摘要目的 探讨支气管哮喘(简称哮喘)患者的气道炎症表型分布及其与哮喘控制水平的相关性.方法 纳入2017年10月至2018年4月就诊于中日友好医院呼吸病门诊符合GINA2017哮喘诊断标准的患者.前瞻性收集非急性发作期哮喘患者的临床资料,包括一般资料、哮喘控制水平、肺功能、诱导痰细胞分类计数、血清总IgE、呼出气一氧化氮(FeNO)、全血细胞分类计数等数据.应用相关分析,分析气道炎症表型分布及气道炎症标志物(痰嗜酸粒细胞、FeNO、血嗜酸粒细胞、血清IgE)与哮喘控制的相关性,分析痰嗜酸粒细胞水平与FeNO、血嗜酸粒细胞计数、第一秒用力呼气量(FEV1)占预计值的百分比(FEV1％预计值)相关性.结果 共纳入符合入选标准哮喘患者97例,男38例(39.2％),女59例(60.8％);年龄(48±14)岁(范围22～80岁).哮喘控制13例(13.4％),部分控制39例(40.2％),未控制45例(46.4％).嗜酸粒细胞型51例(52.6％),中性粒细胞型9例(9.3％),混合性细胞型35例(36.1％),寡细胞型2例(2.1％).气道炎症表型分布及气道炎症标志物与哮喘控制水平之间无显著相关性(P＞0.05).部分控制和未控制患者痰嗜酸粒细胞水平与FeNO水平呈正相关(r=0.420,P=0.008和r=0.325,P=0.031);未控制哮喘患者痰嗜酸粒细胞水平与血嗜酸粒细胞水平呈正相关(r=0.328,P=0.037);痰嗜酸粒细胞水平与FEV1％预计值无显著相关性(P＞0.05).结论 哮喘患者气道炎症表型以嗜酸粒细胞型为主,且与哮喘控制水平间无显著相关性,目前尚不能用其评估哮喘控制水平.

abstractsObjective To investigate the distribution of airway inflammation phenotypes in patients with bronchial asthma and its correlation with asthma control level.Methods Patients who met GINA 2017 asthma diagnostic criteria from October 2017 to April 2018 in respiratory outpatient department of China-Japan Friendship Hospital were included.The clinical data of non-acute asthma patients were prospectively collected,including general data,asthma control level,pulmonary function,induced sputum cell classification,serum total IgE,exhaled nitric oxide (FeNO),blood cell classification.The correlation between phenotype distribution of airway inflammation and airway inflammation markers (eosinophils in sputum,FeNO,blood eosinophil,serum IgE) and asthma control was analyzed by correlation analysis.The correlation between sputum eosinophil level and FeNO,blood eosinophil count,serum total IgE,forced expiratory volume in one-second (FEV1) predicted (FEV1％pred) was analyzed by correlation analysis too.Results A total of 97 asthmatic patients were enrolled.There were 38 males (39.2％) and 59 females (60.8％),aged (48± 14) (range 22 to 80).Control level of asthma:13 cases (13.4％) were controlled,39 cases (40.2％) were partially controlled and 45 cases (46.4％) were uncontrolled.The phenotypes of airway inflammation were eosinophilic 51 cases (52.6％),neutrophilic 9 cases (9.3％),mixed 35 cases (36.1％) and paucigranulocytic 2 cases (2.1％).There was no significant correlation between airway inflammation phenotype distribution,airway inflammation markers and asthma control level (P＞0.05).Sputum eosinophil level was positively correlated with FeNO level in controlled and uncontrolled patients (r=0.420,P=0.008 and r=0.325,P=0.031);sputum eosinophil level was positively correlated with blood eosinophil level in uncontrolled asthma patients (r=0.328,P=0.037).There was no significant correlation between sputum eosinophil level and FEV1％pred (P＞0.05).Conclusions Eosinophil type is the dominant type of airway inflammation in asthmatic patients,and there is no significant correlation between airway inflammation and asthma control level.At present,airway inflammation cannot be used to assess asthma control level.