Inflammatory subtypes in asthma: Assessment and identification using induced sputum
Inflammatory subtypes in asthma: Assessment and identification using induced sputum
复制标题
DOI：
10.1111/j.1440-1843.2006.00784.x
复制
发表时间：
2006-01-01
期刊：
影响因子：
6.9
通讯作者：
Gibson, PG
中科院分区：
文献类型：
--
作者：
Simpson, JL;Scott, R;Gibson, PG
目的：探讨用诱导痰检测非嗜酸性哮喘的方法。虽然这是临床哮喘的一个重要亚型，但其认识尚不规范。方法：对成年非吸烟者哮喘患者和健康对照组进行诱导痰和高渗盐水激发。非嗜酸性哮喘定义为痰嗜酸粒细胞计数正常的症状性哮喘。结果：用嗜酸性粒细胞比例识别非嗜酸性哮喘与基于绝对嗜酸性粒细胞计数的定义(kappa 0.67)是一致的。非嗜酸性哮喘在短期(4周)和长期(5年，kappa 0.77)都是稳定的亚型。根据痰中嗜酸性粒细胞和中性粒细胞的比例，哮喘患者的气道炎症可分为四种炎症亚型。这些亚型包括中性粒细胞哮喘、嗜酸性哮喘、混合性粒细胞哮喘和少粒细胞哮喘。中性粒细胞增多(中性粒细胞哮喘和混合粒细胞哮喘)的受试者年龄较大，细胞总数和细胞存活率高于其他亚型。结论：诱导痰嗜酸粒细胞比例是嗜酸性哮喘的一个很好的鉴别指标，为同质组提供了一个可重复性的定义。其余的非嗜酸性粒细胞受试者是不同的，可以根据中性粒细胞的存在进行进一步的分类。这些炎症亚型对哮喘气道炎症的研究和定性具有重要意义。
Objective: The authors sought to investigate the detection of non-eosinophilic asthma using induced sputum. Although this is an important subtype of clinical asthma, its recognition is not standardized.Methods: Adult non-smokers with asthma and healthy controls under-went sputum induction and hypertonic saline challenge. Non-eosinophilic asthma was defined as symptomatic asthma with normal sputum eosinophil counts. The normal range for sputum eosinophil count was determined using the 95th percentile from the healthy control group as a cut-off point.Results: The recognition of non-eosinophilic asthma using eosinophil proportion was in agreement with a definition based on absolute eosinophil count (kappa 0.67). Non-eosinophilic asthma was a stable subtype over both the short term (4 weeks) and longer term (5 years, kappa 0.77). Airway inflammation in asthma could be categorized into four inflammatory subtypes based on sputum eosinophil and neutrophil proportions. These subtypes were neutrophilic asthma, eosinophilic asthma, mixed granulocytic asthma and paucigranulocytic asthma. Subjects with increased neutrophils (neutrophilic asthma and mixed granulocytic asthma) were older and had an increased total cell count and cell viability compared with other subtypes.Conclusion: Induced sputum eosinophil proportion is a good discriminator for eosinophilic asthma, providing a reproducible definition of a homogenous group. The remaining non-eosinophilic subjects are heterogeneous and can be further classified based on the presence of neutrophils. These inflammatory subtypes have important implications for the investigation and characterization of airway inflammation in asthma.