嗜酸粒细胞祖细胞在嗜酸粒细胞性支气管炎发病机制的作用初探
发布时间:2018-03-28 13:07
本文选题:嗜酸粒细胞性支气管炎 切入点:嗜酸粒细胞祖细胞 出处:《广州医科大学》2017年硕士论文
【摘要】:研究背景:嗜酸粒细胞性支气管炎(Eosinophiic bronchitis,EB)是慢性咳嗽最常见病因之一,以气道嗜酸粒细胞性炎症为主要特征,对激素治疗敏感,但发病机制尚未完全明确。随着治疗,EB患者嗜酸性粒细胞水平下降至正常,但在症状复发时再度升高。嗜酸粒细胞的前体细胞为嗜酸粒细胞祖细胞(Eosinophil progenitors,EoP),来源于骨髓造血干细胞(Hematopoietic Progenitor Cell,HPC),主要存在于骨髓,大部分在骨髓内分化为成熟嗜酸粒细胞后入血。但近年研究发现部分造血干细胞和嗜酸粒细胞祖细胞亦可由骨髓直接释放入血并迁移至气道后再进行分化,参与肺脏局部/气道的嗜酸粒细胞性炎症的发生。但在嗜酸粒细胞性支气管炎发病过程中,嗜酸粒细胞祖细胞是否亦可同样参与气道炎症的发生,目前尚不明确。目的:通过检测EB患者的诱导痰细胞以及外周血细胞中的干细胞以及嗜酸粒细胞祖细胞,观察其分别在气道局部以及系统循环中的水平,并观察其治疗后的变化,初步探讨其参与EB发病机制的可能。方法:筛选广州呼吸疾病研究所门诊就诊的EB及支气管哮喘的首诊患者,并纳入健康志愿者作为对照。按照指南诊治流程予以行诱导痰、呼出气一氧化氮、血清TIgE、肺通气功能+气道反应性、血常规等检查。其中,诱导痰细胞除行常规炎症细胞分类计数外,所剩痰细胞行流式细胞学检测;采集静脉血除行血细胞分类计数外,分离PBMC进行流式细胞术检测。流式细胞学检测干细胞以及嗜酸粒细胞祖细胞数量。EB及支气管哮喘患者治疗后第四周进行随访,予以留取血液及诱导痰再次行流式细胞学检测。结果:1.共纳入EB患者18例,哮喘患者28例(其中嗜酸粒细胞型哮喘EA 15例,非嗜酸粒细胞型哮喘NEA 11例,诱导痰失败2例),健康对照14例;复诊子集中,EB患者9例,哮喘患者16例(其中EA 10例,NEA 6例)。2.在气道局部水平上,诱导痰EoP水平EB组[91(256)个/ml]及哮喘组[87(250)个/ml]明显高于正常对照组[17(51)个/ml],(P均0.05),但EB组及哮喘组相比未见明显差异(P0.05),NEA及EA组间未见差异(P0.05)。3.在系统循环水平上,外周血EoP水平EB组[70(115)个/ml]与健康对照组[118(127)个/ml]未见差异(P0.05)。但哮喘组[113(154)个/ml]较EB组有升高趋势(P=0.10);尤其以EA组[121(156)个/ml]较EB组升高趋势明显(P=0.08)。4.吸入激素治疗四周后,EB组诱导痰EoP水平较治疗前明显降低[7(200)vs 91(256)个/ml,P=0.05],但外周血EoP未见明显改变[76(143)vs 68(219)个/ml,P0.05]。而哮喘组外周血及气道EoP均较治疗下降(P均0.05)。结论:1.EB患者气道EoP水平增高,可能参与气道嗜酸粒细胞性炎症的发生。2.相比支气管哮喘而言,EB患者炎症可能更局限于气道。
[Abstract]:Background: eosinophitic bronchitis (EBB) is one of the most common causes of chronic cough. It is characterized by airway eosinophil inflammation and is sensitive to hormone therapy. However, the pathogenesis of eosinophils in patients with EB was not completely clear, and the eosinophil level decreased to normal with the treatment of Epstein-Barr. The progenitor cells of eosinophil were Eosinophil progenitor cells (Eosinophil progenitor cells), derived from bone marrow hematopoietic stem cells (hematopoietic stem cells) and hematopoietic Progenitor cells (HPCs), which were mainly found in bone marrow, and Eosinophil progenitor cells (Eosinophil progenitor cells) were derived from bone marrow hematopoietic stem cells. Most of them differentiate into mature eosinophils in bone marrow and enter blood. But in recent years, some hematopoietic stem cells and eosinophil progenitor cells can also be directly released into blood from bone marrow and migrated to the airway before differentiation. Eosinophils are involved in the development of eosinophilic inflammation in the lung. But whether eosinophil progenitor cells are also involved in the development of airway inflammation in the course of eosinophil bronchitis. Objective: to investigate the level of induced sputum cells and peripheral blood stem cells and eosinophils progenitor cells in patients with EB. The changes after