哮喘联盟

   摘要
   背景：成人哮喘患者气道可逆性高(HR)与主要临床表现有关。本研究旨在比较气道可逆性高和可逆性低(LR)哮喘患者的肺功能、生物标志物及疾病控制情况。
   方法：该研究为回顾性分析，数据来源于两项设计类似且已完成的临床试验(NCT01018550和NCT01199289)。根据对支气管扩张药物的反应，把患者分为气道可逆性高（即用药后FEV1增加≥ +20%）和可逆性低两个亚组。根据血IgE、嗜酸粒细胞、呼出气一氧化氮(FeNO)、生物标志物把患者分为高Th2和低Th2两种表型，并用来评价哮喘控制不佳(1.5 ≤ ACQ ≤ 2.143)和控制严重不佳(ACQ > 2.143)的患者。
   结果：大部分的可逆性高和可逆性低亚组患者均呈现低Th2生物标志物特征，且哮喘控制严重不佳。气道可逆性高更多地与高Th2生物标志物 (40.1% vs. 29.4%; p=0.006)、肺功能降低(FEV1: 63.5±7.7% vs. 67.9±8.4% pred; p<0.001)及特应性（93.7% vs. 86.5%; p=0.005)有关。
   结论：气道可逆性高是肺功能降低的生理表现，与中重度哮喘的气道可逆性低相比，它更多地与Th2生物标志物升高有关。然而，本研究中大部分气道可逆性高和可逆性低的患者均呈现了低Th2生物标志物的特征。而且，高Th2生物标志物与疾病控制不佳并不相关。
 

（苏欣 审校）
Chest. 2015 Jul 30. doi: 10.1378/chest.14-2457. [Epub ahead of print]


 

Biomarker Profiles in Asthma with High vs. Low Airway Reversibility and Poor Disease Control.
 

Busse WW, Holgate ST, Wenzel SW, Klekotka P, Chon Y, Feng J, Ingenito E, Nirula A.
 

Abstract
BACKGROUND:High bronchodilator reversibility (HR) in adult asthma is associated with distinct clinical characteristics. This analysis compares lung function, biomarker profiles and disease control in HR and low reversibility (LR) asthma patients.
METHODS:A retrospective analysis was performed with data from 2 completed clinical trials of similar design (NCT01018550 and NCT01199289). Patients were divided into HR and LR subgroups based on their response to bronchodilators (HR = ΔFEV1 post-bronchodilator ≥ +20%). Serum IgE, blood eosinophils, and exhaled nitric oxide (FeNO), biomarkers commonly used to stratify patients into Th2-high vs. Th2-low phenotypes, were measured in "not well controlled" (1.5 ≤ ACQ ≤ 2.143) and "very poorly controlled" (ACQ > 2.143) patients.
RESULTS:The majority of patients in HR and LR subgroups displayed Th2-low biomarker profiles and very poor disease control. HR was more frequently associated with Th2-high biomarkers (40.1% vs. 29.4%; p=0.006), lower lung function (FEV1: 63.5±7.7% vs. 67.9±8.4% pred; p<0.001), and atopy (93.7% vs. 86.5%; p=0.005).
CONCLUSIONS:HR is a physiological indicator of reduced lung function, and is more often associated with elevations in Th2 biomarkers than LR in moderate-to-severe asthma. However, the majority of HR and LR patients in this analysis displayed a Th2-low biomarker profile. Moreover, a Th2-high biomarker profile was not associated with worse disease control.
 

Chest. 2015 Jul 30. doi: 10.1378/chest.14-2457. [Epub ahead of print]