哮喘联盟

   摘要
   背景：呼出气一氧化氮(FeNO)和血嗜酸性粒细胞计数(B-eos)是哮喘诊断和治疗中用来判定嗜酸性粒细胞炎症的标志物。抽烟与FeNO和血嗜酸性粒细胞计数的关系复杂。那么，这两种标志物与抽烟的哮喘患者关系如何呢？
   目的：本研究旨在根据抽烟状态来探讨FeNO和血嗜酸性粒细胞计数的关系及哮喘与特应性疾病的关系。
   方法：本研究的对象来源于横断面研究ELISABET中的一般人群，1,607例中年人中有1,579例和1,496例分别测定了FeNO和血嗜酸性粒细胞计数。过敏性哮喘的定义为哮喘（自述经医生确诊患有哮喘、过去12个月内有喘息，或使用过哮喘药物）伴有特应症（过去12个月有过敏性鼻炎或花粉症病史，或点刺试验阳性史，或变应原脱敏治疗史）。非过敏性哮喘则定义为哮喘不伴有特应症。
   结果：纳入分析的不抽烟者、戒烟者、吸烟者分别有812 (51.4%)例、473 (30%)例、294 (18.6%)例。共490 (32%)例受试者为特应症，80 (5.1%)例患有过敏性哮喘，31 (2%)例患有非过敏性哮喘。仅有16.2% (18/111)的哮喘患者使用吸入性糖皮质激素治疗，提示他们中的大多数为轻度哮喘。多因素分析模型表明，抽烟状态与过敏性哮喘有关，FeNO和血嗜酸性细胞计数的p值分别为0.003、0.001。与非过敏性哮喘相比，不抽烟和戒烟的过敏性哮喘患者FeNO值更高(+63.4%, 95% CI : 39 - 92)、血嗜酸性粒细胞计数更高(+63.2% , 95% CI: 38.2 - 92.7)，而抽烟的过敏性哮喘患者并非如此。ROC曲线表明，两种标志物均可恰当识别过敏性哮喘，但仅限于不抽烟的人群。
   结论及临床意义：FeNO和血嗜酸性粒细胞计数与轻度过敏性哮喘有关，但仅限于不抽烟的人群，而不是抽烟人群。那么，FeNO和血嗜酸性粒细胞计数在抽烟人群中的临床价值到底如何，尚不得而知。

 

（杨冬 审校）
Clin Exp Allergy. 2015 Nov 5. doi: 10.1111/cea.12669. [Epub ahead of print]


 

Both exhaled nitric oxide and blood eosinophil count were associated with mild allergic asthma only in non-smokers.
 

Giovannelli J1,2,3, Chérot-Kornobis N1,2, Hulo S1,2, Ciuchete A3, Clément G1,3, Amouyel P1,2,3, Matran R1,2,Dauchet L1,2,3.
 

Abstract
BACKGROUND:The fractional exhaled nitric oxide (FENO) and the blood eosinophil count (B-eos) are markers of eosinophilic inflammation used in the diagnosis and management of asthma. The relationships between smoking cigarette and both FENO and B-eos are complex and raise questions about the association between these markers and asthma in smokers.
OBJECTIVE:To determine the relationships between both FENO and B-eos on one hand and asthma and atopy on the other, according to smoking status.
METHODS:FENO and B-eos were measured in respectively 1579 and 1496 of the 1607 middle-aged adults randomly selected from the general population in the cross-sectional ELISABET survey. Allergic asthma was defined as asthma (a self-report of physician-diagnosed asthma, and wheezing in the previous 12 months or the use of asthma medications) with atopy (allergic rhinitis or hay fever in the previous 12 months, or a previous positive prick test or allergen desensitization therapy). Nonallergic asthma was defined as asthmawithout atopy.
RESULTS:The analysis included 812 (51.4%) never-, 473 (30%) former- and 294 (18.6%) current smokers. A total of 490 (32%) participants were atopic, 80 (5.1%) had allergic asthma, and 31 (2%) had nonallergicasthma. Only 16.2% (18/111) of asthmatics were treated with glucocorticoid inhalants, suggesting that among them a majority of participants had mild asthma. A positive interaction between smoking status and allergicasthma was observed in multivariate models explaining FENO (p=0.003) and B-eos (p=0.001). Thus, compared to those without allergic asthma, participants with allergic asthma had higher FENO values (+63.4%, 95%CI=[39; 92]) and higher B-eos (+63.2% [38.2; 92.7]) in never and former smokers, but not in current smokers. Lastly, an analysis of receiver operating characteristic curves showed that each of the two markers was able to discriminate moderately allergic asthma but only in non-smokers.
CONCLUSIONS & CLINICAL RELEVANCE:FENO and B-eos were associated with the presence of mild allergic asthma only in non-smokers, not in current smokers. These findings raise questions about the clinical value of FENO and B-eos in smokers.
 

Clin Exp Allergy. 2015 Nov 5. doi: 10.1111/cea.12669. [Epub ahead of print]