Staticescu Sorana, Chereches-Panta Paraschiva, Ichim Gabriela, Valeanu Madalina, Nanulescu Mircea Victor
Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
Clujul Med. 2014;87(3):171-6. doi: 10.15386/cjmed-284. Epub 2014 Aug 5.
Induced sputum in children with bronchial asthma represents a non-invasive method of bronchial inflammation assessment. The main objective of our study was to analyze the cellularity of sputum in patients with bronchial asthma according to the level of disease control and the controlling therapy (with/without inhaled glucocorticoids). The second objective was to establish the correlation between sputum cellularity and other indirect parameters used to evidence bronchial inflammation (exhaled nitric oxide) and obstruction (forced expiratory volume in 1 second).
The study included children with bronchial asthma that were assessed clinically (physical exam, questionnaire on the control of bronchial asthma in children) and by medical tests (induced sputum, exhaled nitric oxide, spirometry).
In patients with partially controlled asthma and those with uncontrolled asthma, the eosinophils percentage in the sputum was higher than in patients with controlled asthma (19.8±26.4% respectively 9.2±20.5% versus 4.5±14.6%, p<0.001). Higher percentage of neutrophils in the sputum was found in the partially controlled and uncontrolled asthma than in the controlled asthma (43.9±20.1% respectively 51.6±38.3% versus 35±19.7%, p=0.009). We also evidenced a direct and statistically significant correlation between the exhaled nitric oxide and the neutrophils percentage in the sputum (r=0.67, p=0.0003). Also, an indirect, moderate to good correlation (r=-0.56, p=0.005) was evidenced between the values of the forced expiratory volume in 1 second and the high eosinophils percentage in the sputum.
In partially controlled and uncontrolled bronchial asthma the eosinophils and neutrophils count in the sputum is significantly higher than in patients with controlled asthma. There is an indirect correlation between the high eosinophils count in the sputum and the forced expiratory volume in 1 second, as well as a direct correlation between the neutrophils count and the exhaled nitric oxide, suggesting that induced sputum should be used in combination with other indirect parameters for the evidence of bronchial inflammation.
诱导痰液是评估支气管哮喘患儿支气管炎症的一种非侵入性方法。我们研究的主要目的是根据疾病控制水平和控制治疗情况（使用/不使用吸入性糖皮质激素）分析支气管哮喘患者痰液的细胞成分。第二个目的是确定痰液细胞成分与用于证明支气管炎症（呼出一氧化氮）和阻塞（一秒用力呼气量）的其他间接参数之间的相关性。
该研究纳入了患有支气管哮喘的儿童，这些儿童接受了临床评估（体格检查、儿童支气管哮喘控制问卷）和医学检查（诱导痰液、呼出一氧化氮、肺功能测定）。
在部分控制的哮喘患者和未控制的哮喘患者中，痰液中嗜酸性粒细胞百分比高于控制良好的哮喘患者（分别为19.8±26.4%和9.2±20.5%，而控制良好的哮喘患者为4.5±14.6%，p<0.001）。在部分控制和未控制的哮喘患者中，痰液中中性粒细胞百分比高于控制良好的哮喘患者（分别为43.9±20.1%和51.6±38.3%，而控制良好的哮喘患者为35±19.7%，p=0.009）。我们还证明呼出一氧化氮与痰液中中性粒细胞百分比之间存在直接且具有统计学意义的相关性（r=0.67，p=0.0003）。此外，一秒用力呼气量值与痰液中高嗜酸性粒细胞百分比之间存在间接的、中度至良好的相关性（r=-0.56，p=0.005）。
在部分控制和未控制的支气管哮喘中，痰液中嗜酸性粒细胞和中性粒细胞计数显著高于控制良好的哮喘患者。痰液中高嗜酸性粒细胞计数与一秒用力呼气量之间存在间接相关性，中性粒细胞计数与呼出一氧化氮之间存在直接相关性，这表明诱导痰液应与其他间接参数联合使用以证明支气管炎症。
