【摘要】 背景支气管扩张症（简称支扩症）是常见的气道慢性炎症性疾病,但患者存在明显异质性。诱导痰及呼出气一氧化氮（FeNO）检查已广泛应用于哮喘及慢性阻塞性肺疾病的病情评估,但是否有助于评估支扩症患者的气道炎症状态尚缺乏相关临床研究。目的评估诱导痰及FeNO检查与支扩症患者临床特征、肺功能指标的关系,探讨无创气道炎症检查在支扩症患者中的应用价值。方法选择2017年1月—2018年12月于沧州市中心医院就诊的稳定期支扩症患者62例为研究对象,记录患者性别、年龄、体质指数（BMI）、吸烟史、病程、急性加重次数、痰量、咯血史、发生支扩症的病因、铜绿假单胞菌定植等情况,并进行胸部高分辨率CT（HRCT）检查,记录HRCT评分;进行肺功能检查,记录第1秒用力呼气末容积占预计值的百分比（FEV₁%pred）、用力肺活量占预计值的百分比（FVC%pred）、第1秒用力呼气末容积占用力肺活量的百分比（FEV₁/FVC）、应用支气管扩张剂后第1秒用力呼气末容积（FEV₁）增加量;进行诱导痰检查,测定白介素（IL）-8、IL-6、IL-13水平,观察细胞分型情况;进行FeNO检查,并记录FeNO。采用Pearson相关性分析探讨诱导痰检查的部分指标与FeNO及肺检查指标的相关性。结果支扩症患者按照诱导痰细胞学分类可以分为中性粒细胞型（32例）、嗜酸粒细胞型（10例）、混合细胞型（6例）、寡细胞型（14例）。中性粒细胞型患者IL-8、IL-6水平高于嗜酸粒细胞型、寡细胞型患者,IL-13水平、FeNO、应用支气管扩张剂后FEV₁增加量低于嗜酸粒细胞型、混合细胞型患者,HRCT评分高于嗜酸粒细胞型、混合细胞型、寡细胞型患者（P<0.05）;嗜酸粒细胞型患者IL-8、IL-6水平低于混合细胞型患者,IL-13水平、FeNO高于寡细胞型患者,应用支气管扩张剂后FEV₁增加量高于混合细胞型、寡细胞型患者（P<0.05）;混合细胞型患者应用支气管扩张剂后FEV₁增加量、IL-8水平、IL-6水平、IL-13水平、FeNO高于寡细胞型患者（P<0.05）。IL-8水平与HRCT评分（r=0.625）、中性粒细胞百分比（r=0.711）呈正相关,与FEV₁%pred（r=-0.327）、FVC%pred（r=-0.401）、FEV₁/FVC（r=-0.398）、应用支气管扩张剂后FEV₁增加量（r=-0.312）呈负相关（P<0.05）;IL-6水平与HRCT评分（r=0.342）、中性粒细胞百分比（r=0.221）呈正相关（P<0.05）;IL-13水平与应用支气管扩张剂后FEV₁增加量（r=0.439）、嗜酸粒细胞百分比（r=0.536）、FeNO（r=0.526）呈正相关（P<0.05）;中性粒细胞百分比与HRCT评分（r=0.548）呈正相关,与FEV₁%pred（r=-0.372）、FVC%pred（r=-0.345）、FEV₁/FVC（r=-0.253）、应用支气管扩张剂后FEV₁增加量（r=-0.346）、嗜酸粒细胞百分比（r=-0.553）呈负相关（P<0.05）;嗜酸粒细胞百分比与应用支气管扩张剂后FEV₁增加量（r=0.522）、FeNO（r=0.576）呈正相关（P<0.05）;FeNO与应用支气管扩张剂后FEV₁增加量（r=0.423）呈正相关（P<0.05）。结论诱导痰细胞分类、IL-8、IL-6、IL-13水平及FeNO与支扩症患者临床指标相关,有助于支扩症患者病情的综合评价。更多还原

【Abstract】 Background Bronchiectasis is a common chronic airway inflammatory disease,but varies significantly across individuals.Induced sputum and fractional exhaled nitric oxide（FeNO）have been widely used in the assessment of asthma and chronic obstructive pulmonary disease,but little is known about whether they could be used for evaluating airway inflammation in bronchiectasis.Objective To evaluate the associations of induced sputum and Fe NO with the clinical characteristics and lung function parameters in patients with bronchiectasis,to explore the value of noninvasive airway inflammation tests in stable bronchiectasis.Methods We enrolled 62 patients with stable bronchiectasis who were treated in Cangzhou Central Hospital from January 2017 to December 2018.Data were collected,including clinical characteristics（gender,age,BMI,smoking history,course of bronchiectasis,number of exacerbations per year,sputum volume,history of hemoptysis,cause of bronchiectasis,colonization of Pseudomonas aeruginosa）,results of high-resolution CT（HRCT）of the chest,lung function test parameters（FEV₁%pred,FVC%pred,FEV₁/FVC ratio,increase in FEV₁ after