误吸在哮喘患者气道中的潜在作用
2017/07/24
背景：尽管接受了当前治疗，许多哮喘患者仍然控制不佳。导致哮喘恶化的原因可能包括一些合并症，比如胃食管反流（gastro-esophageal reflux，GER）。 我们旨在探索哮喘患者是否有误吸的发生以及它是否与哮喘的控制相关。
方法：患者接受ACQ-7，FeNO和肺功能检查来对哮喘的控制水平进行评估。进行钡餐检查并表现出激惹的征象来评估是否有误吸的倾向。患者接受了支气管镜检查，测量支气管肺泡灌洗液（BAL）胃蛋白酶的水平作为发生误吸的一个标志。
结果：78例哮喘患者根据病情的严重程度分为轻（35.8%）、中（21.7%）、重（42.3%）三组进行研究。在46/78（58.9%）例患者的BAL中检测到胃蛋白酶。不同病情严重程度患者的胃蛋白酶水平无统计学差异。并且胃蛋白酶的水平与哮喘控制、FEV1、ACQ或者急性发作频率之间没有显著的相关性。同样，与吸烟史、BMI、质子泵抑制剂（PPI）的使用、嗜酸粒细胞计数或IgE之间也没有显著的相关性。当根据BAL中的细胞计数分为嗜酸粒细胞哮喘或中性粒细胞哮喘时，两组间的胃蛋白酶浓度也没有差异。钡餐检查结果阳性（33/60例患者）与BAL中的胃蛋白酶水平没有相关性，并且用多变量分析发现钡餐检查的结果与ACQ、GINA、急性发作频率或FEV1之间也没有显著相关性。
结论：我们的研究表明，误吸对当前哮喘控制与急性发作频率的重要性可能被过度陈述。 但是，我们的研究确实没有解决误吸在未来急性发作风险中的作用。
The potential role of aspiration in the asthmatic airway
Eoin B. Hunt, MD, Chris Ward, PhD, Stephen Power, MD, Ashley Sullivan, Bsc,
Jeffrey 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 FCCP
CHEST (2017), doi: 10.1016/j.chest.2017.03.005
Background: Many asthmatics remain sub-optimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastro-esophageal reflux (GER). We aimed to investigate whether aspiration occurs in asthmatic patients and if so does it correlate with asthma control.
Methods: Patients had ACQ-7, FeNO, 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 bronchoalveolar lavage (BAL) pepsin measured as a marker of aspiration.
Results: Seventy-eight patients stratified by disease severity (GINA) 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 orexacerbation frequency. Similarly no associations were found with adjustments forsmoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations based on BAL therewas 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 nosignificant association between barium swallow result and ACQ, GINA, exacerbation frequency or FEV1 using either univariate or multivariate analyses.
Conclusion: Our study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be over-stated. However, our study did not address the role of aspiration and future risk of exacerbation.
方法：患者接受ACQ-7，FeNO和肺功能检查来对哮喘的控制水平进行评估。进行钡餐检查并表现出激惹的征象来评估是否有误吸的倾向。患者接受了支气管镜检查，测量支气管肺泡灌洗液（BAL）胃蛋白酶的水平作为发生误吸的一个标志。
结果：78例哮喘患者根据病情的严重程度分为轻（35.8%）、中（21.7%）、重（42.3%）三组进行研究。在46/78（58.9%）例患者的BAL中检测到胃蛋白酶。不同病情严重程度患者的胃蛋白酶水平无统计学差异。并且胃蛋白酶的水平与哮喘控制、FEV1、ACQ或者急性发作频率之间没有显著的相关性。同样，与吸烟史、BMI、质子泵抑制剂（PPI）的使用、嗜酸粒细胞计数或IgE之间也没有显著的相关性。当根据BAL中的细胞计数分为嗜酸粒细胞哮喘或中性粒细胞哮喘时，两组间的胃蛋白酶浓度也没有差异。钡餐检查结果阳性（33/60例患者）与BAL中的胃蛋白酶水平没有相关性，并且用多变量分析发现钡餐检查的结果与ACQ、GINA、急性发作频率或FEV1之间也没有显著相关性。
结论：我们的研究表明，误吸对当前哮喘控制与急性发作频率的重要性可能被过度陈述。 但是，我们的研究确实没有解决误吸在未来急性发作风险中的作用。
(任慧玲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)
（CHEST (2017), doi: 10.1016/j.chest.2017.03.005）
（CHEST (2017), doi: 10.1016/j.chest.2017.03.005）
The potential role of aspiration in the asthmatic airway
Eoin B. Hunt, MD, Chris Ward, PhD, Stephen Power, MD, Ashley Sullivan, Bsc,
Jeffrey 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 FCCP
CHEST (2017), doi: 10.1016/j.chest.2017.03.005
Background: Many asthmatics remain sub-optimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastro-esophageal reflux (GER). We aimed to investigate whether aspiration occurs in asthmatic patients and if so does it correlate with asthma control.
Methods: Patients had ACQ-7, FeNO, 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 bronchoalveolar lavage (BAL) pepsin measured as a marker of aspiration.
Results: Seventy-eight patients stratified by disease severity (GINA) 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 orexacerbation frequency. Similarly no associations were found with adjustments forsmoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations based on BAL therewas 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 nosignificant association between barium swallow result and ACQ, GINA, exacerbation frequency or FEV1 using either univariate or multivariate analyses.
Conclusion: Our study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be over-stated. However, our study did not address the role of aspiration and future risk of exacerbation.
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