ANÁLISE ESTATÍSTICA

As variáveis categóricas (gênero, raça, atopia, sucesso na indução, viabilidade do escarro) estão representadas através de freqüência absoluta e percentagens. As variáveis contínuas foram inicialmente avaliadas quanto a critérios de normalidade. As variáveis com distribuição contínua (idade, peso, altura, VEF1 basal, VEF1/CVF,

VEF1 pós-salbutamol) estão expressas como média, desvio padrão ou

valor mínimo e máximo. Devido à distribuição não gaussiana da contagem celular total e de alguns componentes celulares (eosinófilos e linfócitos) os resultados da citologia do escarro encontram-se expressos como média e desvio padrão, mediana, intervalo interquartil além dos Percentis (10 e 90). Diferenças entre grupos foram analisadas usando ANOVA ou teste t de student para amostras não pareadas. Foram considerados significativos os valores de p inferiores a 0.05. Para se testar a aderência à normalidade, utilizou-se o teste de Kolmogorov- Smirnov.

Os dados foram analisados através do pacote estatístico SPSS-

Statistical Package for the Social Siences para Windows, versão 18.0

2.8. REFERÊNCIAS BIBLIOGRÁFICAS

1. Simpson JL, McElduff P, Gibson PG. Assessment and Reproducibility of Non-Eosinophilic Asthma Using Induced Sputum. Respiration. 2009 Oct 8.

2. Bartoli ML, Di Franco A, Vagaggini B, Bacci E, Cianchetti S, Dente FL, et al. Biological markers in induced sputum of patients with different phenotypes of chronic airway obstruction. Respiration. 2009;77(3):265-72.

3. Kim CK, Koh YY, Callaway Z. The validity of induced sputum and bronchoalveolar lavage in childhood asthma. J Asthma. 2009 Mar;46(2):105-12.

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6. Holz O, Kips J, Magnussen H. Update on sputum methodology. Eur Respir J. 2000 Aug;16(2):355-9.

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8. Hargreave FE, Leigh R. Induced sputum, eosinophilic bronchitis, and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999 Nov;160(5 Pt 2):S53-7.

9. Hargreave FE. Induced sputum for the investigation of airway inflammation: evidence for its clinical application. Can Respir J. 1999 Mar-Apr;6(2):169-74.

10. Drews AC, Pizzichini MM, Pizzichini E, Pereira MU, Pitrez PM, Jones MH, et al. Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children. Allergy. 2009 Nov;64(11):1597-601.

11. Rovina N, Dima E, Gerassimou C, Kollintza A, Gratziou C, Roussos C. Interleukin-18 in induced sputum: association with lung function in chronic obstructive pulmonary disease. Respir Med. 2009 Jul;103(7):1056-62.

Tabela 3. Citologia diferencial do escarro induzido expressa em percentual

Amplitude normal

Média Média Mediana Percentis

Média ±DP -2DP +2DP (IQR) 10 90 Eosinófilos 0.01 ± 0.03 -0.06 0.07 0 (0) 0 0.5 Neutrófilos 23.4 ± 14.3 -5.2 52.8 21.7 (21) 6.9 41.3 Macrófagos 68.4 ± 14.7 39.0 97.8 71.0 (17.9) 47.9 86.0 Linfócitos 3.1 ± 2.4 -1.4 7.9 3.0 (3.0) 0 6.5 Células broncoepiteliais 5.2 ± 7.9 -10.6 21.0 2.8 (4.9) 0.5 13.3

Cél . = células, DP = desvio padrão

As figuras 1 a 9 representam histogramas mostrando a distribuição da contagem celular diferencial expressa em percentuais e em números absolutos por grama de escarro.

As amostras de escarro obtidas possuíam boa viabilidade como indicado pela média de 77.5 % (desvio padrão 11.1) de células viáveis e estavam minimamente contaminadas por saliva uma vez que amostras com contaminação por células escamosas superior a 20% foram consideradas inadequadas. O resultado da contagem total e diferencial do escarro induzido demonstrou que estas eram originárias das vias aéreas inferiores conforme indicado pela presença majoritária de macrófagos e células bronco-epiteliais bem como pela ausência de células escamosas (Tabelas 2 e 3). Além disto, os resultados demonstram que o escarro induzido em indivíduos saudáveis é composto predominantemente por macrófagos seguindo-se de neutrófilos em menor proporção. Eosinófilos foram encontrados infrequentemente.

Tabela 2. Citologia do escarro induzido, total e diferencial, em números absolutos (x 106 células/g)

Amplitude normal

Média Média Mediana Percentis Média ±DP -2DP +2DP (IQR) 10 90 Contagem celular total 4.8 ± 4.2 -3.6 13.2 3.5 (4.0) 1.2 10.8 Eosinófilos 0.004 ± 0.01 -0.016 0.024 0 (0) 0 0.02 Neutrófilos 1.4 ± 2.1 -2.8 5.6 0.9 (1.4) 0.1 3.0 Macrófagos 3.2 ± 2.5 -1.8 8.2 2.3 (3.0) 0.6 6.8 Linfócitos 0.1 ± 0.1 -0.1 0.3 0.09 (0.2) 0 0.3 Células broncoepiteliais 0.1 ± 0.1 -0.1 0.3 0.1 ± 0.1 0.01 0.3 DP = desvio padrão

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CAPITULO III RESULTADOS

1. Características dos participantes

Um total de 99 adultos hígidos foram incluídos no estudo. Destes, obteve-se amostra satisfatória de escarro induzido em 88, gerando uma taxa de sucesso de 88,9%. Onze indivíduos foram incapazes de produzir escarro e foram excluídos da análise.

Houve predominância de voluntários do sexo feminino (55,7%) e da faixa etária de adultos jovens com idade entre 18 aos 30 anos (44,3%). Atopia estava presente em um terço dos participantes. As características dos participantes encontram-se descritas na tabela 1. Tabela 1: Características dos participantes (n= 88)

Idade, anos* 36.9 (19-68)

Gênero masculino, n (%) 39 (44.3)

Atopia , n (%) 27 (30.7)

Índice de Massa Corporal * 23.7 (23.1;24.5) VEF1 pré BD, % do previsto* 98.5 (96.2;100.9)

VEF1 / CVF pré BD, %* 82.4 (81.2;83.8)

n = número de participantes

Atopia significa um ou mais testes cutâneo por puntura positivo, com diâmetro de enduração 2mm maior que o controle negativo

*Resultados expressos em média e intervalo de 95% de confiança VEF1 = Volume expiratório forçado no primeiro segundo

BD = broncodilatador CVF = Capacidade vital forçada

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