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ID naloge: 131 Letnik: 2002 Predmet: interna medicina
Ocena tipa in aktivnosti vnetja pri bolnikih z obstruktivno pljucno boleznijo
Avtor: Simona Lucija Avcin, Matej Jezernik
Mentor: doc.dr. Mitja Košnik
Izhodišce: Vnetje v dihalnih poteh ima glavno vlogo pri nastanku obstruktivne pljucne bolezni. S klinicnimi preiskavami prepoznavamo le funkcionalne spremembe, težko pa odkrijemo in locimo vrsto vnetja. Inducirani sputum (IS) je nova, neinvazivna metoda, s katero lahko ugotavljamo vrsto in aktivnost vnetnega dogajanja v dihalnih poteh.
Namen: Želeli smo ugotoviti ali je IS diagnosticno uporabna metoda za ugotavljanje vrste in aktivnosti vnetnega dogajanja pri bolnikih z astmo in KOPB. Zanimal nas je delež vnetnih celic in koncentracija njihovih topnih izlockov.
Hipoteza: S preiskavo vnetnih celic in njihovih topnih izlockov v IS bomo locili tip vnetja v dihalnih poteh pri bolnikih z astmo in KOPB. Pri bolnikih z astmo bomo našli velik delež eozinofilcev in povecano koncentracijo eozinofilnega kationskega proteina (EKP). Pri bolnikih s KOPB bomo našli prevladujoc delež nevtrofilcev in povecano koncentracijo elastaze nevtrofilcev (EN).
Metode: V raziskavo smo vkljucili 21 zdravih preiskovancev (9 žensk in 12 moških), povprecna starost 42,7 let, standardna deviacija (St.D.) 15,5 let, 17 bolnikov z astmo (10 žensk in 7 moških), povprecna starost 51,0 let, (St.D. 18,3 let) in 6 bolnikov s KOPB (1 ženska in 5 moških), povprecna starost 70,2 let, (St.D. 11,1 let) v stabilni fazi bolezni. V IS smo dolocali deleže posamezne vrste vnetnih celic. V supernatantu IS in serumu smo merili koncentracijo EKP in EN.
Rezultati: Delež eozinofilcev je bil pri bolnikih z astmo (8,2%, St.D. 10,8%) statisticno znacilno višji od zdravih preiskovancev (0,3%, St.D. 0,6%) (p<0,05). Delež eozinofilcev pri bolnikih s KOPB je bil (2,4%, St.D. 1,9%). Delež nevtrofilcev je bil pri bolnikih s KOPB (89,5%, St.D. 2,0%) statisticno znacilno višji od bolnikov z astmo (65,8%, St.D. 23,7%) (p<0,05). Koncentracija EKP v IS je bila pri bolnikih z astmo (148,9 µg/l, St.D. 103,5 µg/l) statisticno znacilno višja od zdravih preiskovancev (48,3 µg/l, St.D. 36,8 µg/l) (p<0,05). Prav tako je bila koncentracija EKP v IS pri bolnikih s KOPB (112,7 µg/l, St.D. 122,2 µg/l) statisticno znacilno višja od zdravih preiskovancev (p<0,05).
Zakljucek: Delež eozinofilcev in koncentracija EKP v IS sta diagnosticno uporabna za razlikovanje bolnikov z astmo od zdrave populacije. Delež nevtrofilcev v IS je primeren za razlikovanje bolnikov s KOPB od bolnikov z astmo. Merjenje koncentracije EKP in EN v IS in serumu ne razlikuje bolnikov s KOPB in astmo.
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[Abstract / English version]
Ocena tipa in aktivnosti vnetja pri bolnikih z obstruktivno pljucno boleznijo
Author: Simona Lucija Avcin, Matej Jezernik
Mentor: doc.dr. Mitja Košnik
Background: Airway inflammation is fundamental to the persistence of asthma and chronic obstructive pulmonary disease (COPD). The presence and type of airway inflammation can be difficult to detect clinically. Induced sputum cell counts are a relatively noninvasive and safe method for discriminating between eosinophilic and neutrophilic inflammation.
Aim: Induced sputum cell counts were used to discriminate between asthma and COPD. Inflammation markers of eosinophilic and neutrophilic type were measured in induced sputum and serum to monitor cell activity.
Hypothesis: We expected that the highest number of eosinophils and concentration of eosinophil cationic protein (ECP) in induced sputum and serum would be found in patients with asthma. Additionally, we supposed that the patients with COPD would have the highest number of neutrophils and concentration of polymorphonuclear elastase (PMN elastase) in induced sputum and serum.
Methods: We included 21 healthy subjects in our study (9 female and 12 male), mean age 42.7 years, (S.D. 15.5 yrs), 17 patients with asthma (10 female and 7 male), mean age 51.0 yrs, (S.D. 18.3 yrs) and 6 patients with stable COPD, mean age 70.2 yrs, (S.D. 11.1 yrs). Sputum induction was used to obtain samples for cell counts. The concentration of ECP and PMN elastase was measured in induced sputum and serum.
Results: Eosinophil cell counts in induced sputum in patients with asthma (8.2%, S.D. 10.8%) were statistically significantly higher than in healthy subjects (0.3%, S.D. 0.6%) (p<0.05). Eosinophils were also found in patients with COPD (2.4%, S.D. 1.9%). Neuthrophil cell counts in patients with COPD (89.5%, S.D. 2.0%) were significantly higher than in patients with asthma (65.8%, S.D. 23.7%) (p<0.05). The concentration of ECP in induced sputum in patients with asthma (148.9 µg/l, S.D. 103.5 µg/l) was statistically significantly higher than in healthy subjects (48.3 µg/l, S.D. 36.8 µg/l) (p<0.05). In addition, the concentration of ECP in patients with COPD (112.7 µg/l, S.D. 122.2 µg/l) was significantly higher than in healthy subjects (p<0.05).
Conclusions: Eosinophil cell counts and concentration of ECP in induced sputum could be used to discriminate between patients with asthma and healthy subjects. Neutrophil cell counts in induced sputum could be used to discriminate between patients with COPD and asthma. Measurement of ECP and PMN elastase concentration in induced sputum and serum would not discriminate between patients with COPD and asthma.
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