Chavannes Niels H, Vernooy Juanita H J, Schermer Tjard R J, Jacobs Jan A, Dentener Mieke A, van Weel Chris, van Schayck Onno C P, Wouters Emiel F M
Department of General Practice, Caphri Research Institute, Maastricht University, The Netherlands.
BMC Pulm Med. 2006 Jun 1;6:11. doi: 10.1186/1471-2466-6-11.
Although both smoking and respiratory complaints are very common, tools to improve diagnostic accuracy are scarce in primary care. This study aimed to reveal what inflammatory patterns prevail in clinically established diagnosis groups, and what factors are associated with eosinophilia.
Induced sputum and blood plasma of 59 primary care patients with COPD (n = 17), asthma (n = 11), chronic bronchitis (CB, n = 14) and smokers with no respiratory complaints ('healthy smokers', n = 17) were collected, as well as lung function, smoking history and clinical work-up. Patterns of inflammatory markers per clinical diagnosis and factors associated with eosinophilia were analyzed by multiple regression analyses, the differences expressed in odds ratios (OR) with 95% confidence intervals.
Multivariately, COPD was significantly associated with raised plasma-LBP (OR 1.2 [1.04-1.37]) and sTNF-R55 in sputum (OR 1.01 [1.001-1.01]), while HS expressed significantly lowered plasma-LBP (OR 0.8 [0.72-0.95]). Asthma was characterized by higher sputum eosinophilic counts (OR 1.3 [1.05-1.54]), while CB showed a significantly higher proportion of sputum lymphocytic counts (OR 1.5 [1.12-1.9]). Sputum eosinophilia was significantly associated with reversibility after adjusting for smoking, lung function, age, gender and allergy.
Patterns of inflammatory markers in a panel of blood plasma and sputum cells and mediators were discernable in clinical diagnosis groups of respiratory disease. COPD and so-called healthy smokers showed consistent opposite associations with plasma LBP, while chronic bronchitics showed relatively predominant lymphocytic inflammation compared to other diagnosis groups. Only sputum eosinophilia remained significantly associated with reversibility across the spectrum of respiratory disease in smokers with airway complaints.
尽管吸烟和呼吸道疾病都很常见，但在基层医疗中提高诊断准确性的工具却很匮乏。本研究旨在揭示在临床确诊的诊断组中普遍存在的炎症模式，以及与嗜酸性粒细胞增多相关的因素。
收集了59例基层医疗患者的诱导痰和血浆，这些患者包括慢性阻塞性肺疾病（COPD，n = 17）、哮喘（n = 11）、慢性支气管炎（CB，n = 14）以及无呼吸道疾病症状的吸烟者（“健康吸烟者”，n = 17），同时收集了肺功能、吸烟史和临床检查结果。通过多元回归分析分析每个临床诊断的炎症标志物模式以及与嗜酸性粒细胞增多相关的因素，差异以比值比（OR）和95%置信区间表示。
多因素分析显示，COPD与血浆脂多糖结合蛋白（LBP）升高（OR 1.2 [1.04 - 1.37]）以及痰液中可溶性肿瘤坏死因子受体55（sTNF - R55）升高（OR 1.01 [1.001 - 1.01]）显著相关，而健康吸烟者的血浆LBP显著降低（OR 0.8 [0.72 - 0.95]）。哮喘的特征是痰液嗜酸性粒细胞计数较高（OR 1.3 [1.05 - 1.54]），而CB显示痰液淋巴细胞计数比例显著更高（OR 1.5 [1.12 - 1.9]）。在调整吸烟、肺功能、年龄、性别和过敏因素后，痰液嗜酸性粒细胞增多与可逆性显著相关。
在呼吸道疾病的临床诊断组中，血浆和痰液细胞及介质中的炎症标志物模式是可辨别的。COPD和所谓的健康吸烟者与血浆LBP呈现出一致的相反关联，而与其他诊断组相比，慢性支气管炎患者表现出相对占主导的淋巴细胞炎症。在有呼吸道症状的吸烟者中，只有痰液嗜酸性粒细胞增多与整个呼吸道疾病谱中的可逆性仍显著相关。
