慢性支气管炎型慢性阻塞性肺疾病患者稳定期诱导痰炎性细胞的表达情况分析

摘要

目的：分析慢性支气管炎型与非慢性支气管炎型慢性阻塞性肺疾病( COPD)患者诱导痰中炎性细胞的表达是否存在差异。方法连续收集我院呼吸科门诊随访的稳定期肺功能分级Ⅰ~Ⅳ级COPD患者，连续收集我院呼吸科门诊随访的稳定期肺功能分级Ⅰ~Ⅳ级COPD患者，依据其是否具有慢性咳嗽咳痰病史每年3个月连续超过2年将患者分为慢性支气管炎型及非慢性支气管炎型COPD组。对两组患者分别进行常规肺功能检测及留取诱导痰进行细胞分析。结果共纳入稳定期COPD患者68例，平均年龄为(63．34±7．24)岁；其中男42人，平均年龄为(61．72±10．16)岁；女26人，平均年龄为(65．54±9．25)岁；按照患者有无慢性支气管炎症状将患者分为慢性支气管炎型38例及非慢性支气管炎型30例。伴有慢性支气管炎的COPD患者的痰嗜酸性粒细胞百分比显著高于不伴有慢性支气管炎的COPD患者，差异有统计学意义(P=0．03)。伴有慢性支气管炎的COPD患者比不伴有慢性支气管炎的COPD患者有显著的痰巨噬细胞的百分比较高，差异有统计学意义(P=0．04)；而痰中性粒细胞的百分比差异无统计学意义(P=0．45)。结论慢性支气管炎的临床症状反映着COPD患者基于痰和支气管活检中炎症细胞的不同的分型，这可能对伴有和不伴有慢性支气管炎COPD患者的治疗策略的调整起到提示作用。%Objective To analyze whether there are differences in the expression of inflammatory cells in the induced sputum between patients with chronic bronchitic chronic obstructive pulmonary disease( COPD) and those with non chrnonic bron-chitic COPD. Methods Followed up COPD outpatiens in stable stage with lung function gradeⅠ~Ⅳin the Department of Res-piration in our hospital were continuously collected. According to whether they have a history of chronic coμgh and expectoration more than 3 months every year and over 2 consecutive years,patients were divided into chronic bronchitic type and non chronic bronchitic type COPD group. The routine pulmonary function test and the cell analysis of induced sputum of the two groups were conducted,respectively. Results A total of 68 COPD patients in stable stage were enrolled. The average age was(63. 34 ± 7. 24) years old. There are 42 males,the average age of which was(61. 72 ± 10. 16) years old,and 26 females,the average age of which was (65. 54 ± 9. 25) years old. According to whether the patients have chronic bronchitic symptoms,they were divided into 38 cases of chronic bronchitic type and 30 cases of non chronic bronchitic type. Sputum eosinophil percentage was significantly higher in COPD patients with chronic bronchitis than those without chronic bronchitis,a statistically significant difference(P=0. 03). COPD patients with chronic bronchitis had a significantly higher percentage of sputum macrophages than those without chronic bronchitis,a statistical-ly significant difference(P=0. 04),while there was no significant difference in the percentage of sputum neutrophils(P=0. 45). Conclusion The clinical symptoms of chronic bronchitis reflect the classification of patients with COPD based on inflammatory cells in the sputum and bronchial biopsies,which may play a role in the adjustment of the treatment strategies for COPD patients with chro-nic bronchitis and those without chronic bronchitis.