痰诱导涂片COPD分型与急性加重期患者肺功能及炎症因子的关系  

Relationship of classification based on induced sputum smear with pulmonary function and inflammatory factor levels in COPD patients with acute exacerbation

作　　者：蔡晓盛 陈芒芒 龚昌要 池琼 潘景业[3] CAI Xiaosheng;CHEN Mangmang;GONG Changyao;CHI Qiong;PAN Jingye(Department of Emergency,Wenzhou Central Hospital,Wenzhou 325000,China)

机构地区：[1]温州市中心医院急诊科,325000 [2]温州市中心医院呼吸内科,325000 [3]温州医科大学附属第一医院重症监护室

出　　处：《浙江医学》2021年第3期284-289,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2015KYB365)。

摘　　要：目的探讨痰诱导涂片慢性阻塞性肺疾病(COPD)分型与COPD急性加重期(AECOPD)患者肺功能指标及炎症因子的关系,为AECOPD患者制定个性化治疗方案提供参考依据。方法选取2016年6月至2017年1月温州市中心医院呼吸内科收治的AECOPD患者122例作为研究对象,入院后48 h内进行肺功能指标及痰诱导涂片检测,根据涂片细胞计数及分类分为嗜酸性粒细胞型(EOS型)、中性粒细胞型(NE型)、粒细胞缺乏型(AGR型)、混合粒细胞型(MIX型)4型;检测患者血常规、活性氧(ROS)、超氧化物歧化酶(SOD)、IL-8、粒细胞-巨噬细胞集落刺激因子(GM-CSF)及TNF-α,予静脉滴注广谱抗生素,并予雾化吸入支气管扩张剂治疗,观察疗效。结果NE型及MIX型患者外周血及诱导痰中性粒细胞百分比均高于EOS型及AGR型患者(均P<0.05),而EOS型及MIX型患者外周血及痰诱导嗜酸性粒细胞百分比均高于NE型及AGR型患者(均P<0.05)。NE型及MIX型患者第一秒用力呼气容积(FEV1)均低于EOS型及AGR型患者(均P<0.05),NE型患者FEV1/用力肺活量(FVC)均低于EOS型、AGR型及MIX型患者(均P<0.05)。NE型及MIX型患者血清ROS、IL-8、GM-CSF及TNF-α水平均高于EOS型及AGR型,血清SOD活性均低于EOS型及AGR型患者(均P<0.05)。不同分型COPD患者血清ROS、IL-8、GM-CSF、TNF-α水平与FEV1及FEV1/FVC均呈负相关(均P<0.05),血清SOD活性与FEV1及FEV1/FVC均呈正相关(均P<0.05)。NE型及MIX型患者症状恢复时间、住院时间、治疗失败率均高于EOS型及AGR型患者(均P<0.05)。结论根据痰诱导涂片结果对AECOPD患者进行分型,其中NE型和MIX型COPD患者的肺功能较差、氧化/抗氧化系统失衡较为严重、对治疗反应性较差。这种分型可为AECOPD患者个性化治疗方案的制定提供参考。Objective To investigate the relationship of chronic obstructive pulmonary disease(COPD)typing based on induced sputum smear with pulmonary function and inflammatory factor levels in patients with acute exacerbation of COPD(AECOPD).Methods A total of 122 patients with AECOPD admitted to the Department of Respiratory of Wenzhou Central Hospital from June 2016 to January 2017 were enrolled in the study.All patients underwent pulmonary function and sputum induction tests within 48 h after admission.Based on the results of induced sputum smears patients were classified into four types:neutrophils type(NE type),eosinophilic type(EOS type),agranulocytic type(AGR type)and mixed granulocytic type(MIX type).The blood routine,ROS,SOD,IL-8,GM-CSF and TNF-αwere tested,and the curative effect was observed.Results The percentages of neutrophils in peripheral blood and sputum induction in patients with NE type and MIX type were significantly higher than those in patients with AGR type and EOS type,while the percentages of eosinophils in peripheral blood and sputum induction in patients with EOS type and MIX type were significantly higher than those in patients with AGR type and NE type(all P<0.05).In terms of pulmonary function,FEV1 in NE type and MIX type patients were significantly lower than that in AGR type and EOS type,FEV1/FVC in patients with NE type was significantly lower than that in AGR type,EOS type and MIX type(all P<0.05).The serum levels of ROS,IL-8,GM-CSF and TNF-αin NE type and MIX type were significantly higher,while SOD level was significantly lower than those in AGR type and EOS type(all P<0.05).The FEV1 and FEV1/FVC were negatively correlated with ROS,IL-8,GM-CSF,TNF-α,and positively correlated with SOD in different types of COPD patients(all P<0.05).The symptoms recovery time,hospitalization time and drug treatment failure rate of NE type and MIX type patients were higher than those of EOS type and AGR type(all P<0.05).Conclusion According to the classification based on induced sputum smears,the AECOPD

关 键 词：慢性阻塞性肺疾病 痰诱导 炎症因子 肺功能 

分 类 号：R563.9[医药卫生—呼吸系统]