哮喘联盟

   摘要
   背景：监测哮喘患者痰嗜酸粒细胞可以预测哮喘急性加重风险并提高哮喘管理。迄今为止，血嗜酸粒细胞与呼出气一氧化氮（FENO）的结果在预测嗜酸性气道炎症中自相矛盾。近年来，人们逐渐将血清骨膜蛋白（periostin）视为嗜酸性炎症的新型生物学标志。
   目标：为了量化血嗜酸粒细胞、FENO和血清骨膜蛋白与痰嗜酸粒细胞之间的相互关系，我们在不同炎症程度的哮喘患者中进行两组独立的队列研究作为外部验证。
   方法：第一支队列由110位轻度和中度的哮喘患者组成（外部验证队列），重复队列则包含37位中度至重度的哮喘患者，两组队列均进行横断面调查。评价内容包括诱导痰嗜酸粒细胞、血嗜酸粒细胞、血清骨膜蛋白浓度以及FENO。采用受试者工作特征曲线下面积（ROC AUC）评价这些标志识别嗜酸性哮喘患者（痰嗜酸性粒细胞≥3%）在诊断上的准确性
   结果：在外部验证队列中，辨别痰嗜酸性粒细胞≥3%的ROC AUC分别为：血嗜酸性粒细胞为89% （p<0.001）、FENO水平 为78%（p<0.001）。血清骨膜蛋白未能区分嗜酸性与非嗜酸性气道炎症（ROC AUC=55%, p=0.44）。将三个变量结合分析未观察到明显改善。血嗜酸粒细胞的诊断价值在重复队列研究中得到确认（ROC AUC 85%，p<0.001）
   结论：在轻、中及重度的哮喘患者中，血嗜酸性粒细胞在识别哮喘患者的痰嗜酸粒细胞准确性最好。血嗜酸性粒细胞的应用有利于个体化的治疗和哮喘的管理。

（南方医科大学南方医院 吴越 赵海金）
Wagener AH, de Nijs SB, Lutter R, et al. Thorax. 2015 Feb;70(2):115-20.


 

External validation of blood eosinophils, FENO and serum periostin as surrogates for sputum eosinophils in asthma.

Wagener AH, de Nijs SB, Lutter R, et al. Thorax. 2015 Feb;70(2):115-20.

Abstract
BACKGROUND:Monitoring sputum eosinophils in asthma predicts exacerbations and improves management of asthma. Thus far, blood eosinophils and FE(NO) show contradictory results in predicting eosinophilic airway inflammation. More recently, serum periostin was proposed as a novel biomarker for eosinophilic inflammation.
OBJECTIVES:Quantifying the mutual relationships of blood eosinophils, FE(NO), and serum periostin with sputum eosinophils by external validation in two independent cohorts across various severities of asthma.
METHODS:The first cohort consisted of 110 patients with mild to moderate asthma (external validation cohort). The replication cohort consisted of 37 patients with moderate to severe asthma. Both cohorts were evaluated cross-sectionally. Sputum was induced for the assessment of eosinophils. In parallel, blood eosinophil counts, serum periostin concentrations and FENO were assessed. The diagnostic accuracy of these markers to identify eosinophilic asthma (sputum eosinophils ≥3%) was calculated using receiver operating characteristics area under the curve (ROC AUC).
RESULTS:In the external validation cohort, ROC AUC for blood eosinophils was 89% (p<0.001) and for FE(NO) level 78% (p<0.001) to detect sputum eosinophilia ≥3%. Serum periostin was not able to distinguish eosinophilic from non-eosinophilic airway inflammation (ROC AUC=55%, p=0.44). When combining these three variables, no improvement was seen. The diagnostic value of blood eosinophils was confirmed in the replication cohort (ROC AUC 85%, p<0.001).
CONCLUSIONS:In patients with mild to moderate asthma, as well as patients with more severe asthma, blood eosinophils had the highest accuracy in the identification of sputum eosinophilia in asthma. The use of blood eosinophils can facilitate individualised treatment and management of asthma.