润。在十二指肠、食管、回盲瓣等处取材,嗜酸性粒细胞的检出率50.0%。对症治疗对于轻症患者有效,激素治疗对于重症患者有效。结论 EG是过敏反应相关性疾病,其临床表现和内镜表现均无特异性,外周血和胃肠道黏膜的病理学检查中检测到嗜酸性粒细胞的增多是明确诊断的关键。内镜下在十二指肠、食管、回盲瓣取活检组织可提高诊断率。根据患者病情轻重选择不同治疗方法。     

Paediatric eosinophilic oesophagitis: Towards early diagnosis and best treatment

Eosinophilic oesophagitis is an emerging disease, well known also in paediatric age, probably caused by both IgE and non-IgE mediated food allergies, diagnosed by upper endoscopy with biopsy. The most severe complication is oesophageal stenosis. The identification of the offending allergens is often difficult; therapy is focused to eliminate the supposed antigenic stimulus, to control the acute symptoms and to induce long-term remission. AIM: We report the clinical outcome and the typical endoscopic findings of children and adolescents affected by eosinophilic oesophagitis, referring a proposal of diagnostic and treatment protocol. PATIENTS AND METHODS: Twelve patients, affected by eosinophilic oesophagitis with a histological diagnosis, underwent radiographic upper gastro-intestinal series, 24 h pH-probe and standardised allergic testing; they were treated with steroids (oral prednisone and swallowed aerosolised fluticasone) and elimination diet. Dilations were performed when eosinophilic oesophagitis was not yet diagnosed, or in patients resistant to conventional treatment. RESULTS: Two patients were lost to follow up (mean follow up: 1 year 11 months); seven patients have no symptoms and normal histology, five of them on restricted diet (without cow's milk protein) and two patients on elemental diet (amino acid formula). In two patients (no allergens identified), mild dysphagia and eosinophilic infiltration persist; one patients underwent Nissen fundoplication for Barrett's oesophagus: he has no symptoms and normal oesophagus, on restricted diet (without cow's milk/eggs protein and wheat). CONCLUSION: The recognition of typical endoscopic picture with careful biopsies extended to the whole oesophagus, even in emergency, could more quickly lead to the correct diagnosis and avoid severe complications of eosinophilic oesophagitis in children, as stricture and failure to growth. Elimination diet is the key of resolution when the allergens are identified. A great challenge remains the relation between gastro-oesophageal reflux disease and eosinophilic oesophagitis, which should however be explained.