The Analysis Of The Cytologic Classification Of Induced Sputum Among The Asthma Patients

Objective: In this research, we can subdivide the inflammatory cellsthrough the examination of different cells in the induced sputum, and theninquire into the mechanism and process of asthma, thereby provide newmethods for the diagnostics and therapy of asthma.Methods: We have selected60outpatients or inpatients who werediagnosed as bronchial asthma and20healthy controls during Sep.2012toMar.2013in the First Hospital of Jilin University as research objects. Eachsubjects’ pulmonary function should be examined before the sputuminduction. During the process of sputum induction, we let the subjectsinhale4.5%hypertonic saline with an Ultrasonic atomizer. Stop inhalingsaline at the time of30seconds,1.5minutes,3.5miniutes,7.5minutes,11.5minutes and15.5minutes, at the interval each subjects’ pulmonaryfunction should be examined again to ensure the safety of operation. At thesame time，the total process of sputum induction should be not more than30minutes.Before the operation of induction, the subjects should rinse the mouth,clean up the nasal cavity to reduce contamination of bacteria and epithelialcells in sputum, so as to improve the qualified rate of sputum specimens ofsubjects. During the process of sputum induction, we should encourage thesubjects to cough the sputum of deep airway, collect the sputum in adisposable sterile Petri dish. Before and during the induction, we shouldrecord the prediction value of FEV1%and FEV1/FVC to ensure the safetyof the whole operation process. Observe the tolerance of the subjects inthe process of inhaling hypertonic saline, a few objects may appear thesymptom such as irritating cough, nausea, vomit, we should give them symptomatic treatment. Sputum should be processed within2hours, useliquefaction, concussion, filtration, centrifugation, suspension, smear andother means to treat the sputum. Then count the total inflammatory cells inevery sample and classify the cells under the microscope, finally calculatethe proportion of different inflammatory cells. By using statisticalmethod，analyze and compare the similarities and differences of the totalcellular score and the percentage of different kinds of inflammatory cellamong different subjects in the level of P=0.05.Results:1. Comparative analysis of inflammatory cells in induced sputum of threegroups of subjects①Total cell counts: The TCC in group of acute stage asthmatic patientsis (5.50±2.09)×106/ml, in group of relieving stage is (4.15±1.69)×106/ml, inhealthy control group is (3.35±1.28)×106/ml, the TCC of asthmatic patients ofacute stage is significantly higher than that in the relieving stage patients andhealthy control group (P <0.01), the TCC of asthmatic patients of relievingstage has no significant difference compared with that in healthy control group;②Eosinophils: The percentages of eosinophils in group of acute stageasthmatic patients is7.71±4.90%, in group of relieving stage is3.87±2.24%, inthe healthy control group is2.05±1.59%, the percentages of eosinophils ininduced sputum of three groups decreased gradually (P <0.05);③Neutrophils: The percentages of neutrophils in group of acute stageasthmatic patients is51.50±9.36%, in group of relieving stage is46.19±8.56%,in the healthy control group is35.46±8.46%, the percentages of neutrophils ininduced sputum of three groups decreased gradually (P <0.05);④Lymphocytes: The percentages of lymphocytes in group of acutestage asthmatic patients is13.73±4.87%, in group of relieving stage is 11.20±3.87%, in the healthy control group is10.33±4.21%, the percentages oflymphocytes in induced sputum of asthmatic patients of acute stage issignificantly higher than that in the relieving stage patients and healthy controlgroup (P <0.05), the percentages of lymphocytes have no significantdifference between asthma patients of relieving stage and healthy controlgroup(P＞0.05);⑤Macrophages: The percentages of macrophages in group of acutestage asthmatic patients is18.33±7.12%, in group of relieving stage is27.90±8.18%, in the healthy control group is42.03±10.30%, the percentagesof macrophages in induced sputum of three groups increased gradually (P <0.01).2. The inflammatory classification of induced sputum among the asthmapatientsThere are55cases of60asthmatic patients who were induced sputumsuccessfully, including34cases of eosinophilic asthma（the percentage ofeosinophils in induced sputum＞3%），accounting for61.8%(34/55)，5cases ofneutrophilic asthma (the percentage of neutrophils in induced sputum＞60%)，accounting for9.1%(5/55)，5cases of mixed-granulocytic asthma (thepercentage of eosinophils in induced sputum＞3%and the percentage ofneutrophils in induced sputum＞60%)，accounting for9.1%(5/55)，11cases ofnon-granulocytic asthma (the percentage of eosinophils in induced sputum≤3%and the percentage of neutrophils in induced sputum≤60%)，accountingfor20.0%. In28patients with acute exacerbation of asthma,19cases areeosinophilic asthma, accounting for67.9%(19/28)，3cases are neutrophilicasthma，accounting for10.7%(3/28),4cases are mixed-granulocytic asthma,accounting for14.3%(4/28)，2cases are non-granulocytic asthma, accounting for7.1%(2/28). In27relieving stage asthmatic patients,15cases areeosinophilic asthma, accounting for55.6%(15/27),2cases are neutrophilicasthma，accounting for7.4%(2/27),1cases are mixed-granulocytic asthma,accounting for3.7%(1/27),9cases are non-granulocytic asthma, accounting for33.3%(9/27).Conclusion:1. The TCC in induced sputum of acute stage asthmatic patients issignificantly higher than that in relieving stage asthmatic patients and healthypeople，the TCC in induced sputum between asthmatic patients of remissionand healthy people have no significant difference;2. The percentages of eosinophils and neutrophils in asthmatic patients ofexacerbation and remission are more higher than that in healthy people, thepercentages of eosinophils and neutrophils in asthmatic patients of exacerbationare significantly higher than patients of remission;3. Eosinophils and neutrophils are both important inflammatory cells ofasthma, according to the proportions of the two kinds of cells in inducedsputum we can classify asthmatic patients into different inflammatory subtypes;4. Sputum induction has important clinical significance on discussing thepathogenesis of asthma，and it is very useful for the diagnosis, therapy andprediction prognosis of asthma.