诱导痰细胞分类在重叠综合征患者中的表达

摘要

目的探讨阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）合并慢性阻塞性肺疾病（ COPD）的重叠综合征（ OS）患者气道炎症反应情况。方法入选49例受试者分成3组，OS组18例、COPD组15例、OSAHS组16例，另设20例正常对照组，分别完成体质量指数（ BMI）测定、肺功能检查、多导睡眠图（ PSG）监测、诱导痰细胞分类检测等，并比较4组水平的差异。结果 OS组与OSAHS组的BMI高于正常对照组和COPD组，差异有统计学意义（ P＜0�05）；OS组与OSAHS组的呼吸暂停低通气指数（ AHI）明显高于正常对照组和COPD组，差异有统计学意义（ P＜0�05）；OS组和COPD组的FEV1％pred明显低于正常对照组和OSAHS组，差异有统计学意义（ P＜0�05）；OS组的动脉血氧分压（ PaO2）明显低于其他3组水平，差异有统计学意义（ P＜0�05）。 OS组的嗜中性粒细胞百分比明显高于其他3组，差异均有统计学意义（ P＜0�05）；OSAHS组与COPD组的嗜中性粒细胞百分比都明显高于正常对照组，差异均有统计学意义（ P＜0�05）。49例受试者嗜中性粒细胞相对计数水平与PaO2呈低度负相关（r＝－0�22，P＜0�05），与FEV1％pred呈中度负相关（r＝－0�48，P＜0�05）。结论 OS患者气道炎症反应更加强烈，易引起更为严重的通气功能障碍，间歇性低氧血症更为明显。诱导痰细胞分类计数检测有助于反映OS患者气道炎症病变情况。%Objective To explore the airway inflammation situation in patients with overlap syndrome( OS) through detecting induced sputum cell. Methods Forty⁃nine patients were recruited and divided into three groups, including OS group ( n=18) , COPD group ( n=15) and OSAS group ( n=16) , and 20 normal subjects were selected as control group. Body mass index( BMI) , pulmonary function test( PFT) , arterial blood gas( ABG) ,sputum induction and polysomnography were detected and compared. Results BMI was higher in OS group and OSAHS group, compared with COPD group and control group ( P<0�05) . AHI was much higher in OS group and OSAHS group than that in COPD group and control group ( P<0�05) . However, FEV1%pred was much lower in OS group and COPD group than that in OSAHS group and control group (P<0�05). PaO2 in OS group was the lowest (P<0�05). The percentage of neutrophils in induced sputum was higher in OS group(74�33±14�80, P<0�05), COPD group(63�33±13�22, P<0�05) and OSAS group(60�69±17�06, P<0�05) compared with control group. A weak negative correlation was found between PaO2 and percentage of airway neutrophils ( r=-0�22,P<0�05) . A moderate negative correlation was found between FEV1%pred and percentage of airway neutrophils ( r=-0�48,P<0�05) . Conclusions Patients suffering from OS present a higher percentage of neutrophils in induced sputum than those suffering from COPD or OSASHS alone. It means that OS induces more adverse airway inflammation because of coexistence of upper and peripheral airway obstruction. It would result in more significant intermittent hypoxemia.