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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04) : 466 -469. doi: 10.3877/cma.j.issn.1674-6902.2020.04.007

论著

诱导痰细胞分类在嗜酸细胞性支气管炎诊断和治疗中的应用
王斌1, 胡明冬2, 徐静1, 张椿3,†(), 陈华萍1,†(), 王关嵩1, 徐智1, 李琦1   
  1. 1. 400037　重庆，陆军（第三）军医大学第二附属医院全军呼吸内科研究所
    2. 400037　重庆，陆军（第三）军医大学第二附属医院全军呼吸内科研究所；400037　重庆，陆军（第三）军医大学第二附属医院老年与特勤医学科
    3. 400037　重庆，陆军（第三）军医大学第二附属医院医务处
  • 收稿日期:2020-04-17 出版日期:2020-08-25
  • 通信作者: 张椿, 陈华萍
  • 基金资助:
    国家重点研发计划(2017YFC0112702); 陆军军事医学创新工程(18CXZ002); 陆军军医大学第二附属医院临床科研重点项目(2016YLC06)

Effect of induced sputum on diagnosis and treatment of eosinophilic bronchitis

Bin Wang1, Mingdong Hu2, Jing Xu1, Chun Zhang3,†(), Huaping Chen1,†(), Guansong Wang1, Zhi Xu1, Qi Li1   

  1. 1. Institute of Respiratory Diseases, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
    2. Institute of Respiratory Diseases, Xinqiao Hospital, Army Medical University, Chongqing 400037, China; Department of Gerontology and Secret Service Medicine, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
    3. Medical Department, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
  • Received:2020-04-17 Published:2020-08-25
  • Corresponding author: Chun Zhang, Huaping Chen
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王斌, 胡明冬, 徐静, 张椿, 陈华萍, 王关嵩, 徐智, 李琦. 诱导痰细胞分类在嗜酸细胞性支气管炎诊断和治疗中的应用[J]. 中华肺部疾病杂志(电子版), 2020, 13(04): 466-469.

Bin Wang, Mingdong Hu, Jing Xu, Chun Zhang, Huaping Chen, Guansong Wang, Zhi Xu, Qi Li. Effect of induced sputum on diagnosis and treatment of eosinophilic bronchitis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(04): 466-469.

目的

探索诱导痰细胞分类在嗜酸细胞性支气管炎(EB)诊断和治疗中的作用。

方法

回顾性分析我院门诊239例慢性咳嗽患者，依据慢性咳嗽中诊断标准，分为非EB组和EB组，分析两组诱导痰中细胞分类情况；同时给予EB患者进行8周治疗，观察经治疗后诱导痰中各细胞分类的改变情况。

结果

239例慢性咳嗽患者中，非EB患者216例，占90.7%，EB患者23例，占9.3%，两组中共有121例(50.6%)患者诱导痰中嗜酸细胞百分比升高；非EB患者组细胞总计数为(4.83±2.61)×106个/g、嗜酸细胞比例为(4.56±10.07)%、中性粒细胞比例为(50.32±26.12)%、淋巴细胞比例为(5.14±7.27)%、单核巨噬细胞比例为(40.30±16.70)%，EB患者组痰中细胞总计数为(5.46±3.07)×106个/g、嗜酸细胞比例为(13.85±1 2.23)、中性粒细胞比例为(46.16±16.89)、淋巴细胞比例为(4.83±2.98)、单核巨噬细胞比例为(35.91±16.35)，两组间EB组嗜酸细胞比例有显著的增多(P<0.05)，在性别、年龄以及其余细胞成分差异无统计学意义(P>0.05)；EB患者组经治疗后，痰中细胞总计数为(4.07±3.89)×106个/g、嗜酸细胞比例为(2.52±3.80)%、中性粒细胞比例为(54.18±17.97)%、淋巴细胞比例为(5.59±4.33)%、单核巨噬细胞比例为(38.32±17.23)%，嗜酸细胞较治疗前有显著减少(P<0.05)，其余细胞改变无显著差异(P>0.05)。

结论

诱导痰细胞分类检查是诊断EB的重要方法，在其诊断和治疗过程中有着重要的指导作用，可作为EB治疗过程的监测指标。

关键词: 诱导痰细胞分类, 嗜酸细胞性支气管炎, 诊断, 治疗
Objective

To explore the effect of induced sputum on the diagnosis and treatment of eosinophilic bronchitis (EB).

