Zhang X-Y, Simpson J L, Powell H, Yang I A, Upham J W, Reynolds P N, Hodge S, James A L, Jenkins C, Peters M J, Lin J-T, Gibson P G
Department of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Graduate School, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Clin Exp Allergy. 2014 Sep;44(9):1137-45. doi: 10.1111/cea.12345.
In asthma, the airway inflammatory phenotype influences clinical characteristics and treatment response. Although induced sputum is the gold standard test for phenotyping asthma, a more accessible method is needed for clinical practice.
To investigate whether white blood cell counts and/or their derived ratios can predict sputum eosinophils or neutrophils in uncontrolled asthma.
This cross-sectional study evaluated 164 treated but uncontrolled asthmatic patients with sputum induction and blood collection. Receiver-operating characteristic (ROC) curves were used to assess the relationship between blood and sputum parameters.
There was a significant positive relationship between blood eosinophil parameters and the percentage of sputum eosinophil count. A weak but significant correlation was found between sputum neutrophil percentage and blood neutrophil percentage (r = 0.219, P = 0.005). ROC curve analysis identified that blood eosinophil percentage count was the best predictor for eosinophilic asthma, with an area under the curve (AUC) of 0.907 (P < 0.001). The optimum cut-point for blood eosinophil percentage was 2.7%, and this yielded a sensitivity of 92.2% and a specificity of 75.8%. The absolute blood eosinophil count was also highly predictive with an AUC of 0.898 (P < 0.0001) at a blood eosinophil cut-off of 0.26 × 10(9) /L. The blood eosinophil/lymphocyte ratio (ELR) and eosinophil/neutrophil ratio (ENR) were increased in eosinophilic asthma, and the neutrophil/lymphocyte ratio (NLR) was increased in neutrophilic asthma. Neutrophilic asthma could also be detected by blood neutrophil percentages and NLR, but with less accuracy.
Blood eosinophil counts and derived ratios (ELR and ENR) can accurately predict eosinophilic asthma in patients with persistent uncontrolled asthma despite treatment. Blood neutrophil parameters are poor surrogates for the proportion of sputum neutrophils. Blood counts may be a useful aid in the monitoring of uncontrolled asthma.
在哮喘中，气道炎症表型影响临床特征和治疗反应。虽然诱导痰是哮喘表型分析的金标准检测方法，但临床实践中需要一种更易获得的方法。
研究白细胞计数和/或其衍生比值是否可预测未控制哮喘患者的痰嗜酸性粒细胞或中性粒细胞。
这项横断面研究对164例接受治疗但未得到控制的哮喘患者进行了痰液诱导和血液采集评估。采用受试者操作特征（ROC）曲线评估血液和痰液参数之间的关系。
血液嗜酸性粒细胞参数与痰嗜酸性粒细胞计数百分比之间存在显著正相关。痰中性粒细胞百分比与血液中性粒细胞百分比之间存在微弱但显著的相关性（r = 0.219，P = 0.005）。ROC曲线分析表明，血液嗜酸性粒细胞百分比计数是嗜酸性粒细胞性哮喘的最佳预测指标，曲线下面积（AUC）为0.907（P < 0.001）。血液嗜酸性粒细胞百分比的最佳切点为2.7%，其敏感性为92.2%，特异性为75.8%。绝对血液嗜酸性粒细胞计数也具有高度预测性，在血液嗜酸性粒细胞临界值为0.26×10⁹/L时，AUC为0.898（P < 0.0001）。嗜酸性粒细胞性哮喘患者的血液嗜酸性粒细胞/淋巴细胞比值（ELR）和嗜酸性粒细胞/中性粒细胞比值（ENR）升高，中性粒细胞性哮喘患者的中性粒细胞/淋巴细胞比值（NLR）升高。中性粒细胞性哮喘也可通过血液中性粒细胞百分比和NLR检测到，但准确性较低。
尽管接受了治疗，但血液嗜酸性粒细胞计数及其衍生比值（ELR和ENR）可准确预测持续性未控制哮喘患者的嗜酸性粒细胞性哮喘。血液中性粒细胞参数不能很好地替代痰中性粒细胞比例。血细胞计数可能有助于监测未控制的哮喘。
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