Cataldo D, Foidart J M, Lau L, Bartsch P, Djukanovic R, Louis R
Department of Pneumology, University of Liège, Liège, Belgium.
Chest. 2001 Dec;120(6):1815-21. doi: 10.1378/chest.120.6.1815.
Sputum induction by hypertonic saline solution inhalation is widely used to study airways secretions in patients with asthma. However, hypertonic saline solution is a potent indirect bronchoconstrictor.
We studied the validity of isotonic saline solution (0.9%) inhalation as a means to induce sputum by comparing it to hypertonic saline solution (4.5%) inhalation.
Sixteen patients with moderate-to-severe asthma reporting a clinical history of mucus hypersecretion.
Subjects underwent sputum induction twice at 1-week intervals. Saline solution (hypertonic or isotonic) was inhaled for three periods of 5 min. The parameters assessed in sputum samples were cell counts, sodium, eosinophil cationic protein (ECP), and albumin concentrations, osmolality, and pro-matrix metalloproteinase (MMP)-9 activity by zymography.
The maximal fall in peak expiratory flow during sputum induction was greater after inhalation of hypertonic saline solution than after inhalation of isotonic saline solution (p < 0.01). Each subject produced analyzable sputum on both visits. There were no statistically significant differences in total and differential sputum cell counts, and the reproducibility coefficients were high for eosinophils and neutrophils when comparing the two methods. Likewise, sputum levels of ECP and albumin as well as sputum pro-MMP-9 activity were not different between the two methods, and were highly reproducible as shown by high intraclass coefficients (Ri) of correlation (0.72, 0.74, and 0.77 for ECP, albumin, and pro-MMP-9, respectively). Sputum sodium concentrations and osmolality were higher after inhalation of hypertonic saline solution (p < 0.05).
In patients with moderate-to-severe asthma reporting a clinical history of mucus hypersecretion, inducing sputum by isotonic or hypertonic saline solution inhalation leads to comparable results in eosinophil and neutrophil cell counts and fluid phase mediators/proteins.
吸入高渗盐溶液诱导痰液广泛用于研究哮喘患者的气道分泌物。然而，高渗盐溶液是一种有效的间接支气管收缩剂。
通过将等渗盐溶液（0.9%）吸入与高渗盐溶液（4.5%）吸入进行比较，研究其作为诱导痰液方法的有效性。
16例有黏液分泌亢进临床病史的中重度哮喘患者。
受试者每隔1周进行两次痰液诱导。吸入盐溶液（高渗或等渗），分三个时段，每次5分钟。对痰液样本评估的参数包括细胞计数、钠、嗜酸性粒细胞阳离子蛋白（ECP）、白蛋白浓度、渗透压，以及通过酶谱法检测的前基质金属蛋白酶（MMP）-9活性。
吸入高渗盐溶液后痰液诱导期间呼气峰值流速的最大下降幅度大于吸入等渗盐溶液后（p<0.01）。每位受试者两次检查均产生了可分析的痰液。两种方法比较时，痰液总细胞计数和分类细胞计数无统计学显著差异，嗜酸性粒细胞和中性粒细胞的重复性系数较高。同样，两种方法的痰液ECP和白蛋白水平以及痰液前MMP-9活性无差异，且具有高度重复性，组内相关系数（Ri）较高（ECP、白蛋白和前MMP-9分别为0.72、0.74和0.77）。吸入高渗盐溶液后痰液钠浓度和渗透压较高（p<0.05）。
对于有黏液分泌亢进临床病史的中重度哮喘患者，吸入等渗或高渗盐溶液诱导痰液在嗜酸性粒细胞和中性粒细胞计数以及液相介质/蛋白质方面产生的结果相当。
