以生物标记物为基础检测慢阻肺人群中ACOS
2015/12/29
摘要
研究背景：哮喘-慢性阻塞性肺部疾病重叠综合征（ACOS）是由全球哮喘协会以及全球慢性阻塞性肺部疾病协会共同提出的概念。目前，ACOS的确切定义尚不明确，ACOS的流行率通常是通过调查问卷的方式了解患者症状以及内科医生的判定来统计的。研究目的：开展多中心，横断面的研究以调查慢阻肺患者合并高FeNO，高IgE个体在慢阻肺患者群体中的流行率，以此作为ACOS在慢阻肺群体的流行率。
研究方法：从日本仙台东北大学医院以及其他5所医院门诊部纳入从2013年4月1日至2014年2月28日就诊于呼吸内科的慢阻肺患者。并且使用FeNO值为35ppb作为高FeNO的截断值。通过评价FeNO以及IgE水平来估计ACOS在慢阻肺群体中的流行率。
研究结果：使用FeNO值为35ppb作为高FeNO的截断值，单纯测量这些慢阻肺人群的FeNO，ACOS的流行率为16.3%，同时使用FeNO以及IgE评估时，高FeNO，高IgE个体占慢阻肺人群的7.8% 。
研究结论：这项研究首次使用生物标记物检测慢阻肺人群中ACOS流行率。ACOS患者应早期吸入糖皮质激素联合β受体激动剂治疗。FeNO和IgE可能可以用来提高对慢阻肺患者中ACOS个体的长期管理效果。
评价：此研究首次应用国际指南推荐的生物标记物来评估慢阻肺人群中ACOS流行情况，FeNO和IgE可能有利于早期发现ACOS亚型，从而早期选择ICS/LABA联合治疗，改善慢阻肺人群中ACOS患者长期管理。
（南方医科大学南方医院 熊婧 赵海金 ）
Tamada, T., et al., Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations. Int J Chron Obstruct Pulmon Dis, 2015. 10: p. 2169-76.
Tamada, T., et al., Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations. Int J Chron Obstruct Pulmon Dis, 2015. 10: p. 2169-76.
Biomarker-based detection of asthma–COPD overlap syndrome in COPD populations.
Abstract
Asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) was proposed by the science committees of both Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD). However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient’s symptoms or the physician’s opinion, based on questionnaire testing. In the current case report, we investigated the prevalence rate of COPD patients with high levels of fractional exhaled nitric oxide (FENO) or immunoglobulin E (IgE) as candidate markers of ACOS in COPD, as a multicenter, cross-sectional study. Outpatients with COPD were enrolled from Tohoku University Hospital, Sendai, Japan, and five hospitals (Tohoku University Hospital, Sendai, Japan; NTT East Tohoku Hospital, Sendai, Japan; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan) with pulmonary physicians from March 1, 2013 to February 28, 2014. When they were estimated using 35 ppb as the cutoff value of FENO, the prevalence rate of ACOS was 16.3% in COPD. When estimated by both FENO and IgE, the high-FENO/highIgE group was 7.8% in COPD. To the best of our knowledge, this study is the first to detect the prevalence rate of ACOS in COPD populations by using objective biomarkers. The results from the current study should be useful to identify the subgroup requiring early intervention by inhaled corticosteroids/long-acting beta agonist combination in COPD in order to improve the long-term management for ACOS.
Tamada, T., et al., Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations. Int J Chron Obstruct Pulmon Dis, 2015. 10: p. 2169-76.
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幼儿期喘息表型影响青春期哮喘、肺功能及呼出一氧化氮(FENO)水平
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屋尘螨激发后加重无哮喘症状的持续变应性鼻炎患者气道炎症和气道高反应性
