Noneosinophilic CD4 lymphocytic airway inflammation in menopausal women with chronic dry cough
Noneosinophilic CD4 lymphocytic airway inflammation in menopausal women with chronic dry cough
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DOI：
10.1378/chest.127.5.1714
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发表时间：
2005-05-01
期刊：
影响因子：
9.6
通讯作者：
Larsson, K
中科院分区：
文献类型：
--
作者：
Mund, E;Christensson, B;Larsson, K
背景：无呼吸困难和喘息的慢性干咳是一种众所周知的疾病，在临床上被认为在女性中有过高的代表性。尽管进行了彻底的调查，但许多病例的病因和形态学仍不清楚。目的：检查病因不明的慢性咳嗽妇女下呼吸道和血液中的炎症细胞和淋巴细胞谱。单位：大学附属医院呼吸内科。参与者：25名患有特发性咳嗽的健康女性和11名年龄匹配的健康对照女性，均为非特应性不吸烟者。测量：为了确定咳嗽的特征，对患者进行了仔细的标准化访谈。检测肺功能。用BAL法收集细胞，并在支气管（第一次）洗涤和池外周洗涤（BAL液）中分离细胞计数进行分析。双色流式细胞术检测BAL液和血淋巴细胞谱。结果：11名女性患者形成了一个特殊的组与干，非生产性咳嗽的历史，总是开始与气道感染相吻合的更年期。运动、气候和季节变化对咳嗽都没有影响。BAL液中T （CD3+）淋巴细胞数量增加：中位数。73%的T淋巴细胞为辅助性T淋巴细胞（CD4+）。中位数为57%的BAL液T细胞表达HLA-DR激活标记物，而对照组和其他14例慢性咳嗽但周期性轻微咳痰的患者中位数为20%（分别p < 0.001和p < 0.0001）。两组之间的血液中没有发现差异。结论：hla - dr激活的CD4+淋巴细胞性气道炎症伴少量嗜酸性粒细胞在一组不吸烟、非特应性、其他健康的女性终身干咳患者中被发现。这种疾病只与更年期有关。
Background: Chronic dry cough without dyspnea and wheezing is a well-known condition that is considered to be clinically overrepresented in women. The etiology and morphology remain unknown in many cases despite thorough investigations.Design: To examine inflammatory cells and the lymphocyte profile in the lower airways and blood in women with chronic cough of unknown etiology. Setting: University hospital department of respiratory medicine.Participants: Twenty-five otherwise healthy women with idiopathic cough and 11 age-matched healthy control women, all nonatopic nonsmokers.Measurements: In order to characterize the cough, a careful standardized interview of the patients was made. Lung functions were tested. Cells were collected by BAL and analyzed for differential cell, counts separate in the bronchial (first) wash and in the pooled peripheral washes (BAL fluid). The lymphocyte profile in BAL fluid and blood was characterized by dual-color flow cytometry.Results: Eleven female patients formed a specific group with a history of a dry, nonproductive cough that always started in connection with an airway infection coinciding with menopause. Neither exercise, climate, nor seasonal change influenced the cough. BAL fluid contained an increased number of T (CD3+) lymphocytes: median. Seventy-three percent of T lymphocytes were T-helper lymphocytes (CD4+). A median of 57% of the BAL fluid T cells expressed HLA-DR activation marker compared with a median of 20% in the control subjects and in the other 14 included patients with chronic cough but with minor expectoration periodically (p < 0.001 and p < 0.0001, respectively). No differences between the groups were found in the blood.Conclusions: HLA-DR-activated CD4+ lymphocytic airway inflammation with a low number of eosinophfls was identified in a group of nonsmoking, nonatopic otherwise healthy women patients with dry cough of life-long character. The disease appeared exclusively in connection to menopause.