老年哮喘患者的表型特征
2016/06/20
摘要
背景：老年哮喘患者的表型特征尚不清楚。本研究的目的是利用肺功能测试和高分辨CT（HRCT）图像来阐明这些特征，并确定临床特征和表型之间的关系。
方法：165名老年患者（大于65岁）接受过临床、功能状态、以及合并症的多层面评估，现对他们进行一项横断面研究。基于胸部HRCT将患者分为三型：（1）哮喘为主，（2）哮喘-气道阻塞性疾病（OAD）重叠，无肺气肿，和（3）哮喘-气道阻塞性疾病重叠伴肺气肿。受试者工作特征（ROC）曲线用来评估区分两OAD表型之间的截断值。多因素分析也被用来区分这两种表型。
结果：以哮喘表型为主的48例（29%），哮喘-气道阻塞性疾病-无肺气肿的有36例（22%），哮喘-肺气肿的81例（49%）。有哮喘-肺气肿的患者有更多吸烟者。在多变量分析中，吸烟状况（比值比为2.92：95% CI 1.21-7.00，P = 0.03）和FEV1占预计值%≤70%（比值比为3.18：95% CI 1.13-8.92，P = 0.03）在哮喘-肺气肿和哮喘-无肺气肿表型之间的差异显著。
结论：老年哮喘患者中有一半是哮喘-肺气肿重叠类型。我们的研究结果表明，有哮喘的老年患者中吸烟的或者有中度或重度气道阻塞性疾病的可能也有肺气肿。
（杨冬 审校）
AllergolInt. 2016 Apr;65(2):204-9.doi:10.1016/j.alit.2015.11.007.Epub 2016 Jan 16.
Characteristics of phenotypes of elderly patients with asthma.
Sano H1, Iwanaga T2, Nishiyama O2, Sano A2, Higashimoto Y2, Tomita K2, Tohda Y2.
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Abstract
BACKGROUND:The characteristics of phenotypes of elderly patients with asthma are unknown. The aim of this study was to classify these phenotypes using lung function tests and images from high-resolution computed tomography (HRCT), and to identify associations between clinical characteristics and phenotypes.
METHODS:A cross-sectional study was conducted in 165 elderly patients (>65 years of age) who underwent a multidimensional assessment of clinical and functional status and comorbidity. The patients were divided into three phenotypes: (1) asthma-predominant, (2) asthma-obstructive airway disease (OAD) overlap without emphysema, and (3) asthma-OAD overlap with emphysema (asthma-emphysema overlap) based on chest HRCT. A receiver operating characteristic (ROC) curve was constructed to evaluate the cutoff for differentiating between the two OAD phenotypes. Multivariate analysis was also used to distinguish between these two phenotypes.
RESULTS:The phenotypes were asthma-predominant in 48 patients (29%), asthma-OAD without emphysema in 36 (22%), and asthma-emphysema in 81 (49%). Patients with asthma-emphysema were more frequent smokers. In multivariate analysis, smoking status (odds ratio 2.92: 95% CI 1.21-7.00, P = 0.03) and % predicted FEV1 ≤70% (odds ratio 3.18: 95% CI 1.13-8.92, P = 0.03) differed significantly between the asthma-emphysema andasthma-OAD without emphysema phenotypes.
CONCLUSIONS:Half of elderly patients with asthma are characterized by asthma-emphysema overlap. Our results showed that elderly patients withasthma who are smokers and have moderate or severe OAD are also likely to have emphysema.
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KEYWORDS:ACOS; Elderly asthma; Emphysema; HRCT; Phenotype
AllergolInt. 2016 Apr;65(2):204-9.doi:10.1016/j.alit.2015.11.007.Epub 2016 Jan 16.
