肥胖人群全身炎症与更高的哮喘样呼吸困难感知
2016/08/08
摘要
背景：有许多自称诊断为哮喘的肥胖患者当前或以前并没有气道受限、支气管可逆性或气道高反应性的证据（误诊哮喘）。然而，肥胖人群哮喘样症状的机制尚不清楚。
目的：评估在支气管激发试验和运动试验中肥胖哮喘患者、肥胖误诊哮喘患者与肥胖非哮喘患者三者对呼吸困难的感知，以识别肥胖患者哮喘样症状的机制。
方法：采用横断面研究，纳入肥胖哮喘患者25例，肥胖误诊哮喘患者23例以及肥胖非哮喘患者27例。测量指标包括肺量计检查、肺容量、呼出气一氧化氮和全身生物标志物水平。在腺苷支气管激发试验和运动试验中记录呼吸困难评分。
结果：在支气管激发试验中，肥胖哮喘患者和肥胖误诊哮喘患者较非哮喘患者ΔBorg/ΔFEV1更高。此外，运动试验中，肥胖哮喘患者和肥胖误诊哮喘患者较非哮喘患者最大呼吸困难评分和Borg/V’O2（摄氧量）更高。支气管激发试验中，最大呼吸困难评分与IL-1β相关；运动试验中，最大呼吸频率、CO2呼吸当量、IL-6和IL-1β水平是Borg/V’O2的独立预测因素（r2 = 0.853, P < .001）。
结论：肥胖患者误诊为哮喘可归咎于对呼吸困难感知的增高，这在运动中主要是与全身炎症和代谢需求而过度通气相关的。
Systemic inflammation and higher perception of dyspnea mimicking asthma in obese subjects
Carlos C; Carlos V; Raul G; David R; Ana de C; Angel H; Francisco GR
J Allergy Clin Immunol; 2016 Mar; 137(3):718-726.e4.
Abstract
Background: There are a variable number of obese subjects with self-reported diagnosis of asthma but without current or previous evidence of airflow limitation, bronchial reversibility, or airway hyperresponsiveness (misdiagnosed asthma). However, the mechanisms of asthma-like symptoms in obesity remain unclear.
Objectives: We sought to evaluate the perception of dyspnea during bronchial challenge and exercise testing in obese patients with asthma and misdiagnosed asthma compared with obese control subjects to identify the mechanisms of asthma-like symptoms in obesity.
Methods: In a cross-sectional study we included obese subjects with asthma (n = 25), misdiagnosed asthma (n = 23), and no asthma or respiratory symptoms (n = 27). Spirometry, lung volumes, exhaled nitric oxide levels, and systemic biomarker levels were measured. Dyspnea scores during adenosine bronchial challenge and incremental exercise testing were obtained.
Results: During bronchial challenge, patients with asthma or misdiagnosed asthma reached a higher Borg-FEV1 slope than control subjects. Moreover, maximum dyspnea and the Borg–oxygen uptake (V’O2) slope were significantly greater during exercise in subjects with asthma or misdiagnosed asthma than in control subjects. The maximum dyspnea achieved during bronchial challenge correlated with IL-1β levels, whereas peak respiratory frequency, ventilatory equivalent for CO2, and IL-6 and IL-1β levels were independent predictors of the Borg-V’O2 slope during exercise (r2 = 0.853, P < .001).
Conclusions: A false diagnosis of asthma (misdiagnosed asthma) in obese subjects is attributable to an increased perception of dyspnea, which, during exercise, is mainly associated with systemic inflammation and excessive ventilation for metabolic demands.
背景：有许多自称诊断为哮喘的肥胖患者当前或以前并没有气道受限、支气管可逆性或气道高反应性的证据（误诊哮喘）。然而，肥胖人群哮喘样症状的机制尚不清楚。
目的：评估在支气管激发试验和运动试验中肥胖哮喘患者、肥胖误诊哮喘患者与肥胖非哮喘患者三者对呼吸困难的感知，以识别肥胖患者哮喘样症状的机制。
方法：采用横断面研究，纳入肥胖哮喘患者25例，肥胖误诊哮喘患者23例以及肥胖非哮喘患者27例。测量指标包括肺量计检查、肺容量、呼出气一氧化氮和全身生物标志物水平。在腺苷支气管激发试验和运动试验中记录呼吸困难评分。
结果：在支气管激发试验中，肥胖哮喘患者和肥胖误诊哮喘患者较非哮喘患者ΔBorg/ΔFEV1更高。此外，运动试验中，肥胖哮喘患者和肥胖误诊哮喘患者较非哮喘患者最大呼吸困难评分和Borg/V’O2（摄氧量）更高。支气管激发试验中，最大呼吸困难评分与IL-1β相关；运动试验中，最大呼吸频率、CO2呼吸当量、IL-6和IL-1β水平是Borg/V’O2的独立预测因素（r2 = 0.853, P < .001）。
结论：肥胖患者误诊为哮喘可归咎于对呼吸困难感知的增高，这在运动中主要是与全身炎症和代谢需求而过度通气相关的。
(王霁1 张丽1 张欣1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
J Allergy Clin Immunol; 2016 Mar; 137(3):718-726.e4
J Allergy Clin Immunol; 2016 Mar; 137(3):718-726.e4
Systemic inflammation and higher perception of dyspnea mimicking asthma in obese subjects
Carlos C; Carlos V; Raul G; David R; Ana de C; Angel H; Francisco GR
J Allergy Clin Immunol; 2016 Mar; 137(3):718-726.e4.
Abstract
Background: There are a variable number of obese subjects with self-reported diagnosis of asthma but without current or previous evidence of airflow limitation, bronchial reversibility, or airway hyperresponsiveness (misdiagnosed asthma). However, the mechanisms of asthma-like symptoms in obesity remain unclear.
Objectives: We sought to evaluate the perception of dyspnea during bronchial challenge and exercise testing in obese patients with asthma and misdiagnosed asthma compared with obese control subjects to identify the mechanisms of asthma-like symptoms in obesity.
Methods: In a cross-sectional study we included obese subjects with asthma (n = 25), misdiagnosed asthma (n = 23), and no asthma or respiratory symptoms (n = 27). Spirometry, lung volumes, exhaled nitric oxide levels, and systemic biomarker levels were measured. Dyspnea scores during adenosine bronchial challenge and incremental exercise testing were obtained.
Results: During bronchial challenge, patients with asthma or misdiagnosed asthma reached a higher Borg-FEV1 slope than control subjects. Moreover, maximum dyspnea and the Borg–oxygen uptake (V’O2) slope were significantly greater during exercise in subjects with asthma or misdiagnosed asthma than in control subjects. The maximum dyspnea achieved during bronchial challenge correlated with IL-1β levels, whereas peak respiratory frequency, ventilatory equivalent for CO2, and IL-6 and IL-1β levels were independent predictors of the Borg-V’O2 slope during exercise (r2 = 0.853, P < .001).
Conclusions: A false diagnosis of asthma (misdiagnosed asthma) in obese subjects is attributable to an increased perception of dyspnea, which, during exercise, is mainly associated with systemic inflammation and excessive ventilation for metabolic demands.
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哮喘患者过敏原刺激后气道树突状细胞的IL-25受体表达
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婴儿期喉气管支气管异常以及与住院期间死亡的相关危险因素
