D'silva Liesel, Allen Christopher J, Hargreave Frederick E, Parameswaran Krishnan
Firestone Institute for Respiratory Health, St. Joseph's Healthcare, and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Can Respir J. 2007 Jul-Aug;14(5):281-4. doi: 10.1155/2007/190618.
Exacerbations of airway disease are eosinophilic, neutrophilic, both or neither. The primary objective of the present study was to identify whether the treatment of a neutrophilic bronchitis can unmask an associated eosinophilia.
A retrospective survey of 2160 consecutive sputum cell counts from 1343 patients with airway disease was conducted to identify patients with an isolated neutrophilic bronchitis, which was defined as a sputum total cell count of greater than or equal to 12 x 10(6) cells/g of sputum and a proportion of neutrophils of 80% or greater. The characteristics of the patients who subsequently demonstrated sputum eosinophilia (3% or greater) within eight weeks of resolving the neutrophilia were compared with the patients who subsequently did not have sputum eosinophilia.
Two hundred thirty-seven patients had 273 neutrophilic exacerbations. The sputum was re-examined within eight weeks in 65 patients (27.4%), of whom 38 (58.5%) had resolution of the neutrophilic bronchitis after treatment with an antibiotic. Of these 38 patients, 13 (34%) showed eosinophilia.
A neutrophilic exacerbation of airway disease was observed to mask sputum eosinophilia in one-third of patients who had sputum cell counts available before and after antibiotic therapy. Hence, the absence of sputum eosinophilia during an infective exacerbation should not be used as an indication to reduce the dose of corticosteroids. To optimize therapy, repeat sputum cell count measurements are recommended after antibiotic treatment before changing corticosteroid treatment.
气道疾病的急性加重期可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。本研究的主要目的是确定中性粒细胞性支气管炎的治疗是否会使相关的嗜酸性粒细胞增多显现出来。
对1343例气道疾病患者连续进行的2160次痰细胞计数进行回顾性调查，以确定单纯性中性粒细胞性支气管炎患者，其定义为痰总细胞计数大于或等于12×10⁶细胞/克痰且中性粒细胞比例为80%或更高。将在中性粒细胞增多症消退后八周内痰嗜酸性粒细胞增多（3%或更高）的患者特征与随后未出现痰嗜酸性粒细胞增多的患者进行比较。
237例患者出现273次中性粒细胞性急性加重。65例患者（27.4%）在八周内重新检查了痰液，其中38例（58.5%）在使用抗生素治疗后中性粒细胞性支气管炎得到缓解。在这38例患者中，13例（34%）出现嗜酸性粒细胞增多。
在抗生素治疗前后有痰细胞计数的患者中，观察到三分之一的气道疾病中性粒细胞性急性加重期掩盖了痰嗜酸性粒细胞增多。因此，感染性急性加重期痰嗜酸性粒细胞缺乏不应作为减少皮质类固醇剂量的指征。为优化治疗，建议在抗生素治疗后且在改变皮质类固醇治疗前重复进行痰细胞计数测量。
