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目的探讨老年人晚发哮喘(LOA)患者诱导痰中嗜酸细胞和嗜酸细胞阳离子蛋白(ECP)水平与其严重程度的关系及与慢性阻塞性肺疾病(COPD)的鉴别诊断价值。方法随机选择54名LOA患者,检测肺功能并分别采用瑞氏染色及荧光免疫法检测高渗盐水诱导痰中嗜酸细胞数量和ECP水平。选择25例老年COPD患者和10例老年健康人作为对照。结果LOA患者诱导痰中嗜酸细胞数量和ECP水平与患者第一秒用力呼气容积占用力肺活量百分比呈显著负相关(r值为-0.68、-0.61,均为P<0.01)。患者诱导痰中嗜酸细胞数量〔(19.4±8.1)%〕和ECP水平〔(391±186)μg/L〕显著高于老年COPD组〔(3.1±1.4)%和(51±26)μg/L,P<0.01〕和老年健康组〔(1.2±0.7)%和(44±22)μg/L,P<0.01〕。以诱导痰中嗜酸细胞≥7%和ECP≥100μg/L为判别标准与COPD鉴别,诊断哮喘的敏感性分别为85.2%和87.0%;特异性分别为84.0%和88.0%。联合检测两者的敏感性和特异性分别为92.6%和92.0%。结论诱导痰中嗜酸细胞和ECP水平可了解LOA的严重程度,并有助于与老年COPD的鉴别。
Objective To investigate the relationship between eosinophil and eosinophil cationic protein (ECP) level in senile patients with late-onset asthma (LOA) and their severity and their relationship with chronic obstructive pulmonary disease (COPD). Methods Fifty-four patients with LOA were randomly selected and tested for lung function. The number of eosinophils and ECP level in sputum induced by hypertonic saline were detected by Wright staining and fluorescence immunoassay respectively. Twenty-five elderly COPD patients and 10 elderly healthy people were selected as controls. Results The number of induced eosinophils in sputa and the level of ECP in LOA patients were negatively correlated with the percentage of forced expiratory volume in forced vital capacity (r = -0.68, -0.61, both P <0.01). The number of sputum eosinophils in patients (19.4 ± 8.1)% and ECP level (391 ± 186 μg / L) were significantly higher than those in COPD patients (3.1 ± 1.4% vs 51 ± 26 μg / L, P <0.01), and (1.2 ± 0.7)% and (44 ± 22) μg / L, respectively; The sensitivities of inducing sputum eosinophils ≥7% and ECP ≥100 μg / L were discriminant criteria and COPD for diagnosing asthma were 85.2% and 87.0% respectively, and the specificity were 84.0% and 88.0% respectively. The sensitivity and specificity of the combined detection were 92.6% and 92.0% respectively. Conclusion Induced sputum eosinophils and ECP levels can understand the severity of LOA, and contribute to the identification of elderly COPD.