D'silva Liesel, Cook Richard J, Allen Christopher J, Hargreave Frederick E, Parameswaran Krishnan
Firestone Institute for Respiratory Health, St. Joseph's Healthcare and Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, Canada L8N 4A6.
Respir Med. 2007 Oct;101(10):2217-20. doi: 10.1016/j.rmed.2007.05.010. Epub 2007 Jul 2.
Exacerbations of airway disease are eosinophilic, neutrophilic, both or neither, and this determines the treatment needed. We examined changes in the cellular nature of airway inflammation between consecutive exacerbations and their predictors in individual patients.
In a retrospective survey of 1786 consecutive sputum cell counts from 1139 patients with airway disease, we identified 79 patients with two or more exacerbations at an interval of >or=6 weeks. The patients were divided into those who demonstrated a change in the type of airway inflammation and those who did not.
There were 186 exacerbations of airway disease over 22 months. The cellular nature of inflammation was eosinophilic in 43%, neutrophilic in 40%, combined eosinophilic and neutrophilic in 5% and unclassified in 12%. A change in the type of airway inflammation was seen in 38 patients (48%). Patients, whose previous exacerbation was eosinophilic or neutrophilic were twice or nearly three times more likely, respectively, to have a subsequent exacerbation of the same type. There was no significant difference in the time to the second exacerbation or the inflammatory type of the second exacerbation in relation to the first exacerbation, irrespective of the cellular nature of the first exacerbation.
Quantitative sputum cell counts during successive exacerbations identify that they are commonly of different type, reflecting different causes and the need for different treatment. Their use, when available, helps to optimize therapy.
气道疾病的加重期表现为嗜酸性粒细胞性、中性粒细胞性、两者皆有或两者皆无，这决定了所需的治疗方法。我们研究了连续加重期之间气道炎症细胞性质的变化及其在个体患者中的预测因素。
在一项对1139例气道疾病患者的1786次连续痰细胞计数的回顾性调查中，我们确定了79例间隔≥6周有两次或更多次加重的患者。将患者分为气道炎症类型发生变化的患者和未发生变化的患者。
在22个月内有186次气道疾病加重。炎症的细胞性质为嗜酸性粒细胞性的占43%，中性粒细胞性的占40%，嗜酸性粒细胞和中性粒细胞混合性的占5%，未分类的占12%。38例患者（48%）出现了气道炎症类型的变化。前一次加重为嗜酸性粒细胞性或中性粒细胞性的患者，随后出现同一类型加重的可能性分别是前者的两倍或近三倍。第二次加重的时间或第二次加重的炎症类型与第一次加重相比，无论第一次加重的细胞性质如何，均无显著差异。
连续加重期的定量痰细胞计数表明，它们通常属于不同类型，反映了不同的病因和不同的治疗需求。在可行时使用痰细胞计数有助于优化治疗。
