诱导痰炎性标志物对老年人晚发哮喘严重程度判断和鉴别诊断的价值  

Use of inflammatory markers of induced sputum for assessing the severity of late onset asthma and differential diagnosis

作　　者：聂汉祥[1] 李长生[1] 杨炯[1] 

机构地区：[1]武汉大学人民医院呼吸内科,430060

出　　处：《中华老年医学杂志》2005年第6期410-412,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨老年人晚发哮喘(LOA)患者诱导痰中嗜酸细胞和嗜酸细胞阳离子蛋白(ECP)水平与其严重程度的关系及与慢性阻塞性肺疾病(COPD)的鉴别诊断价值。方法随机选择54名LOA患者,检测肺功能并分别采用瑞氏染色及荧光免疫法检测高渗盐水诱导痰中嗜酸细胞数量和ECP水平。选择25例老年COPD患者和10例老年健康人作为对照。结果LOA患者诱导痰中嗜酸细胞数量和ECP水平与患者第一秒用力呼气容积占用力肺活量百分比呈显著负相关(r值为-0.68、-0.61,均为P<0.01)。患者诱导痰中嗜酸细胞数量〔(19.4±8.1)%〕和ECP水平〔(391±186)μg/L〕显著高于老年COPD组〔(3.1±1.4)%和(51±26)μg/L,P<0.01〕和老年健康组〔(1.2±0.7)%和(44±22)μg/L,P<0.01〕。以诱导痰中嗜酸细胞≥7%和ECP≥100μg/L为判别标准与COPD鉴别,诊断哮喘的敏感性分别为85.2%和87.0%;特异性分别为84.0%和88.0%。联合检测两者的敏感性和特异性分别为92.6%和92.0%。结论诱导痰中嗜酸细胞和ECP水平可了解LOA的严重程度,并有助于与老年COPD的鉴别。Objective To investigate the relationship between the eosinophil (Eos) percentage and levels of eosinophil cationic protein (ECP) in induced sputum and the severity of late onset asthma(LOA) and differential diagnosis. Methods Fifty-four patients with LOA were selected. The percentage of eosinophil and levels of ECP were measured by Wrigbt′s stain and immuno-CAP system respectively. The lung function was also evaluated. The same indexes were measured in 25 elderly patients with chronic obstructive pulmonary disease (COPD) and 10 healthy elderly subjects as control. Results The percentage of Eos and levels of ECP in induced sputum in patients with LOA were significantly and negatively correlated with FEV_1/FVC (r=-0.68,-0.61, respectively, P<0.01). The percentage of Eos and levels of ECP of induced sputum in patients in LOA group were 〔(19.4±8.1)%〕 and 〔(391±186) μg/L〕 respectively, those in COPD group and healthy group were (3.1±1.4)% vs (1.2±0.7)%, (51±26) μg/L vs(44±22) μg/L, respectively. The percentage of Eos and levels of ECP of induced sputum were significantly higher in patients with LOA than those in control group (P<0.01). When the percentage of Eos≥ 7% and levels of ECP ≥ 100 μg/L in induced sputum were adopted as guideline of LOA for differentiating COPD. Their sensitivity and specificity were 85.2%, 87.0% and 84.0%, 88.0% respectively. When combined ECP and Eos, the sensitivity and specificity were 92.6% and 92.0% respectively. Conclusions The levels of Eos and ECP in induced sputum may evaluate LOA severity and they may be helpful to the differential diagnosis between LOA and COPD.

关 键 词：诱导痰 老年人 炎性标志物 慢性阻塞性肺疾病(COPD) 鉴别诊断 程度判断 哮喘 晚发 嗜酸细胞阳离子蛋白 老年COPD 细胞数量 COPD患者 用力呼气容积 严重程度 免疫法检测 用力肺活量 P水平 诊断价值 高渗盐水 瑞氏染色 老年健康 

分 类 号：R562.25[医药卫生—呼吸系统] R563[医药卫生—内科学]