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目的观察支气管哮喘患者诱导痰中嗜酸粒细胞(EOS)凋亡的超微结构变化,并探讨其临床意义。方法对2000年8月至2007年12月沈阳医学院沈洲医院门诊及住院的90例支气管哮喘患者,用3%高渗盐水超声雾化吸入进行痰液诱导,观察哮喘患者治疗前后诱导痰中EOS凋亡的超微结构变化。结果 (1)治疗前哮喘患者茶碱组、激素组、联合用药组的FEV1分别为(1.91±0.23)L、(1.96±0.27)L、(2.02±0.32)L,与治疗后的3组FEV1(2.2±0.22)L、(2.29±0.24)L、(2.51±0.18)L相比较,差异有统计学意义(P<0.05),且联合用药组较其他两组差异有统计学意义(P<0.05)。(2)治疗前哮喘患者茶碱组、激素组、联合用药组的FEV1%分别为(73.99±2.17)%、(74.65±1.82)%、(73.63±2.63)%,与治疗后的3组FEV1%(80.16±2.85)%、(80.90±1.70)%、(85.44±2.51)%相比较,差异有统计学意义(P<0.05),且联合用药组较其他两组差异有统计学意义(P<0.05)。(3)治疗后哮喘患者茶碱组、激素组、联合用药组的总IgE较治疗前,差异有统计学意义(P<0.05),且联合用药组与其他两组比较,有统计学意义(P<0.05)。(4)在透射电镜下观察哮喘患者治疗后诱导痰中的EOS,有典型的凋亡特征。结论EOS凋亡是支气管哮喘的一个显著病理特征;氨茶碱、糖皮质激素都对EOS的凋亡有促进作用,联合用药对患者诱导痰中EOS凋亡有促进作用,并且EOS的凋亡特征比单独用药明显。
Objective To observe the ultrastructural changes of eosinophils (EOS) induced apoptosis in sputum of patients with bronchial asthma and to explore its clinical significance. Methods Ninety patients with bronchial asthma who were hospitalized and inpatient in Shenzhou Hospital of Shenyang Medical College from August 2000 to December 2007 were induced with 3% hypertonic saline inhalation for sputum induction, and the changes of sputum in asthmatic patients before and after treatment were observed Ultrastructural changes of EOS apoptosis. Results (1) FEV1 in theophylline group, hormone group and combination group were (1.91 ± 0.23) L, (1.96 ± 0.27) L and (2.02 ± 0.32) L, respectively (2.22 ± 0.22) L, (2.29 ± 0.24) L and (2.51 ± 0.18) L, respectively (P <0.05), and the difference between the two groups was statistically significant (P < 0.05). (2) FEV1% of theophylline group, hormone group and combination group before treatment were (73.99 ± 2.17)%, (74.65 ± 1.82)% and (73.63 ± 2.63)%, respectively, (80.16 ± 2.85)%, (80.90 ± 1.70)%, (85.44 ± 2.51)%, the difference was statistically significant (P <0.05), and there was a significant difference between the combination group and the other two groups (P <0.05). (3) The total IgE of theophylline group, the hormone group and the combination group after treatment were significantly different from those before treatment (P <0.05), and there was significant difference between the combination group and the other two groups P <0.05). (4) Observed under transmission electron microscope in patients with asthma sputum EOS after treatment, the typical characteristics of apoptosis. Conclusion EOS apoptosis is a significant pathological feature of bronchial asthma. Aminophylline and glucocorticoids both promote the apoptosis of EOS. Combined treatment can promote the apoptosis of EOS in sputum, and the apoptosis of EOS Than medication alone significantly.