摘要目的:探讨外周血清可溶性CD163(sCD163)及相关炎症因子白细胞介素1β(IL-1β)、IL-4、IL-5、IL-6、IL-8、IL-9在不同哮喘炎症表型中表达的差异以及临床意义。方法:选择2016年1月至2018年10月期间在成都中医药大学附属四川省康复医院/四川省八一康复中心内科就诊的支气管哮喘(哮喘)患者172例，作为哮喘组。采集患者稳定期时的诱导痰液样本和外周血清样本。依据诱导痰标本中嗜酸粒细胞比例和中性粒细胞比例对哮喘患者进行炎症分型。另外采集30例健康志愿者的外周血，作为健康组。采用酶联免疫吸附测定法检测IL-1β、IL-4、IL-5、IL-6、IL-8、IL-9及sCD163水平。结果:哮喘组患者血清IL-1β、IL-5、IL-6、IL-8、sCD163水平明显高于健康组志愿者( t＝7.788、5.385、3.144、8.216、11.038， P值均<0.05)。依据痰诱导炎症细胞分型，嗜酸粒细胞增多型哮喘(EA)79例(45.93%)，粒细胞缺乏型哮喘(PA)83例(48.26%)，混合细胞型哮喘(MA)3例(1.74%)，中性粒细胞增多型哮喘(NA)7例(4.07%)。MA型患者痰中性粒细胞计数高于其他3个表型患者，并且MA型和NA型患者痰中性粒细胞百分比高于EA型和PA型患者( F＝695.904、2.890， P值均<0.05)。EA型和MA型患者诱导痰嗜酸粒细胞计数和百分比明显高于PA型和NA型患者( F＝1 080.975、136.314， P值均<0.05)。而EA型和PA型痰巨噬细胞计数和百分比明显高于MA型和NA型患者( F＝23.149、464.899， P值均<0.05)。经ELISA检测，NA组患者血清IL-6和IL-8水平明显高于其他3个表型患者( F＝2.890、12.329， P值均<0.05)。PA组患者血清IL-5水平明显低于其他3个表型患者，而sCD163水平却高于其他3个表型患者( F＝21.182、14.506， P值均<0.05)。经Spearman相关性分析，sCD163水平与FeNO、痰巨噬细胞计数呈正相关( r＝0.364、0.322， P值均<0.05)，与痰嗜酸粒细胞计数呈负相关( r＝－0.411， P<0.05)。 结论:不同炎症表型哮喘患者炎症细胞和炎性介质的表达具有一定的差异性，血清sCD163与气道嗜酸粒细胞和巨噬细胞浸润有关，在EA患者中表达水平相对较低。

abstractsObjective:To detect the peripheral serum expression of soluble CD163 (sCD163) and related interleukin-1β (IL-1β), IL-4, IL-5, IL-6, IL-8, IL-9 in stable asthma patients with different phenotypes and its significance.Methods:A total of 192 stable asthma patients as asthma group in Sichuan Bayi Rehabilitation Center and 30 healthy volunteers as healthy group were selected from January 2016 to October 2018.Induced sputum samples and peripheral blood samples were collected from stable asthma patients.According to the proportion of neutrophils and eosinophil ratio, patients were classified into eosinophiis asthma (EA), neutrophilic asthma (NA), paucigranulocytic asthma (PA) and mixed granulocytic asthma (MA). Enzyme linked immunosorbent assay was used to measure serum IL-1β, IL-4, IL-5, IL-8, IL-9, IL-6 and sCD163.Results:The levels of serum IL-1β, IL-5, IL-6, IL-8, sCD163 in stable asthma patients were higher than these in healthy volunteers ( t=7.788, 5.385, 3.144, 8.216, 11.038, all P<0.05). According to the proportion of neutrophils and eosinophil ratio in induced sputum, patients were classified into 79(45.93%) EA, 83(48.26%) PA, 3(1.74%) MA and 7(4.07%) NA.The neutrophils count in MA patients was highest among that of patients with 4 phenotypes, and the ratios in MA patients and NA patients were higher than that in EA or NA patients ( F=695.904, 2.890, both P<0.05). The eosinophil counts and ratios in EA patients and MA patients were higher than that in PA or NA patients ( F=1 080.975, 136.314, both P<0.05). The macrophage counts and ratios in EA patients and PA patients were higher than that in MA or NA patients ( F=23.149, 464.899, both P<0.05). Besides, the sputum levels of IL-6 and IL-8 in NA patients were highest among these of patients with 4 phenotypes ( F=2.890, 12.329, both P<0.05). And PA patients had lowest IL-5 levels and highest sCD163 levels in 4 phenotypes ( F=21.182, 14.506, both P<0.05). By spearman analysis, sCD163 was positively related with FeNO and macrophage counts ( r=0.364, 0.322, both P<0.05), while negatively related with eosinophil counts ( r=-0.411, P<0.05). Conclusions:There may be significant difference of inflammatory cells and medium in EA, NA, MA, PA phenotypes.It′s suggested that sCD163 be involved in the pathogenesis of asthma and tend to inhibit eosinophil inflammation in EA patients.