treatment were observed and the possibility of its involvement in the pathogenesis of EB was preliminarily discussed. Methods: EB and bronchial asthma patients in outpatient clinic of Guangzhou Institute of Respiratory Diseases were selected. The healthy volunteers were included as control group. Induced phlegm, exhaled nitric oxide, serum tige, pulmonary ventilation function airway reactivity, blood routine examination were performed according to the procedure of diagnosis and treatment. In addition to routine inflammatory cell classification count, the remaining sputum cells were detected by flow cytology, venous blood was collected except for blood cell classification count. The stem cells and eosinophils progenitor cells were detected by flow cytometry. EB was detected by flow cytometry and followed up for the fourth week after treatment with bronchial asthma. Blood was collected and sputum was reexamined by flow cytology. Results 1. 18 cases of EB and 28 cases of asthma (including 15 cases of eosinophil asthma EA and 11 cases of NEA of non-eosinophil asthma) were included. There were 2 cases of induced sputum failure, 14 cases of healthy control, 9 cases of EB patients and 16 cases of asthma (EA 10 cases 6 cases of NEA). The level of EoP in induced sputum in EB group [91: 256 / ml] and asthma group [87 / 250 / ml] was significantly higher than that in normal control group [17: 51] / ml] P 0.05, but there was no significant difference between EB group and asthma group. There was no significant difference between EB group and asthma group. There was no difference in peripheral blood EoP level between EB group [70 卤115 / ml] and healthy control group [1188 / 127 / ml], but there was a tendency to increase in asthma group [113 / 154 / ml] than that in EB group, especially in EA group [121156 / ml] and EB group after inhaling hormone for four weeks. The level of induced phlegm EoP was significantly lower than that before treatment [7(200)vs 91: 256) / ml / ml P0. 05], but the peripheral blood EoP did not change [76(143)vs 682 19 / ml P 0.05]. However, the level of EoP in peripheral blood and airway in asthma group was significantly lower than that before treatment (P < 0 05). Conclusion 1. The level of EoP in the airway of patients with 1 / EB was significantly higher than that of the control group (P < 0. 05). May be involved in airway eosinophils inflammation. 2. Epstein-Barr inflammation may be more limited to the airway than bronchial asthma.
【学位授予单位】:广州医科大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R562.21
【参考文献】
相关期刊论文 前2条
1 中华医学会呼吸病学分会哮喘学组;咳嗽的诊断与治疗指南(草案)[J];中华结核和呼吸杂志;2005年11期
2 罗炜,赖克方,陈如冲,刘春丽,曾运祥,钟淑卿,李德容,吴华,何梦璋,钟南山;嗜酸粒细胞性支气管炎患者气道炎症细胞及介质特征的探讨[J];中华结核和呼吸杂志;2005年09期
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