稳定期慢性阻塞性肺疾病患者支气管舒张试验和诱导痰炎性标志物的测定

目的:探讨支气管舒张试验阳性的稳定期慢性阻塞性肺疾病(COPD)气道炎症特征。方法:对63例稳定期COPD患者作肺功能测定和支气管舒张试验,并分别采用瑞氏染色、荧光免疫法和酶联免疫吸附试验检测诱导痰中细胞学计数、嗜酸性粒细胞阳离子蛋白(ECP)和髓过氧化物酶(MPO)、白介素-5(IL-5)、白介素-8(IL-8)水平。选择30名急性发作期哮喘患者和20名健康人作为对照。结果:63例稳定期COPD患者中,支气管舒张试验阳性15例(23.8%)。支气管舒张试验阳性的COPD患者诱导痰中嗜酸性粒细胞(EOS)(4.9±2.1)%]和ECP(121.3±60.2)μg/L]水平显著高于支气管舒张试验阴性的COPD患者(P<0.05)和健康对照组(P<0.01),但显著低于哮喘组(P<0.01);患者诱导痰IL-5水平(14.6±8.1)μg/L]显著低于哮喘患者(P<0.01),与支气管舒张试验阴性的COPD患者和健康对照组比较差异无统计学意义(P>0.05);患者诱导痰中性粒细胞数量(58.1±14.3)%]、MPO(521.9±98.5)μg/L]和IL-8(30.2±12.7)μg/L]水平与支气管舒张试验阴性的COPD患者比较差异无统计学意义(P>0.05),但显著高于哮喘组和健康对照组(P<0.01)。结论:支气管舒张试验阳性的COPD患者既具有气道嗜酸性粒细胞炎症特征,又存在气道中性粒细胞炎症。

Clinical Significance of Inflammatory Markers in Induced Sputum from Patients with Positive Bronchodilator Reversibility Testing During Stable Stage of COPD

Objective:To identify the characteristics of airway inflammation in patients with positive bronchodilator reversibility testing during stable stage of COPD.Methods:Sixty-three patients with stable COPD were selected.Lung function and bronchodilator reversibility testing were performed and cellular differential count and levels of eosinophil cationic protein(ECP),myeloperoxidase(MPO),interleukin-5(IL-5),and interleukin-8(IL-8) in induced sputum were measured by Wrights' stain,Immuno-CAP System,and ELISA,respectively.Thirty patients with asthma during the exacerbation period and twenty healthy subjects were selected as control.Results:Of sixty-three patients with stable stage of COPD,15 cases(23.8%) showed positive bronchodilator reversibility testing.The percentage of eosinophil(EOS)(4.9 ± 2.1] %) and level of ECP(121.3 ± 60.2] μg/L) in induced sputum in patients with positive bronchodilator reversibility testing during stable stage of COPD were higher than those in patients with negative bronchodilator reversibility testing during stable COPD(all P<0.05) and in healthy subjects(all P<0.01) respectively.The level of IL-5(14.6±8.1] μg/L) in induced sputum in patients with positive bronchodilator reversibility testing during stable stage of COPD were lower than that in patients with asthma(P<0.01) and there was no difference in level of IL-5 in induced sputum between healthy subjects,patients with positive and negative bronchodilator reversibility testing during stable stage of COPD(all P>0.05).The percentage of neutrophil,levels of MPO,and IL-8(58.1±14.3]%,521.9±98.5] μg/L,and 30.2±12.7] μg/L) in induced sputum in patients with positive bronchodilator reversibility testing during stable stage of COPD were higher than those in patients with asthma and healthy subjects(all P<0.01).There was no difference in percentage of neutrophil,levels of MPO,and IL-8 in induced sputum between patients with positive and negative bronchodilator reversibility testing during stable stage of COPD(all P>0.05).Conclusion:The patients with positive bronchodilator reversibility testing in stable stage of COPD may present not only eosinophilic airway inflammation but also neutrophilic airway inflammation.