Grootendorst D C, Sont J K, Willems L N, Kluin-Nelemans J C, Van Krieken J H, Veselic-Charvat M, Sterk P J
Department of Pulmonology, Leiden University Medical Centre, The Netherlands.
Clin Exp Allergy. 1997 Jul;27(7):769-79.
Induced sputum potentially allows monitoring of airway inflammation in patients with asthma in a non-invasive way. However, the relationship between the cellular content in sputum and airway tissue has not been fully clarified.
We compared the cellular compositions of hypertonic saline-induced sputum, bronchoalveolar lavage fluid (BAL) and bronchial biopsies in 18 clinically stable patients with mild to moderate atopic asthma (baseline FEV1: range 61-114%pred, PC20 methacholine: 0.04-4.7 mg/mL). They were treated with inhaled short-acting bronchodilators on demand, with (n = 8) or without (n = 10) regular inhaled steroids.
Each patient underwent sputum induction and fiberoptic bronchoscopy on separate days in random order. Differential cell counts of induced sputum, bronchoalveolar lavage and bronchial wash were determined on May-Grünwald-Giemsa stained cytospins. Flow cytometry was performed on sputum and BAL samples. Immunohistochemical techniques were used to stain inflammatory cells in 6 microm cryostat sections of bronchial biopsies.
Sputum cell differentials were not different between the patients with and without inhaled steroids, and showed a median value of 19.4% squamous cells, with 1.0% eosinophils, 3.3% lymphocytes, 28.7% neutrophils, 49.4% macrophages and 6.9% cylindric epithelial cells (in percentage non-squamous cells). The percentage eosinophils in sputum was significantly correlated with their percentage in bronchial wash (Rs = 0.52, P = 0.03) and in BAL (Rs = 0.55, P= 0.02), whilst there was a trend towards such a correlation between the number of eosinophils/mL sputum and the number of EG2+ eosinophils/mm2 lamina propria in bronchial biopsies (Rs = 0.44, P = 0.07). In addition, the percentage of CD4+ lymphocytes correlated between sputum and BAL (Rs = 0.55, P = 0.03).
We conclude that the eosinophil counts in hypertonic saline-induced sputum from patients with asthma are related to those in bronchial wash and BAL and, to a lesser extent, with the counts in bronchial biopsies. This suggests that induced sputum can be used to monitor the presence and severity of airway inflammation in asthma.
诱导痰有可能以非侵入性方式监测哮喘患者的气道炎症。然而，痰中的细胞成分与气道组织之间的关系尚未完全阐明。
我们比较了18例临床稳定的轻至中度特应性哮喘患者（基线FEV1：预测值范围为61%-114%，乙酰甲胆碱PC20：0.04-4.7mg/mL）的高渗盐水诱导痰、支气管肺泡灌洗液（BAL）和支气管活检组织的细胞组成。他们按需使用吸入短效支气管扩张剂治疗，其中8例使用（n = 8）或10例未使用（n = 10）常规吸入性糖皮质激素。
每位患者在不同日期按随机顺序接受痰诱导和纤维支气管镜检查。对May-Grünwald-Giemsa染色的细胞涂片进行诱导痰、支气管肺泡灌洗和支气管冲洗的细胞分类计数。对痰和BAL样本进行流式细胞术检测。免疫组织化学技术用于对支气管活检组织6微米冰冻切片中的炎性细胞进行染色。
使用和未使用吸入性糖皮质激素的患者之间痰细胞分类无差异，鳞状细胞中位数为19.4%，嗜酸性粒细胞为1.0%，淋巴细胞为3.3%，中性粒细胞为28.7%，巨噬细胞为49.4%，柱状上皮细胞为6.9%（以非鳞状细胞百分比计）。痰中嗜酸性粒细胞百分比与支气管冲洗液（Rs = 0.52，P = 0.03）和BAL中（Rs = 0.55，P = 0.）的百分比显著相关，而痰中每毫升嗜酸性粒细胞数量与支气管活检组织固有层中EG2+嗜酸性粒细胞每平方毫米数量之间有这种相关趋势（Rs = 0.44，P = 0.07）。此外，痰和BAL中CD4+淋巴细胞百分比相关（Rs = 0.55，P = 0.03）。
我们得出结论，哮喘患者高渗盐水诱导痰中的嗜酸性粒细胞计数与支气管冲洗液和BAL中的相关，并在较小程度上与支气管活检组织中的计数相关。这表明诱导痰可用于监测哮喘气道炎症的存在和严重程度。
