衰老对气道炎症和哮喘控制的影响
2017/04/28
摘要
背景：老年哮喘患者发病率和死亡率较高。关于衰老对气道炎症和哮喘控制的影响，目前认识有限。
目的：比较老年哮喘组和年轻哮喘组气道炎症及其与哮喘控制的关系，以及确定这些差异是来自哮喘本身还是“炎性衰老”。
方法：采用前瞻性研究，纳入市中心老年（>60岁）和年轻（21-40岁）哮喘患者。经过一个监控ICS使用的导入期后，获取诱导痰。为了观察年龄相关的炎症变化，纳入年龄匹配的非哮喘对照受试者。
结果：与年轻哮喘组（平均年龄：30.8±5.9岁；共37例）相比，老年哮喘组（平均年龄：67.9±5.1岁；共35例）哮喘控制更差，FEV1更低。老年哮喘患者诱导痰中性粒细胞（30.5 × 104/mL、23.1%）和嗜酸性粒细胞（7.0 × 104/mL；3.8%）的计数和百分比均高于年轻哮喘患者（中性粒细胞：13.0 × 104/mL [P < .01]、6.9% [P < .01]；嗜酸性粒细胞：2.0 × 104/mL [P < .01]、1.2% [P < .01]）。老年哮喘患者诱导痰IL-6（P < .01）和IL-8（P = .01）表达水平更高。老年对照和年轻对照炎症水平无明显差异。在老年哮喘患者中，诱导痰IL-6和巨噬细胞炎症蛋白3α/CCL20表达水平增高与哮喘控制水平下降有关；诱导痰中性粒细胞计数与IL-1β、IL-6和巨噬细胞炎症蛋白3α/CCL20表达水平增高与住院情况相关。
结论：老年哮喘与年轻哮喘患者炎症类型的差异，表现在诱导痰中性粒细胞和嗜酸性粒细胞计数以及细胞因子水平增高，这与中性粒细胞募集有关。老年哮喘患者气道炎症的差异会降低哮喘的控制水平。尚需进一步研究老年哮喘的病理生理学特征，以改善其哮喘管理。
Effect of aging on sputum inflammation and asthma control
Busse PJ, Birmingham JM, Calatroni A, Manzi J, Goryachokovsky A, Fontela G, Federman AD, Wisnivesky JP
J Allergy Clin Immunol; 2016 Oct 8. pii: S0091-6749(16)31115-0
Abstract
Background: Aged asthmatic patients experience increased morbidity and mortality. Knowledge of the aging effect on airway inflammation and asthma control is limited.
Objectives: We sought to compare airway inflammation and its relationship to asthma control in aged versus younger patients and determine whether differences are asthma specific or caused by "inflamm-aging."
Methods: We performed a prospective study of aged (>60 years) and younger (21-40 years) inner-city patients with asthma. After a run-in period to control for inhaled corticosteroid use, induced sputum was collected. Age-matched nonasthmatic control subjects were included to measure age-related inflammatory changes.
Results: Aged (mean age, 67.9 ± 5.1 years; n = 35) compared with younger (mean age, 30.8 ± 5.9 years; n = 37) asthmatic patients had significantly worse asthma control and lower FEV1. Aged asthmatic patients had higher sputum neutrophil (30.5 × 104/mL and 23.1%) and eosinophil (7.0 × 104/mL and 3.8%) numbers and percentages compared with younger patients (neutrophils, 13.0 × 104/mL [P < .01] and 6.9% [P < .01]; eosinophils, 2.0 × 104/mL [P < .01] and 1.2% [P < .01]). Aged asthmatic patients had higher sputum IL-6 (P < .01) and IL-8 (P = .01) levels. No significant inflammatory differences between aged and younger control subjects were observed. In aged asthmatic patients increased sputum IL-6 and macrophage inflammatory protein 3α/CCL20 levels were significantly associated with decreased asthma control and increased sputum neutrophil numbers and IL-1β, IL-6, and macrophage inflammatory protein 3α/CCL20 levels were associated with hospitalization.
Conclusions: The inflammatory patterns of aged versus younger asthmatic patients are associated with increased sputum neutrophil and eosinophil values and cytokine levels related to neutrophil recruitment. Differences in airway inflammation can contribute to diminished asthma control in the aged. Further understanding of asthma pathophysiology in aged patients is needed to improve management of this vulnerable population.
