难治性哮喘与慢性阻塞性肺病患者临床特征及诱导痰中炎症细胞分类的比较

目的比较难治性哮喘和慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者的临床特征和诱导痰炎症细胞分类,为难治性哮喘炎症类型研究及诊疗提供参考。方法收集2009年10月至2010年10月在我院呼吸内科门诊和住院治疗的难治性哮喘患者32例和COPD患者21例,分析临床资料,经瑞氏-吉姆萨染色后比较分析诱导痰中炎症细胞的分类百分比。结果①71.9%(23/32)的难治性哮喘患者存在严重的气流受限(FEV1<60%预计值),仅6.3%(2/32)的患者FEV1占预计值百分比>80%;60%患者(9/15)气道阻塞可逆性>12%,与COPD组临床特征相似。②68.8%(22/32)的难治性哮喘患者诱导痰中嗜酸性粒细胞增多(嗜酸性粒细胞比例≥3%),28.1%(9/32)的患者中性粒细胞增多(中性粒细胞比例≥61%);仅1例(3.1%)患者诱导痰中出现嗜酸性粒细胞和中性粒细胞增高。难治性哮喘组诱导痰中嗜酸性粒细胞和中性粒细胞的比例与COPD组差异有显著性(P<0.05),而中性粒细胞性哮喘组与COPD组比较则差异无显著性(P>0.05)。结论依据诱导痰中炎症细胞的分类百分比,难治性哮喘可分为嗜酸性粒细胞和中性粒细胞哮喘两种亚型,其中,中性粒细胞性哮喘与COPD诱导痰检测有明显的相似性。

Clinical characteristics of patients with refractory asthma and chronic obstructive pulmonary disease and types of inflammatory cells in sputum induced from them: A comparative study

Objective To compare the clinical characteristics of patients with refractory asthma and chronic obstructive pulmonary disease(COPD) and types of inflammatory cells in sputum induced from them.Methods Clinical data about 32 refractory asthma patients and 21 COPD patients admitted to our hospital from October 2009 to October 2010 were analyzed.Inflammatory cells in sputum induced from them were detected with Wright-Gimsa staining.Results Severe airflow limitation(FEV1<60% predicted value) was observed in 71.9%(23/32) of the asthma patients,and the FEV1/predicted value >80% was found in 6.3%(2/32) of these patients.In addition,the bronchial reversibility was over 12% in 60%(9/15) of these patients,which was similar to that in COPD patients.The number of eosinophils(EOS) and neutrophils(NEU) in sputum induced from the patients increased in 68.8%(22/32)of refractory asthma patients(>3%) and in 28.1%(9/32) of refractory asthma patients(>61%),respectively.The EOS and NEU were detected only in sputum induced from 1 patient(3.1%),and were significantly in sputum induced from refractory asthma patients than from COPD patients(P<0.05).However,no significant difference was found in NEU between refractory asthma and COPD patients(P>0.05).Conclusion Refractory asthma can be divided into EOS and NEU subtypes of asthma according to the types of inflammatory cells in sputum induced from the patients.Inflammatory cells detected in sputum induced from EOS asthma patients are similar to those detected in sputum induced from NEU asthma patients.