关键词: 支气管扩张症, 诱导痰, 呼出气一氧化氮, 肺功能, 炎性因子

Abstract: Background　Bronchiectasis is a common chronic airway inflammatory disease，but varies significantly across individuals.Induced sputum and fractional exhaled nitric oxide（FeNO）have been widely used in the assessment of asthma and chronic obstructive pulmonary disease，but little is known about whether they could be used for evaluating airway inflammation in bronchiectasis.Objective　To evaluate the associations of induced sputum and FeNO with the clinical characteristics and lung function parameters in patients with bronchiectasis，to explore the value of noninvasive airway inflammation tests in stable bronchiectasis.Methods　We enrolled 62 patients with stable bronchiectasis who were treated in Cangzhou Central Hospital from January 2017 to December 2018.Data were collected，including clinical characteristics（gender，age，BMI，smoking history，course of bronchiectasis，number of exacerbations per year，sputum volume，history of hemoptysis，cause of bronchiectasis，colonization of Pseudomonas aeruginosa），results of high-resolution CT（HRCT）of the chest，lung function test parameters（FEV1%pred，FVC%pred，FEV1/FVC ratio，increase in FEV1 after using the bronchodilator），induced sputum test parameters（IL-8，IL-6 and IL-13）and sputum cell classification，and FeNO.Pearson correlation analysis was used to explore the associations of some induced sputum test parameters with FeNO and lung function test parameters.Results　Patients with bronchiectasis can be divided into neutrophilic type （32 cases），eosinophilic type （10 cases）， mixed granulocytic type （6 cases）and paucigranulocytic type（14 cases）according to the cytological classification of induced sputum.The levels of IL-8 and IL-6 in neutrophilic type were higher compared with those of eosinophilic and paucigranulocytic types，while the level of IL-13，FeNO，increase in FEV1 after using the bronchodilator were lower than those of eosinophilic and mixed granulocytic types（P<0.05）.The neutrophilic type had more severe bronchiectasis in HRCT（P<0.05）.The eosinophilic type had lower levels of IL-8 and IL-6 than mixed granulocytic type，greater level of IL-13 and FeNO than paucigranulocytic type，and more increase of FEV1 after using the bronchodilator than mixed granulocytic and paucigranulocytic types（P<0.05）.The increase in FEV1 after using the bronchodilator，levels of IL-8，IL-6，IL-13，and FeNO of mixed granulocytic type were higher than those of paucigranulocytic type（P<0.05）.The level of sputum IL-8 was positively correlated with the score of HRCT（r=0.625）and the percentage of neutrophils（r=0.711），and was negatively correlated with FEV1%pred（r=-0.327），FVC%pred（r=-0.401），FEV1/FVC ratio（r=-0.398），increase in FEV1 after using the bronchodilator（r=-0.312，P<0.05）.IL-6 was positively correlated with the score of HRCT（r=0.342）and the percentage of neutrophils（r=0.221，P<0.05）.The level of IL-13 was correlated with the increase in FEV1 after using the bronchodilator（r=0.439），the percentage of eosinophils（r=0.536），and FeNO（r=0.526，P<0.05）.The percentage of neutrophils was positively correlated with the score of HRCT（r=0.548），and negatively correlated with FEV1%pred（r=-0.372），FVC%pred（r=-0.345），FEV1/FVC ratio（r=-0.253），increase in FEV1 after using the bronchodilator（r=-0.346），the percentage of eosinophils（r=-0.553，P<0.05）.The percentage of eosinophils was positively correlated with the increase in FEV1 after using the bronchodilator（r=0.522）and FeNO（r=0.576，P<0.05）.FeNO was correlated with the increase in FEV1 after using the bronchodilator（r=0.423，P<0.05）.Conclusion　The induced sputum cell classification，IL-8，IL-6，IL-13 levels and FeNO were related with the clinical indicators of patients with bronchiectasis，which may be helpful for the comprehensive evaluation of bronchiectasis.

Key words: Bronchiectasis, Induced sputum, FeNO, Lung function tests, Inflammatory cytokine