哮喘联盟

    背景：COPD为异质性疾病，其特征是包括了3种不同的疾病，即慢性哮喘、慢性支气管炎和肺气肿，患者有时可同时出现上述三种疾病。
    目的：本研究目的为比较不同表现型的气道阻塞患者痰液中的炎症标志物。
    方法：45名患者（第1秒用力呼气量/肺活量58.8±12.2％；FEV1：49.8 ±11.5%预计值）分为慢性哮喘（n＝10）组和COPD（n＝35）组，后者再根据临床病史和功能评价分为以慢性支气管炎为主组（n＝24）和以肺气肿为主组(n＝11)。诱导咳痰后分析其中炎性细胞和可溶性介质。
    结果：与COPD患者相比，慢性哮喘患者唾液中嗜酸性细胞较多，嗜酸性阳离子蛋白水平较高，而中性粒细胞百分比及中性粒细胞弹性蛋白酶较低。慢性哮喘患者和COPD患者痰液上清液中的中性粒细胞趋化活性均较正常人高。慢性支气管炎患者和肺气肿患者痰液在细胞组成和可溶性介质水平上无显著差异。
    结论：诱导痰分析显示，慢性哮喘患者的气道炎症形式与具有相同FEV1的COPD患者不同。然而在COPD患者中，慢性支气管炎患者和肺气肿患者之间的气道炎症形式无明显差异，这表明，虽然两者为临床和功能上不同的两种表现型，但诱导痰显示两者具有相同的炎症形式。

（刘国梁 审校）
Bartoli ML, et al. Respiration. 2008 Dec 11. [Epub ahead of print]

Biological Markers in Induced Sputum of Patients with Different Phenotypes of Chronic Airway Obstruction.

Bartoli ML, Di Franco A, Vagaggini B, Bacci E, Cianchetti S, Dente FL, Tonelli M, Paggiaro PL.
Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by a combination of 3 different disorders, namely chronic asthma, chronic bronchitis and pulmonary emphysema, sometimes simultaneously present in the same subject.
Objectives: The aim of our study was to compare sputum inflammatory markers in patients with different phenotypes of chronic airway obstruction.
Methods: Forty-five subjects (forced expiratory volume in 1 s/vital capacity, FEV(1)/VC: 58.8 +/- 12.2%; FEV(1): 49.8 +/- 11.5% of predicted) were classified as chronic asthma (n = 10) or COPD patients (n = 35); the latter were further divided into patients with prevalent chronic bronchitis (n = 24) or prevalent pulmonary emphysema (n = 11) according to clinical history and functional evaluation, and underwent sputum induction and analysis of inflammatory cell and soluble mediators.
Results: Patients with chronic asthma showed higher sputum eosinophil percentages and eosinophilic cationic protein levels, and lower neutrophil percentages and neutrophil elastase levels than COPD patients. Neutrophil chemotactic activity in sputum supernatant was higher than the pool of normal subjects both in chronic asthma and COPD patients. No difference in sputum cell composition and levels of soluble mediators was observed between patients with chronic bronchitis and patients with pulmonary emphysema.
Conclusions: The pattern of airway inflammation in induced sputum of patients with chronic asthma is different from that of COPD patients with a similar FEV(1). Among COPD patients, however, the pattern of airway inflammation shows no difference between chronic bronchitis and patients with pulmonary emphysema, suggesting that these two clinically and functionally distinct phenotypes share a common inflammatory pattern as detected by induced sputum.