某些呼吸道疾病常会导致我们咳痰，那么痰液是如何产生的呢？痰液的颜色与呼吸道疾病又有什么关联呢？
痰液的产生
气管、支气管的内壁覆盖着一层由纤毛柱状上皮细胞、杯状细胞等组成的黏膜，
黏膜下层又含有较多的
黏液腺和浆液腺，腺体导管开口于粘膜表面。正常情况下，杯状细胞和腺体分泌少量
黏液覆盖在粘膜表面，起到湿润保护作用。如果吸入气管、支气管内的尘埃颗粒、细菌、其他异物等，通过
黏液粘附、纤毛摆动，把他们排到气管上端，刺激神经末梢感受器，引起复杂协调的咳嗽动作，从而将混合物从口腔吐出，即是痰液。
当气管、支气管和肺组织等被致病菌感染发生炎症时候，大量的炎性细胞浸润，血管扩张，
黏膜充血、水肿，渗出增多，
黏液分泌量增多，同时一些组织细胞变性坏死，那么
黏液和坏死组织就组成了脓痰。
不同的细菌感染，不同的疾病就可能出现不同颜色、不同性状的痰液。
痰液颜色与呼吸道疾病密切相关
1. 白色黏液性痰
如急、慢性支气管炎患者，在咳痰初期，一般只有白色黏液性痰或稀薄的无色黏液，也可能是黏度较稠、不易咳出的浅白色透明黏液。
2. 黄色
一般为脓性痰，表示呼吸系统有化脓性感染。多由支气管炎、支气管肺炎或肺部混合感染、肺结核等疾病引起，若病情进一步加重，则会出现黄绿色黏稠的块状或不透明的脓汁状痰液，此时就要怀疑肺脓肿、慢性支气管炎、支气管扩张、空洞型肺结核合并严重感染等病症。
3. 铁锈色
常见于肺炎链球菌引起的大叶性肺炎，是其特征之一。但也可见于肺梗塞。
4. 红色或棕红色
痰内有血液或血红蛋白，见于肺癌、 肺结核、支气管扩张等；肺吸虫病的患者可有棕红色烂桃样痰，肺的坏死组织分解所致；急性肺水肿的痰液常呈粉红色泡沫状；肺炎克雷白杆菌肺炎患者可有砖红色胶冻痰。
5. 棕褐色
见于阿米巴肺脓肿，或阿米巴肝脓肿破入支气管时。
6. 绿色
多见于肺部铜绿假单胞菌、嗜血杆菌感染者；严重黄疽病人亦可出现绿色痰液。
7. 黑色或灰色
常见于各种肺尘埃沉着症（如炭末、煤灰、 铁末、石粉等沉着），吸烟过多者或生活于富有烟灰环境中健康人的痰中。
8. 乳白色痰
则可能因长期大量用抗生素，细菌被抑制，白色念珠菌大量繁殖导致的真菌性呼吸道疾病。
9. 蓝色痰液
少见，可能与吸入蓝色颗粒物、食入蓝色物质时残留口腔所致。
一般把透明或泡沫状视为
黏痰，而黄色、绿色、棕色、铁锈色等均归为脓痰
[1]。痰液颜色是较容易观察的临床现象 ，脓痰常常是呼吸道疾病加重期细菌感染的潜在标志 。
有学者
[2] 对慢性支气管炎和支气管扩张患者痰液颜色与中性粒细胞炎症反应物，包括形成痰液绿色的绿过氧化特酶（MAO）水平的相关性进行了研究，结果显示：痰液颜色越加深，MAO 在痰液中含量越高，MAO 的浓度与炎症细胞水平显著相关（如组织蛋白酶、白介素 8、白三烯 B4 等增高）。
因此脓痰预示出现新的或重要细菌感染。因此，有人认为可以将脓痰作为辨别细菌与非细菌性恶化的简单参数
[3]。
对于慢性呼吸道疾病如慢阻肺，严重急性发作患者病因多可能是细菌感染导致，痰颜色的不同细菌谱不一样 ，深色痰液更提示为革兰氏阴性菌感染。
痰液颜色对于判断病情轻重具有一定参考价值
[4]，然而 ，由于痰液颜色描述多为主观性，仅凭痰液颜色选用抗菌素多少有些的经验主义成分 ，临床工作中还需要结合相关炎性指标实验室检查来更精准的选用药物。
排版：fufu
参考文献：
1. 彭敏. COPD 急性加重期痰颜色与细菌学、临床参数关系研究. 国际医药卫生导报. 2008,14（4）:19-22.
2. 任少华，胡华成 . 根据痰液颜色判断气道中性粒细胞和炎症水平. 国外医学（呼吸系统分册）.21（2）：封四页.
3. Stockley RA， Brien C， Pye A，et a1． RelationshiP of sputum color to nature and outpatient management of acuteexacerbationsof COPD[J]. Thest, 2000;117：1638—1645.
4. Sputum color as a marker of acute bacteria1 exacerbations of chronic obstructive pulmonarY disease[J]． ResPiratorY Mediclne， 2005．99：742-747 .
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