Clinical, radiologic, and induced sputum features of chronic obstructive pulmonary disease in nonsmokers - A descriptive study
Clinical, radiologic, and induced sputum features of chronic obstructive pulmonary disease in nonsmokers - A descriptive study
复制标题
DOI：
10.1164/rccm.200203-245oc
复制
发表时间：
2002-10-15
影响因子：
24.7
通讯作者：
Pavord, ID
中科院分区：
文献类型：
--
作者：
Birring, SS;Brightling, CE;Pavord, ID
流行病学研究表明，5-12%的慢性阻塞性肺疾病（COPD）患者不吸烟。对这些患者的固定气流阻塞的病理生理知之甚少。我们前瞻性地确定了25例COPD患者，他们从未吸烟或吸烟史少于5包年，并呈现临床、放射学和诱导痰特征。我们的患者占2年固定气流阻塞患者的5.7%。患者平均年龄为70岁，以女性为主（86%），平均呼吸道症状持续时间为7年。平均FEV1为58%，FEV1/FVC为55%。高分辨率计算机断层扫描的特征是非特异性的，并且被认为是更广泛的COPD人群的典型特征。诱导的痰炎性细胞计数表明存在两种不同的组。9例痰嗜酸性粒细胞明显增多（平均8.1%，正常，小于1.9%），其余13例痰嗜酸性粒细胞正常，且痰中性粒细胞计数有升高趋势（平均70.1%，正常，小于65%）。22例患者中有7例（32%）存在器官特异性自身免疫性疾病，在无痰嗜酸性粒细胞增多的患者中尤为普遍（13例中有6例）。总之，COPD在非吸烟者中主要影响女性，并且至少有两个病理亚组，其中一个可能与器官特异性自身免疫性疾病有关。进一步的研究可能揭示固定气流阻塞的新机制。
Epidemiologic studies show that 5-12% of subjects with chronic obstructive pulmonary disease (COPD) are nonsmokers. Little is known about the pathophysiology of the fixed airflow obstruction in these subjects. We have prospectively identified 25 patients with COPD who had never smoked or had a less than 5 pack years smoking history and present the clinical, radiologic, and induced sputum features. Our population represented 5.7% of total referrals with fixed airflow obstruction over 2 years. Patients had a mean age of 70 years, were predominantly female (86%), and had a mean duration of respiratory symptoms of 7 years. The mean FEV1 was 58%, and the FEV1/FVC was 55%. Features on high-resolution computed tomographic scanning were nonspecific and were considered typical of a wider population with COPD. An induced sputum differential inflammatory cell count suggested the presence of two distinct groups. Nine had significant sputum eosinophilia (mean, 8.1%; normal, less than 1.9%), and the remaining 13 had a normal sputum eosinophil and tended to have a raised sputum neutrophil count (mean, 70.1%, normal, less than 65%). Organ-specific autoimmune disease was present in 7 of the 22 patients (32%) and was particularly prevalent in those without sputum eosinophilia (6 of 13). In conclusion, COPD in nonsmokers predominantly affects females and has at least two pathologic subgroups, one of which may be associated with organ-specific autoimmune disease. Further investigation of this group may disclose novel mechanisms of fixed airflow obstruction.