Gibson P G, Norzila M Z, Fakes K, Simpson J, Henry R L
Airway Research Centre, Respiratory Medicine Unit, John Hunter Hospital and School of Paediatrics, University of New South Wales, Randwick, New South Wales, Australia.
Pediatr Pulmonol. 1999 Oct;28(4):261-70. doi: 10.1002/(sici)1099-0496(199910)28:4<261::aid-ppul5>3.0.co;2-i.
The aim of this study was to examine the relationship between sputum cell counts and clinical variables in children with an acute exacerbation of asthma. Sputum was successfully obtained from 37 of 42 children presenting to the Emergency Department with acute asthma, using ultrasonically nebulized normal saline (n = 19) or spontaneous expectoration (n = 18). Sputum portions were selected and dispersed, and total and differential cell counts were performed. Sputum supernatant was assessed for eosinophil cationic protein (ECP), interleukin (IL)-5, and IL-8. The exacerbations were of 3 inflammatory cell patterns: eosinophilic (n = 16 or 43% of total), combined eosinophilic/neutrophilic (E/N; n = 13.3 or 35% of total), or noneosinophilic (n = 8 or 22% of total). IL-5 was highest in eosinophilic exacerbations. Combined E/N exacerbations had increased mast cells (77%) and higher sputum ECP levels than eosinophilic exacerbations: 2,146 ng/mL vs. 666 ng/mL (P = 0.04). The speed of onset of the exacerbation was not related to the inflammatory cell profile. Logistic regression identified maintenance asthma treatment (odds ratio (OR), 5.9; 95% confidence interval (CI), 1.3-26.8) and lung function during the acute episode (OR, 4.0; 95% CI, 1.7-93) as significantly associated with the intensity of sputum eosinophilia. Eosinophils were lowest in children who received maintenance treatment with oral corticosteroids compared to those with no background asthma preventer therapy (P = 0.001). In conclusion, we identified three distinct patterns of airway inflammation in children with acute asthma; they included increased eosinophils, combined eosinophilic-neutrophilic infiltration, and a noneosinophilic pattern. Eosinophil degranulation was greatest with the combined eosinophilic/neutrophilic pattern of airway inflammation. Sputum eosinophils were associated with clinical severity, and background asthma therapy, but not with outcome, nor with speed of onset of exacerbations. These different inflammatory cell profiles imply different etiological agents and may require differing treatment strategies.
本研究旨在探讨哮喘急性加重期儿童痰液细胞计数与临床变量之间的关系。对42名因急性哮喘就诊于急诊科的儿童中的37名成功采集了痰液，其中19名使用超声雾化生理盐水，18名采用自主咳痰。选取痰液样本并进行分散处理，然后进行细胞总数及分类计数。对痰液上清液检测嗜酸性粒细胞阳离子蛋白（ECP）、白细胞介素（IL）-5和IL-8。急性加重期呈现3种炎症细胞模式：嗜酸性粒细胞性（n = 16，占总数的43%）、嗜酸性粒细胞/中性粒细胞混合性（E/N；n = 13，占总数的35%）或非嗜酸性粒细胞性（n = 8，占总数的22%）。IL-5在嗜酸性粒细胞性急性加重期最高。E/N混合性急性加重期的肥大细胞增多（77%），且痰液ECP水平高于嗜酸性粒细胞性急性加重期：分别为2146 ng/mL和666 ng/mL（P = 0.04）。急性加重期的起病速度与炎症细胞类型无关。逻辑回归分析显示，维持期哮喘治疗（比值比（OR）为5.9；95%置信区间（CI）为1.3 - 26.8）及急性发作期的肺功能（OR为4.0；95%CI为1.7 - 93）与痰液嗜酸性粒细胞增多的程度显著相关。与未接受背景哮喘预防治疗的儿童相比，接受口服糖皮质激素维持治疗的儿童嗜酸性粒细胞数量最低（P = 0.001）。总之，我们在急性哮喘儿童中确定了三种不同的气道炎症模式；包括嗜酸性粒细胞增多、嗜酸性粒细胞 - 中性粒细胞混合浸润以及非嗜酸性粒细胞模式。在气道炎症的嗜酸性粒细胞/中性粒细胞混合模式中，嗜酸性粒细胞脱颗粒最为显著。痰液嗜酸性粒细胞与临床严重程度及背景哮喘治疗有关，但与结局及急性加重期的起病速度无关。这些不同的炎症细胞类型提示病因不同，可能需要不同的治疗策略。
