哮喘联盟

   摘要
   背景：全球哮喘管理的目标是达到哮喘控制。然而哮喘防治创议（GINA）通过临床结果和未来风险的综合指标来定义哮喘的控制水平，却没有包括气道炎症生物标志物。我们旨在探索在广泛人群中的临床哮喘控制水平是否反映嗜酸性粒细胞炎症水平。
   方法：纳入111例哮喘患者，通过为期4周的观察来评估哮喘控制水平：完全控制22例，部分控制47例和未控制42例。我们获得的指标包括：肺功能，生活质量，对一磷酸腺苷（adenosine monophosphate,AMP）的气道高反应性，痰液及血液中嗜酸性粒细胞计数，呼出气一氧化氮（fractional exhaled nitric oxide, FeNO）以及支气管活检。
   结果：与未控制组的42例受试者相比，哮喘控制组的69例受试者（包括完全控制和良好控制）的血液嗜酸性粒细胞计数、AMP高反应性的斜率和肺泡NO水平的中位数更低：分别为0.18 (范围为 0.01–0.54)比0.22(0.06–1.16)×109/l (p<0.05), 3.8 (−0.4–17 750)比39.7 (0.4–28 000) mg/ml (p<0.05) and 5.3 (1.5–14.9)比 6.7 (2.6–51.7) ppb (p<0.05)。与未控制组受试者相比，哮喘控制组受试者的组织活检包含嗜酸性粒细胞颗粒更少以及更完整的上皮组织：分别为113 (6–1787)比219 (19–5313) (p<0.05)和11.8% (0–65.3)比5.6% (0–47.6)(p<0.05)。与未控制组的受试者比较，处于哮喘控制组的受试者的哮喘生活质量问卷（Asthma Quality of Life Questionnaire，AQLQ)得分更高：6.7 (5.0–7.0) 比 5.9 (3.7–7.0)(p<0.001)。
   结论：基于临床结果综合指标的哮喘控制水平与其炎症标志物相关，尤其是在完全控制和良好控制之间差异甚小的嗜酸性粒细胞炎症。
 

(马利  四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Thorax;2013;68:19–24.）
 

Clinical control of asthma associates with measures of airway inflammation

Volbeda F, Broekema M, Lodewijk ME,  Hylkema MN, Reddel HK, Timens W, Postma DS, Nick H T ten Hacken

Thorax;2013;68:19–24.

ABSTRACT
Background: Control of asthma is the goal of asthma management worldwide. The Global Initiative for Asthma defined control by a composite measure of clinical findings and future risk but without using markers of airway inflammation, the hallmark of asthma. We investigated whether clinical asthma control reflects eosinophilic inflammation in a broad population.
Methods: Control of asthma was assessed over a period of 4 weeks in 111 patients with asthma: 22 totally controlled, 47 well controlled and 42 uncontrolled. Lung
function, quality of life, airway hyperresponsiveness to AMP, sputum and blood eosinophils, exhaled nitric oxide (NO) and bronchial biopsies were obtained.
Results: The 69 subjects with controlled asthma (totally and well controlled combined) had lower median blood eosinophil numbers, slope of AMP hyperresponsiveness,and alveolar NO levels than the 42 subjects with uncontrolled asthma: 0.18 (range 0.01–0.54) versus 0.22(0.06–1.16)×109/litre (p<0.05), 3.8 (−0.4–17 750) versus 39.7 (0.4–28 000) mg/ml (p<0.05) and 5.3 (1.5–14.9)versus 6.7 (2.6–51.7) ppb (p<0.05) respectively. Biopsies from subjects with controlled asthma contained fewer eosinophilic granules and more intact epithelium than uncontrolled subjects: 113 (6–1787) versus 219 (19–5313) (p<0.05) and 11.8% (0–65.3) versus 5.6% (0–47.6)(p<0.05) respectively. Controlled asthmatics had better Asthma Quality of Life Questionnaire scores than uncontrolled patients: 6.7 (5.0–7.0) versus 5.9 (3.7–7.0)(p<0.001).
Conclusions: The level of asthma control, based on a composite measure of clinical findings, is associated with inflammatory markers, particularly eosinophilic inflammation, with little difference between totally controlled and well controlled asthma.