呼吸道感染后咳嗽与咳嗽变异性哮喘痰炎症细胞和气道反应性特点及其意义

目的探讨呼吸道感染后咳嗽与咳嗽变异性哮喘患者痰炎症细胞的特点及其临床意义。方法收集呼吸道感染后咳嗽（Ⅰ组，22例）和咳嗽变异性哮喘（Ⅱ组，24例）患者痰或高渗盐水诱导痰，作瑞氏染色后细胞涂片，并在显微镜下细胞分类计数，测定其通气功能和乙酰甲胆硷吸入测定气道反应性。结果Ⅰ组和Ⅱ组痰液炎症细胞总数分别为8．22×10^9／L和8．94×10^9／L，两组比较无统计学意义（P〉0．05）；而Ⅰ组嗜酸细胞和中性粒细胞的中位数分别为0．20％、5．88％，与Ⅱ组比较，两种细胞（分别为9．62％、2．48％）的组间比较差异均有显著性（P〈0．01）。Ⅱ组的气道反应性（支气管激发试验阳性100％，其PC20为1．24g／L）明显高于Ⅰ组（支气管激发试验阳性16．7％，且其PC10较高，为4．85g／L，P〈0．01）。咳嗽变异性哮喘组痰液嗜酸细胞与气道反应性指标PC10成呈显著负相关（r=-0．56，P〈0．01）。结论呼吸道感染后咳嗽与咳嗽变异性哮喘痰炎症细胞特点不同，痰中炎症细胞检查和气道反应性测定，可作为鉴别呼吸道感染后咳嗽与咳嗽变异性哮喘的一项参考指标。

Sputum inflammatory cells and airway reaction in postinfectious cough and cough variant asthma

Objective To compare the sputum inflammatory cells in patients with postinfectious cough and cough variant asthma and its clinical significance. Methods 22 patients with postinfectious cough （group Ⅰ ） and 24 with cough variant asthma （ group Ⅱ ） were enrolled. Sputum samples were obtained by spontaneous expectoration or by hypertonic saline aerosol induction. Sputum smear was stained by Wright＇ s stain. And the total cells and differentials in sputum suspension and lung ventilation function including airway hyperresponseness were done. Results The difference of total cells in two groups was not significant（P 〉0.05）. The percentage of eosinophils in sputum of group I was significantly lower than that of group Ⅱ （median 0.20% vs 9.60% ,P 〈0.01 ）. Meanwhile the percentage of neutrophils in sputum of group Ⅰ was significantly higher compared with group Ⅱ （median 5.88% vs 2.88% ,P 〈0.01 ）. Airway reaction in group Ⅰ （hyperreaction rate 16.7% ,PC 4.85 g/L） was much lower than that （hyperreaction rate 100%, PC 1.24 g/L, P 〈 0.01 ） in group ft. There were significant negative correlation between sputum eosinophils and PC20 （ airway hyperreaction） in group Ⅱ （ r = - 0.56 ,P 〈 0.01 ）. Conclusion Sputum inflammatory cells and airway reaction may be a useful markers reflecting the type of airway inflammation and differing between postinfectious cough and cough variant asthma.