慢性阻塞性肺疾病急性加重期支气管肺泡灌洗液的细胞分类特点分析  

Analysis of the characteristic and classification of the cells from bronchoalveolar lavage fluid in chronic obstructive pulmonary disease acute exacerbation period

作　　者：李冠华[1] 李广生[1] 赵芳[1] 乔晟[1] 李月川[1] 

机构地区：[1]天津市胸科医院胸内科RICU,300051

出　　处：《国际呼吸杂志》2012年第16期1226-1229,共4页International Journal of Respiration

摘　　要：目的慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）气道炎症特征足气道壁以淋巴细胞和肺泡巨噬细胞浸润为主，而管腔内则以中性粒细胞和巨噬细胞作用为主，为进一步了解COPD急性加重期气道炎症细胞的特点。方法对23例COPD急性呼吸衰竭气管插管机械通气的患者进行支气管肺泡灌洗共32次，灌洗液进行白细胞计数及细胞分类分析。结果23例患者中成功脱机拔除气管插管14例，住院死亡6例，病情恶化自动出院3例。23例患者共进行支气管肺泡灌洗32次，灌洗液回收量为（12．88±4．98）ml，回收率为（32．2±12．45）％；23例患者气管插管后即刻或次日行支气管肺泡灌洗，灌洗液白细胞计数中位数M为50×10^6／L；细胞分类中位数M为：上皮细胞18％、中性粒细胞60％、淋巴细胞2％、巨噬细胞8％、嗜酸粒细胞0％；其中14例顺利脱机拔管的患者，灌洗液白细胞计数中位数M为25×10^6／L；细胞分类中位数M为：上皮细胞19％、中性粒细胞60％、淋巴细胞1．5％、巨噬细胞6．5％、嗜酸粒细胞0％；住院死亡6例，灌洗液白细胞计数中位数M为50×10^6／L；细胞分类中位数M为：上皮细胞19％、中性粒细胞62％、淋巴细胞1％、巨噬细胞10％、嗜酸粒细胞0％；病情恶化自动出院3例，白细胞计数中位数M为100×10^6／L，细胞分类中位数M为：上皮细胞15％、中性粒细胞10％、淋巴细胞25％、巨噬细胞2％、嗜酸粒细胞2％；在14例顺利脱机拔管的患者中8例患者在病情好转脱离呼吸机前重复上述检查，白细胞计数中位数M为50×10^6／L，细胞分类中位数M为：上皮细胞11％、中性粒细胞52％、淋巴细胞1．5％、巨噬细胞4％、嗜酸粒细胞0％。结论从支气管肺泡灌洗液所获得的COPD患者气道炎症细胞主要为肺泡巨噬细胞以及较多的中性粒细胞、T淋巴细胞，一部分患者还存在较多�Objective The characteristics of airway inflammation in chronic obstructive pulmonary disease （COPD） was the infiltration of the airway wall with lymphocytes and alveolar macrophages mainly, but there were mainly neutrophils and alveolar macrophages in airway lumens. Therefore, it was necessary to study more about the characteristics of airway inflammatory cells in COPD acute exacerbation period. Methods 23 patients intubated were treated with mechanically ventilation cause of acute respiratory failure with COPD, were done with bronchoalveolar lavage 32 times, and the lavage fluid were sent to the laboratory for analysis of leukocyte count and cell sorting. Results 14 of 23 patients were recovered and the trachea cannulas were pulled out. 6 of the patients were die, 3 of the patients were discharged because of deterioration, 23 patients were done with bronchoalveolar lavage 32 times. The recovery of lavage fluid was （12.88±4.98） ml, and the recovery rate was （32.2±12.45） % ,23 patients were lavaged immediately after intubation or in next day. The median of leukocyte count was 50 X 10~/L, and the median of cell sorting was： epithelial cells 18%, neutrophils 60%, lymphocytes 2%, macrophages 8%, eosinophils 0%,14 of the patients were recovered. The median of leukocyte count was 25×10^6/L, and the median of cell sorting was： epithelial cells 19%, neutrophils 60%, lymphoeytes 1.5 %, macrophages 6.5 %, eosinophils 0 %, 6 of the patients were die. The median of leukocyte count was 50 × 10^6/L, and the median of cell sorting was： epithelial cells 19 %, neutrophils 62 %, lymphocytes 1%, macrophages 10%, eosinophils 0%,3 of the patients were discharged because of deterioration. The median of leukocyte count was 100 × 10^6/L, and the median of cell sorting was.. epithelial cells 15%, neutrophils 10×, lymphocytes 25%, macrophages 2%, eosinophils 2%, 14 of the patients were recovered and had spontaneously breathing without respirator. Before the trachea cannulas pulled out, that 8 patients were lavaged

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 机械通气 支气管肺泡灌洗 细胞 

分 类 号：R563.9[医药卫生—呼吸系统]