返流在哮喘中的潜在作用
2017/07/12
摘要
背景：造成目前许多哮喘患者症状控制不佳和加重的很重要的一个原因就是胃食管反流。 我们的目的是调查哮喘患者是否发生反流，以及反流是否与哮喘控制相关。
材料与方法：使用哮喘控制问卷7（ACQ-7），呼气一氧化氮和肺活量三个指标来检测患者哮喘控制水平。 使用钡餐的易激惹征象来评估反流倾向性。 对患者进行支气管镜检查，以肺泡灌洗液中胃蛋白酶作为反流的金标准。
结果:研究纳入了78例哮喘患者，依据GINA中对疾病严重程度的定义分为轻度（35.8％），中度（21.7％）和严重（42.3％）。其中 46/78（58.9％）的BAL中可检测到胃蛋白酶。不同疾病严重程度的患者胃蛋白酶水平无差异。此外，胃蛋白酶水平与哮喘控制，FEV1，ACQ-7或加重频率之间没有显著关联，另外，没有发现关于吸烟史，BMI，质子泵抑制剂使用情况，嗜酸性粒细胞计数或IgE之间存在关联。将患者基于BAL分为嗜酸性或嗜中性粒细胞群体分析，结果显示胃蛋白酶浓度组见无明显差异。钡餐易激惹征象（见于33/60例患者）与BAL胃蛋白酶水平无关，且钡餐结果与ACQ-7，哮喘加重频率或FEV1之间没有显着的关联。
结论：这项研究表明返流在目前哮喘症状控制和恶化中的重要性可能被夸大了。
The Potential Role of Aspiration in the Asthmatic Airway
Eoin B. Hunt, MD; Chris Ward, PhD; Stephen Power, MD; Ashley Sullivan, BSc; Jeffrey P. Pearson, PhD; Susan Lapthorne, PhD; Paul M. O’Byrne, MD, FCCP; Joseph Eustace, MD; Barry J. Plant, MD; Michael M. Maher, MD; John MacSharry, PhD; Desmond M. Murphy, MD, FCC
Abstract
Background Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control?
Methods Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration. Patients underwent bronchoscopic investigation, with BAL pepsin measured as a marker of aspiration.
Results Seventy-eight patients stratified by disease severity (Global Initiative for Asthma) into mild (35.8%), moderate (21.7%) and severe (42.3%) were studied. Pepsin was detectable in BAL in 46/78 (58.9%). There were no differences between pepsin levels in patients with different disease severity. Furthermore, no significant associations were seen between pepsin level and measures of asthma control, FEV1, ACQ-7 or exacerbation frequency. Similarly no associations were found with adjustments for smoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations on the basis of BAL, there was no relationship to detected pepsin concentrations. A positive barium swallow (seen in 33/60 patients) did not correlate with BAL pepsin level and we found no significant association between barium swallow result and ACQ-7, Global Initiative for Asthma, exacerbation frequency or FEV1 using either univariate or multivariate analyses.
Conclusions This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.
背景：造成目前许多哮喘患者症状控制不佳和加重的很重要的一个原因就是胃食管反流。 我们的目的是调查哮喘患者是否发生反流，以及反流是否与哮喘控制相关。
材料与方法：使用哮喘控制问卷7（ACQ-7），呼气一氧化氮和肺活量三个指标来检测患者哮喘控制水平。 使用钡餐的易激惹征象来评估反流倾向性。 对患者进行支气管镜检查，以肺泡灌洗液中胃蛋白酶作为反流的金标准。
结果:研究纳入了78例哮喘患者，依据GINA中对疾病严重程度的定义分为轻度（35.8％），中度（21.7％）和严重（42.3％）。其中 46/78（58.9％）的BAL中可检测到胃蛋白酶。不同疾病严重程度的患者胃蛋白酶水平无差异。此外，胃蛋白酶水平与哮喘控制，FEV1，ACQ-7或加重频率之间没有显著关联，另外，没有发现关于吸烟史，BMI，质子泵抑制剂使用情况，嗜酸性粒细胞计数或IgE之间存在关联。将患者基于BAL分为嗜酸性或嗜中性粒细胞群体分析，结果显示胃蛋白酶浓度组见无明显差异。钡餐易激惹征象（见于33/60例患者）与BAL胃蛋白酶水平无关，且钡餐结果与ACQ-7，哮喘加重频率或FEV1之间没有显着的关联。
结论：这项研究表明返流在目前哮喘症状控制和恶化中的重要性可能被夸大了。
(中日友好医院医院呼吸与危重症医学科 王圆方摘译 林江涛审校)
（Hunt E B, Ward C, Power S, et al. The potential role of aspiration in the asthmatic airway.[J]. Chest, 2017.）
（Hunt E B, Ward C, Power S, et al. The potential role of aspiration in the asthmatic airway.[J]. Chest, 2017.）
The Potential Role of Aspiration in the Asthmatic Airway
Eoin B. Hunt, MD; Chris Ward, PhD; Stephen Power, MD; Ashley Sullivan, BSc; Jeffrey P. Pearson, PhD; Susan Lapthorne, PhD; Paul M. O’Byrne, MD, FCCP; Joseph Eustace, MD; Barry J. Plant, MD; Michael M. Maher, MD; John MacSharry, PhD; Desmond M. Murphy, MD, FCC
Abstract
Background Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control?
Methods Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration. Patients underwent bronchoscopic investigation, with BAL pepsin measured as a marker of aspiration.
Results Seventy-eight patients stratified by disease severity (Global Initiative for Asthma) into mild (35.8%), moderate (21.7%) and severe (42.3%) were studied. Pepsin was detectable in BAL in 46/78 (58.9%). There were no differences between pepsin levels in patients with different disease severity. Furthermore, no significant associations were seen between pepsin level and measures of asthma control, FEV1, ACQ-7 or exacerbation frequency. Similarly no associations were found with adjustments for smoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations on the basis of BAL, there was no relationship to detected pepsin concentrations. A positive barium swallow (seen in 33/60 patients) did not correlate with BAL pepsin level and we found no significant association between barium swallow result and ACQ-7, Global Initiative for Asthma, exacerbation frequency or FEV1 using either univariate or multivariate analyses.
Conclusions This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.
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客观咳嗽频率，气道炎症和哮喘疾病控制
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呼出气一氧化氮和支气管舒张剂反应的联合使用在儿童过敏性哮喘控制失败中的预测作用
