Iredale M J, Wanklyn S A, Phillips I P, Krausz T, Ind P W
Department of Respiratory Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Clin Exp Allergy. 1994 Oct;24(10):940-5. doi: 10.1111/j.1365-2222.1994.tb02725.x.
Bronchial inflammation in mild asthma has been investigated using bronchoscopical techniques. The safety of bronchoscopy in patients with more severe asthma has been questioned. We have used the non-invasive technique of hypertonic saline (HS) inhalation to induced sputum samples for cellular analysis whilst simultaneously yielding a measure of bronchial responsiveness. Ten normal subjects and a heterogenous group of 24 asthmatic patients (range % predicted FEV1 43.3-111.5) underwent HS challenge. Sputum samples induced were analysed. Total and differential cell counts between the two groups were compared. The association between bronchial responsiveness to HS and sputum cell counts was examined in the asthma group. Mean maximum fall in FEV1 for normal subjects was 4.0 (2.1-5.9, 95% CI)% after saline. Geometric mean PD20HS for asthma patients was 7.7 (range 0.68-40.92)ml. Adequate sputum samples were obtained from 9/10 normals and 23/24 asthmatic patients. Sputum from normal subjects contained a median of 3.8 (2.8-8.1, interquartile range)% eosinophils compared with 17.6 (8.9-34.1)% in sputum from asthma patients (P < 0.001). Sputum from asthma patients contained fewer of all other cell types compared with normals, with the difference in macrophages reaching significance. There was no correlation between PD20HS and cell count for any cell type in asthma subjects. Analysis of induced sputum represents a simple, safe, non-invasive and well-tolerated method of assessment of bronchial inflammation, suitable for use in patients with a range of asthma severity. There was no relationship between inflammation, as assessed by sputum cell counts and a measure of 'indirect' bronchial responsiveness.
已使用支气管镜技术对轻度哮喘中的支气管炎症进行了研究。支气管镜检查在更严重哮喘患者中的安全性受到了质疑。我们使用高渗盐水（HS）吸入这种非侵入性技术来诱导痰液样本进行细胞分析，同时得出支气管反应性的测量值。10名正常受试者和一组由24名哮喘患者组成的异质性群体（预计FEV1范围为43.3 - 111.5%）接受了HS激发试验。对诱导出的痰液样本进行了分析。比较了两组之间的总细胞计数和分类细胞计数。在哮喘组中检查了支气管对HS反应性与痰液细胞计数之间的关联。正常受试者盐水激发后FEV1的平均最大下降值为4.0（2.1 - 5.9，95%CI）%。哮喘患者的几何平均PD20HS为7.7（范围为0.68 - 40.92）ml。从9/10的正常受试者和23/24的哮喘患者中获得了足够的痰液样本。正常受试者痰液中的嗜酸性粒细胞中位数为3.8（2.8 - 8.1，四分位间距）%，而哮喘患者痰液中的嗜酸性粒细胞为17.6（8.9 - 34.1）%（P < 0.001）。与正常受试者相比，哮喘患者痰液中的所有其他细胞类型数量更少，巨噬细胞数量的差异具有显著性。在哮喘受试者中，任何细胞类型的PD20HS与细胞计数之间均无相关性。诱导痰液分析是一种简单、安全、非侵入性且耐受性良好的评估支气管炎症的方法，适用于不同严重程度的哮喘患者。通过痰液细胞计数评估的炎症与“间接”支气管反应性测量值之间没有关系。
