南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (10): 1215-.doi: 10.12122/j.issn.1673-4254.2018.10.10

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哮喘-慢性阻塞性肺疾病重叠患者中痰髓过氧化物酶、嗜酸粒细胞阳离子蛋白与临床特征的相关性

杨宏宽，张艳，张佳颖，潘俊杰，王芳，罗旭平，陈芳   

  • 出版日期:2018-10-20 发布日期:2018-10-20

Correlation between expressions of myeloperoxidase and eosinophil cationic protein in sputum and clinical features of asthma-chronic obstructive pulmonary disease overlap

  • Online:2018-10-20 Published:2018-10-20

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摘要： 目的探讨髓过氧化物酶（MPO）、嗜酸粒细胞阳离子蛋白（ECP）在哮喘-慢性阻塞性肺疾病重叠（ACO）患者气道炎症中的 作用及其与临床特征的相关性。方法入组慢性阻塞性肺疾病（COPD）、哮喘、ACO患者及正常人各20例，行肺功能检查测定第 1秒用力呼气量、用力肺活量、呼气流量峰值、最大呼气中期流量。COPD组及ACO组利用COPD患者自我评估测试进行临床 症状评估，哮喘组及ACO组采用哮喘控制测试进行哮喘控制评估。诱导痰检查留取痰液，行细胞分类计数并计算中性粒细胞 比例及嗜酸性粒细胞比例，酶联免疫吸附测定法检测痰MPO、ECP水平。结果ACO组自我评估测试评分较COPD组差异无统 计学意义（P>0.05），但哮喘控制测试评分较哮喘组减小（P<0.05）。ACO组第1秒用力呼气量、呼气流量峰值、最大呼气中期流 量较哮喘组减小（P<0.05），用力肺活量较COPD组增大（P<0.05）。ACO组痰中性粒细胞比例较哮喘患者增大（P<0.01），痰嗜酸 性粒细胞比例较COPD组增大（P<0.01）。ACO组痰MPO水平较哮喘组增高（P<0.05），痰ECP水平较哮喘组及COPD组均增 高（P<0.05，P<0.01）。ACO组痰MPO水平与痰中性粒细胞比例呈正相关（r=0.8358，P<0.01），与自我评估测试评分及第1秒用 力呼气量无相关性（P>0.05）。ACO组痰ECP水平与痰嗜酸性粒细胞比例呈正相关（r=0.4666，P<0.05），与哮喘控制测试评分及 第1秒用力呼气量呈负相关（r=-0.4966，P<0.05；r=-0.4610，P<0.05）。结论ACO患者气道炎症同时存在中性粒细胞性炎症及嗜 酸性粒细胞性炎症，痰ECP水平与哮喘控制水平及阻塞性气流受限程度均存在一定的负相关性。

Abstract: Objective To observe the role of myeloperoxidase（MPO）and eosinophilic cationic protein（ECP）in the airway inflammation and their correlation with clinical feature in asthma-COPD overlap (ACO) patients. Methods Twenty patients with COPD, 20 with asthma, 20 with ACO and 20 control subjects underwent pulmonary function test for measurement of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum midexpiratory flow (MMF25/75). COPD assessment test (CAT) was used to evaluate the clinical symptoms of the patients with COPD and ACO. The asthma control test (ACT) was used to evaluate the asthma control in the patients with asthma and ACO. Induced sputum samples were collected from the subjects for analysis of neutrophil and eosinophil ratios, and enzyme-linked immunosorbent assay was used to determine the expression levels of MPO and ECP in the sputum. Results No significant difference was observed in the CAT scores between ACO group and COPD group (P>0.05). Compared with the asthma group, the patients with ACO had significantly lower ACT scores and lower FEV1, PEF and MMF25/75 (P<0.05). The patients with ACO had significantly higher FVC and sputum eosinophil ratio than those with COPD (P<0.05), and a higher sputum neutrophil ratio than those with asthma (P<0.01). In ACO group, the MPO level in sputum was significantly higher than that in the asthma group (P<0.05), while sputum ECP level was significantly higher than that in both the asthma group and COPD group (P<0.05 or 0.01). In ACO group, sputum MPO level was positively correlated with sputum neutrophil ratio (r=0.8358, P<0.01) but was not correlated with CAT score or FEV1 (P>0.05); sputum ECP level was positively correlated with sputum eosinophil ratio (r=0.4666, P<0.05) and was inversely correlated with ACT score (r=-0.4966, P<0.05) and FEV1 (r=-0.4610, P<0.05). Conclusion Both neutrophilic and eosinophilic inflammations occur in the airway of patients with ACO, and their sputum ECP level is negatively correlated with asthma control and obstructive airflow limitation.