广州地区5～15岁健康儿童高渗盐水诱导痰细胞学检查及其分类正常参考值的初步建立  

Preliminary establishment of cytological examination and the normal reference values for hypertonic saline solution-induced sputum of healthy children in Guangzhou

作　　者：陈德晖[1] 钟帼钰[1] 罗炜[2] 陈桥丽[2] 陈如冲[2] 林育能[1] 潘小安[1] 李瑾瑛[1] 吴上志[1] 赖克方[2] 钟南山[2] 

机构地区：[1]广州医学院第一附属医院儿科,510120 [2]广州医学院第一附属医院呼吸疾病研究所国家重点实验室

出　　处：《中华儿科杂志》2012年第7期525-530,共6页Chinese Journal of Pediatrics

基　　金：广州市科技局资助项目（200821-E331）;广东省科技厅项目（83051）;广州市医药卫生科技资助项目（2007-YB-155）

摘　　要：目的初步建立广州地区5～15岁正常儿童高渗盐水诱导细胞学方法学及细胞分类正常参考值范围。方法选择2010年1—12月广州市中小学正常体检年龄5～15岁的儿童352名，所有儿童均经问卷调查，医生详细询问病史及体格检查，进行肺功能及呼气峰流速（PEF）检查，剔除不符合标准儿童后，实际人选儿童266名，其中男137名，女129名，用5％高渗盐水超声雾化吸入15～30min，每10分钟嘱儿童用力咯痰至培养皿，若无痰或痰量不足则继续雾化，30min后仍无痰则视为失败，终止诱导程序。选取痰液中取出不透明和密度较高的痰液进行诱导痰液细胞分类检测。此研究经医院医学伦理委员会批准，并由监护人签署知情同意书。结果入选人群中成功诱导痰液175名（175／266，占65．8％），其中16名儿童痰标本不合格，91名诱导不成功，共失败107名（107／266，40．2％），实际取得合格痰标本159名，诱导成功率59．8％（159／266）。159名正常儿童诱导痰液细胞分类均呈偏态分布，淋巴细胞中位数为0．012，四分位数间距（IQR）0．020，95％可信区间（95％CI）0．015～0．022；中性粒细胞中位数0．207，IQR0．330，95％CI 0．266～0．356；单核细胞中位数为0．761，IQR0．327，95％CI 0．607～0．699；嗜酸性粒细胞中位数0．004，IQR0．019，95％CI 0．013～0．022，各细胞分类结果以单核细胞及中性粒细胞为主。诱导痰细胞分类值与性别、年龄无关，不受被动吸烟影响（P均〉0．05）。诱导过程中，不良事件发生率为4．4％（7／159），所发生的不良事件症状轻微，无需用药物缓解不适。诱导成功组与诱导失败组诱导后PEF％下降率差异无统计学意义（P〉0．05）。结论在国内首次初步建立较大样本的本地区正常儿童诱导痰液细胞学检查的方法及细胞学分类的正常参考值范围。Objective To establish the method of cytological examination and the normal reference values for hypertonic saline solution-induced sputum of healthy children （age range from 5 to 15 years ） with physical examination in Guangzhou. Method A total of 352 children, 5 to 15 years old, were enrolled from primary school and middle school in Guangzhou from January to December, 2010. All subjects completed a standardized questionnaire on the presence of respiratory, allergic symptoms and family history, the medical history and the physical examination was performed by doctors, lung function （forced expiratory volume at 1 s in predicted normal, FEV,% ） was determined. There were 266 healthy children （137 males, 129 females） who were selected and undergone hypertonic saline solution induction of sputum, and cytological examination was performed. Hypertonic saline （ 5% ） was nebulized and inhaled for 15 - 30 min. No expectoration within 30 min was defined as failure, and the procedure was terminated. The part of opaque and higher density sputum samples was detected by cytology. The proportion of neutrophils, lymphocytes, eosinophils, macrophages and monocytes was calculated. This study was approved by the institutional Ethics Review Committee of First Affiliated Hospital of Guangzhou Medical College. Informed consent was obtained from the legal guardians of all participants following a detailed description of the purpose and potential benefits of the study. Result There were 175 subjects＇ induced sputum specimens （ 175/266, 65.8% ）, non-qualified sputum samples were obtained from 16 of the subjects. The proportions of median （IQR） of lymphocytes were 0. 012（0. 020）, 95% CI were ranged from 0. 015 to 0. 022 ;neutrophils 0. 207 （0. 330）, 95 % CI 0. 266 - 0. 356 macrophages 0. 761 （0. 327 ）, 95 % CI 0. 607 - 0. 699 ; eosinophils 0. 004 （0. 019 ）, 95% CI 0. 013 -0. 022. There were no significant differences in proportions of cytological findings of female or male, different age groups a

关 键 词：诱导痰 细胞学分类 参考值 儿童 

分 类 号：R725.6[医药卫生—儿科]