Methods

A total of 239 outpatients with chronic cough in our hospital were divided into an EB group and a non-EB group according to the diagnosis standard of EB. The cells in the induced sputum were analyzed for all the patients. Then the patients in the EB group were treated for 8 weeks, and the changes of the induced sputum were detected after treatment.

Results

Among the 239 patients with chronic cough, 216 (90.7%) were non-EB patients and 23 (9.3%) were EB patients. The percentage of eosinophils increased in the induced sputum of 121 (50.6%) patients in the two groups. The total cell count of non-EB patients was (4.83±2.61)×106 cells/g, the proportion of eosinophils accounted for (4.56±10.07)%, and the proportion of neutrophils accounted for (50.32±26.12)%. The percentages of lymphocytes and monocyte-macrophages in the sputum accounted for (5.14±7.27)% and (40.30±16.70)%, respectively. In the induced sputum of the EB group, the total number of cells was (5.46±3.07)×106 cells/g, the proportion of eosinophils accounted for (13.85±12.23)%, the proportion of neutrophils accounted for (46.16±16.89)%, the proportion of lymphocytes accounted for (4.83±2.98)%, and the monocyte-macrophages accounted for (35.91±16.35)%. The proportion of eosinophils was higher significantly in the EB group than the non-EB group (P<0.05). However, no significant difference was found in the sex, age or other cell components (P>0.05). After treatment in the EB group, the total number of cells was (4.70±3.89)×106 cells/g, and the proportion of eosinophils accounted for (2.52±3.80)%, neutrophils for (54.18±17.97)%, lymphocytes for (5.59±4.33)%, and monocyte-macrophages for (38.32±17.23)% in the induced sputum. The proportion of eosinophils after treatment was significantly reduced compared with that before treatment (P<0.05). Similarly, there was no significant difference in other cell changes (P>0.05).

Conclusion

Analyzing the induced sputum was an important method for the diagnosis of EB, which plays an important role in the diagnosis and treatment of EB, and can also be used as a detection index in the treatment of EB.