背景：老年哮喘患者发病率和死亡率较高。关于衰老对气道炎症和哮喘控制的影响，目前认识有限。
目的：比较老年哮喘组和年轻哮喘组气道炎症及其与哮喘控制的关系，以及确定这些差异是来自哮喘本身还是“炎性衰老”。
方法：采用前瞻性研究，纳入市中心老年（>60岁）和年轻（21-40岁）哮喘患者。经过一个监控ICS使用的导入期后，获取诱导痰。为了观察年龄相关的炎症变化，纳入年龄匹配的非哮喘对照受试者。
结果：与年轻哮喘组（平均年龄：30.8±5.9岁；共37例）相比，老年哮喘组（平均年龄：67.9±5.1岁；共35例）哮喘控制更差，FEV1更低。老年哮喘患者诱导痰中性粒细胞（30.5 × 104/mL、23.1%）和嗜酸性粒细胞（7.0 × 104/mL；3.8%）的计数和百分比均高于年轻哮喘患者（中性粒细胞：13.0 × 104/mL [P < .01]、6.9% [P < .01]；嗜酸性粒细胞：2.0 × 104/mL [P < .01]、1.2% [P < .01]）。老年哮喘患者诱导痰IL-6（P < .01）和IL-8（P = .01）表达水平更高。老年对照和年轻对照炎症水平无明显差异。在老年哮喘患者中，诱导痰IL-6和巨噬细胞炎症蛋白3α/CCL20表达水平增高与哮喘控制水平下降有关；诱导痰中性粒细胞计数与IL-1β、IL-6和巨噬细胞炎症蛋白3α/CCL20表达水平增高与住院情况相关。
结论：老年哮喘与年轻哮喘患者炎症类型的差异，表现在诱导痰中性粒细胞和嗜酸性粒细胞计数以及细胞因子水平增高，这与中性粒细胞募集有关。老年哮喘患者气道炎症的差异会降低哮喘的控制水平。尚需进一步研究老年哮喘的病理生理学特征，以改善其哮喘管理。
(王霁1 张红萍1 王刚 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 Oct 8. pii: S0091-6749(16)31115-0）
（J Allergy Clin Immunol; 2016 Oct 8. pii: S0091-6749(16)31115-0）
Effect of aging on sputum inflammation and asthma control
Busse PJ, Birmingham JM, Calatroni A, Manzi J, Goryachokovsky A, Fontela G, Federman AD, Wisnivesky JP
J Allergy Clin Immunol; 2016 Oct 8. pii: S0091-6749(16)31115-0
Abstract
Background: Aged asthmatic patients experience increased morbidity and mortality. Knowledge of the aging effect on airway inflammation and asthma control is limited.
Objectives: We sought to compare airway inflammation and its relationship to asthma control in aged versus younger patients and determine whether differences are asthma specific or caused by "inflamm-aging."
Methods: We performed a prospective study of aged (>60 years) and younger (21-40 years) inner-city patients with asthma. After a run-in period to control for inhaled corticosteroid use, induced sputum was collected. Age-matched nonasthmatic control subjects were included to measure age-related inflammatory changes.
Results: Aged (mean age, 67.9 ± 5.1 years; n = 35) compared with younger (mean age, 30.8 ± 5.9 years; n = 37) asthmatic patients had significantly worse asthma control and lower FEV1. Aged asthmatic patients had higher sputum neutrophil (30.5 × 104/mL and 23.1%) and eosinophil (7.0 × 104/mL and 3.8%) numbers and percentages compared with younger patients (neutrophils, 13.0 × 104/mL [P < .01] and 6.9% [P < .01]; eosinophils, 2.0 × 104/mL [P < .01] and 1.2% [P < .01]). Aged asthmatic patients had higher sputum IL-6 (P < .01) and IL-8 (P = .01) levels. No significant inflammatory differences between aged and younger control subjects were observed. In aged asthmatic patients increased sputum IL-6 and macrophage inflammatory protein 3α/CCL20 levels were significantly associated with decreased asthma control and increased sputum neutrophil numbers and IL-1β, IL-6, and macrophage inflammatory protein 3α/CCL20 levels were associated with hospitalization.
Conclusions: The inflammatory patterns of aged versus younger asthmatic patients are associated with increased sputum neutrophil and eosinophil values and cytokine levels related to neutrophil recruitment. Differences in airway inflammation can contribute to diminished asthma control in the aged. Further understanding of asthma pathophysiology in aged patients is needed to improve management of this vulnerable population.
上一篇：
哮喘对患者性功能影响的一项病例对照研究
下一篇：
控制不佳的哮喘患者抗病毒干扰素生成减少与中性粒细胞炎症及大剂量吸入激素相关