using the bronchodilator）,induced sputum test parameters（IL-8,IL-6 and IL-13）and sputum cell classification,and Fe NO.Pearson correlation analysis was used to explore the associations of some induced sputum test parameters with Fe NO and lung function test parameters.Results Patients with bronchiectasis can be divided into neutrophilic type（32 cases）,eosinophilic type（10 cases）, mixed granulocytic type（6 cases）and paucigranulocytic type（14 cases）according to the cytological classification of induced sputum.The levels of IL-8 and IL-6 in neutrophilic type were higher compared with those of eosinophilic and paucigranulocytic types,while the level of IL-13,Fe NO,increase in FEV₁ after using the bronchodilator were lower than those of eosinophilic and mixed granulocytic types（P<0.05）.The neutrophilic type had more severe bronchiectasis in HRCT（P<0.05）.The eosinophilic type had lower levels of IL-8 and IL-6 than mixed granulocytic type,greater level of IL-13 and Fe NO than paucigranulocytic type,and more increase of FEV₁ after using the bronchodilator than mixed granulocytic and paucigranulocytic types（P<0.05）.The increase in FEV₁ after using the bronchodilator,levels of IL-8,IL-6,IL-13,and Fe NO of mixed granulocytic type were higher than those of paucigranulocytic type（P<0.05）.The level of sputum IL-8 was positively correlated with the score of HRCT（r=0.625）and the percentage of neutrophils（r=0.711）,and was negatively correlated with FEV₁%pred（r=-0.327）,FVC%pred（r=-0.401）,FEV₁/FVC ratio（r=-0.398）,increase in FEV₁ after using the bronchodilator（r=-0.312,P<0.05）.IL-6 was positively correlated with the score of HRCT（r=0.342）and the percentage of neutrophils（r=0.221,P<0.05）.The level of IL-13 was correlated with the increase in FEV₁ after using the bronchodilator（r=0.439）,the percentage of eosinophils（r=0.536）,and Fe NO（r=0.526,P<0.05）.The percentage of neutrophils was positively correlated with the score of HRCT（r=0.548）,and negatively correlated with FEV₁%pred（r=-0.372）,FVC%pred（r=-0.345）,FEV₁/FVC ratio（r=-0.253）,increase in FEV₁ after using the bronchodilator（r=-0.346）,the percentage of eosinophils（r=-0.553,P<0.05）.The percentage of eosinophils was positively correlated with the increase in FEV₁ after using the bronchodilator（r=0.522）and Fe NO（r=0.576,P<0.05）.Fe NO was correlated with the increase in FEV₁ after using the bronchodilator（r=0.423,P<0.05）.Conclusion The induced sputum cell classification,IL-8,IL-6,IL-13 levels and Fe NO were related with the clinical indicators of patients with bronchiectasis,which may be helpful for the comprehensive evaluation of bronchiectasis.更多还原