慢性阻塞性肺疾病急性加重期痰细胞分析

目的：探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者痰细胞学检查对疾病诊治的临床价值。方法：对58例AECOPD患者进行痰液中巨噬细胞、中性粒细胞、嗜酸性粒细胞和淋巴细胞计数，并于治疗前后完善肺功能检查。结果：AECOPD患者痰细胞以中性粒细胞及巨噬细胞为主。轻度与中度COPD患者痰巨噬细胞及中性粒细胞比较差异无统计学意义，而其余各组两两比较均有统计学意义（P〈0．05）。痰淋巴细胞及嗜酸细胞各组间两两比较均无明显统计学意义。支气管扩张试验阳性的COPD患者嗜酸细胞比例升高（P〈0．05），经糖皮质激素治疗后FFV1明显改善（P〈0．05）。吸烟与不吸烟患者比较未见痰细胞学差异（P〉0．05）。结论：AECOPD患者痰细胞分析以中性粒细胞及巨噬细胞为主．随疾病程度增加中性粒细胞的比例升高。支气管扩张试验阳性的COPD患者嗜酸细胞比例升高，糖皮质激素治疗效果好。

Analysis of sputum cells during acute exacerbation stage of chronic obstructive pulmonary disease

Objective： To investigate the clinical value of sputum cell counts in patients during acute exacerbation stage of chronic obstructive pulmonary disease （AECOPD）. Methods： Sputum cell counts （macrophage, neutrophile granulocyte, eosinophile granulocyte and lymphocyte ）and pulmonary function test before and after treatment were done in 58 patients with AECOPD. Results： Neutrophile granulocyte and macrophage were the major components of inflammatory cells in the sputum of patients with AECOPD. The comparison of percentages of macrophage and neutrophile granuloeyte among groups had significant difference （ P 〈 0.05 ） respectively except between Group grade I and Ⅱ. Moreover, there were no significant differences in percentage of eosinophile granulocyte or lymphocyte among the groups. Percentage of eosinophils in bronchial dilation test positive patients was higher than that in bronchial dilation test negative patients （ P 〈 0.05 ）, FEV1 were also improved obviously after treatment of glucocorticoid （P 〈 0.05 ）. While there was no different in the cellular composition of sputum between smokers and non-smokers. Conclusions： In acute exacerbation stage of chronic obstructive pulmonary disease, neutrophile granulocyte and macrophage were predominant inflammatory cells of sputum. And as the disease deteriorated, the percentage of neutrophile granulocyte increased. In addition, we also found increased percentage of eosinophils in bronchial dilation test positive patients, and glucocorticoid therapy for them usually had good effect.