Key words: Induced sputum, Eosinophilic bronchitis, Diagnosis, Treatment
表1 非EB组与EB患者诱导痰细胞分类比较
组　别 例数 总细胞计数(×106个/g) EOS(%) NEU(%) LYM(%) MAC(%)
非EB组 236 4.83±2.61 4.56±10.07 50.32±26.12 5.14±7.27 40.30±16.70
EB组 23 5.46±3.07 13.85±12.23a 46.16±16.89 4.83±2.98 35.91±16.35
  Z值   -1.133 -5.240 -1.239 -0.200 -1.121
  P值   0.257 <0.001 0.215 0.841 0.262
图1 EB患者治疗前后诱导痰细胞变化；注：EOS：嗜酸细胞；NEU：中性粒细胞；MAC：单核巨噬细胞
表2 EB患者治疗前后诱导痰中细胞分类变化
组　别 总细胞计数(×106个/g) EOS(%) NEU(%) LYM(%) MAC(%)
治疗前 5.46±3.07 13.85±12.23 46.16±16.89 4.83±2.98 35.91±16.35
治疗后 4.70±3.89 2.52±3.80a 54.18±17.97 5.59±4.33 38.32±17.23
  Z/t值 3.954 20.149 -1.639 -0.669 -0.488
  P值 0.047 <0.001 0.115 0.511 0.631
1
Irwin RS, French CL, Chang AB, et al. Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report[J]. Chest, 2015, 3(1): 196-209.
2
中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2015)[J]. 中华结核和呼吸杂志，2016, 39(5): 323-354.
3
Lai K, Chen R, Lin J, et al. A prospective, multicenter survey on causes of chronic coughin China[J]. Chest, 2013, 143(3): 613-620.
4
Gibson PG, Dolovich J, Denburg J, et al. Chronic cough: eosinophilic bronchitis without asthma[J]. Lancet, 1989, 333(8651): 1346-1348.
5
中华医学会，咳嗽基层诊疗指南(实践版-2018)[J]. 中华全科医师杂志，2019, 18(3): 220-227.
6
中国医师协会呼吸医师分会. 无创气道炎症评估支气管哮喘的临床应用中国专家共识[J]. 中华结核和呼吸杂志，2015, 38(5): 329-341.
7
陈华萍，马千里，张　巧，等. 重庆地区健康成人诱导痰细胞计数及正常参考值的初步建立[J]. 第三军医大学学报，2011, 33(24): 2611-2613.
8
赖克方. 慢性咳嗽[M]. 第1版，北京：人民卫生出版社，2008: 150-178.
9
DI Stefano F, DI Giampaolo L, Verna N. Occupational eosinophilic bronchitis in a foundry worker exposed to isocyanate and a baker exposed to flour[J]. Thorax, 2007, 62(4): 386-370.
10
Guo CL, Sun XM, Wang XW, et al. Serum Eosinophil Cationic Protein Is a Useful Marker for Assessing the Efficacy of Inhaled Corticosteroid Therapy in Children with Bronchial Asthma[J]. Tohoku J Exp Med, 2017, 242(4): 263-271.
11
罗　炜，赖克方，陈如冲，等. 嗜酸粒细胞性支气管炎气道炎症病理特征的探讨[J]. 中国病理生理杂志，2006, 22(5)：943-947.
12
赖克方，钟南山. 嗜酸粒细胞性支气管炎及其与支气管哮喘的关系[J]. 内科理论与实践，2011, 6(2): 88-91.
13
Brightling CE, Pavord ID. Eosinophilic bronchitis-what is it andwhy is it important[J]. Clin Exp Allergy, 2000, 30(1): 4.
14
罗　炜，赖克方，陈如冲，等. 痰嗜酸细胞和ECP在嗜酸细胞性支气管炎诊断中的作用[J]. 广东医学，2006, 27(3)：345-346.
15
Pijnenburg MW. The Role of FeNO in Predicting Asthma[J]. Front Pediatr, 2019, 7: 41.
16
Arnold RJ, Massanari M, Lee TA, et al. A Review of the Utility and Cost Effectiveness of Monitoring Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management[J]. Manag Care, 2018, 27(7): 34-41.
17
Shaw DE. FeNO monitoring to adjust treatment in asthma: has it come of age[J]? Thorax, 2018, 73(12): 1095-1096.
18
Wang Z, Pianosi P, Keogh K, et al. The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management[J]. Rockville (MD): Agency for Healthcare Research and Quality (US), 2017，.: 17(18)-EHC030-EF.
19
Song WJ, Kim HJ, Shim JS, et al. Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough: A systematic review and meta-analysis[J]. J Allergy Clin Immunol, 2017, 140(3): 701-709.
20
张永明，林江涛，苏　楠，等. 呼出气一氧化氮检测在慢性咳嗽病因诊断中的价值[J]. 中华医学杂志，2011, 91(18): 1254- 1258.
21
陈华萍，唐心蔚，周雪梅，等. FeNO与诱导痰细胞分类检测的相关性[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(2): 223-225.
22
Desai D, Brightling C. Cough due to asthma, cough-variant asthma and non-asthmatic eosinophilic bronchitis[J]. Otolaryngol Clin North Am, 2010, 43(1): 123-130.
23
Meersseman W, Lagrou K, Maertens J, et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients[J]. Am J Respir Crit Care Med, 2008, 177(1): 27-34.
24
Zhang S, Wang S, Wan Z, et al. Quantitative real-time PCR and Platelia galactomannan assay for the diagnosis of invasive pulmonary aspergillosis: bronchoalveolar lavage fluid performs better than serum in non-neutropaenic patients[J]. Mycopathologia, 2016, 181(9-10): 625-629.
25
He H, Ding L, Sun B, et al. Role of galactomannan determinations in bronchoalveolar lavage fluid samples from critically ill patients with chronic obstructive pulmonary disease for the diagnosis of invasive pulmonary aspergillosis: a prospective study[J]. Crit Care, 2012, 16(4): R138.
26
Luo W, Chen QL, Chen RC, et al. Reference value of induced sputum cell counts and its relationship with age in healthy adults in Guangzhou, Southern China[J]. The Clinical Respiratory Journal, 2018, 12(3): 1160.
27
李战炜，唐　伟. 培土生金方联合BiPAP呼吸机对慢性阻塞性肺疾病加重期合并Ⅱ型呼吸衰竭痰细胞分类、血ECP变化的影响[J]. 世界中西医结合杂志，2019, 14(10): 1415-1418.
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