寡细胞型稳定期哮喘患者的临床、功能及气道炎症特点：不同痰表型的比较
2017/12/20
摘要
背景：根据诱导痰细胞计数，四种不同的哮喘表型已被确认（嗜酸性、中性、混合、寡细胞性）。本研究的目的是检测寡粒细胞哮喘患者气道炎症及功能特征。
方法：将240例哮喘患者按诱导痰细胞计数分为四种表型。所有患者均行肺功能检查，和呼出气一氧化氮（FENO）检查。在痰上清液中测定IL-8、IL-13和嗜酸细胞阳离子蛋白（ECP）。治疗，哮喘控制和严重的难治性哮喘的存在（SRA）情况也被记录。
结果：患者分为四种表型：嗜酸性粒细胞型（40%），混合型（6.7%），嗜中性粒细胞型（5.4%）、寡细胞型（47.9%）。虽然哮喘控制水平各组之间无显著性差异（P = 0.288），但寡粒细胞哮喘患者有较好的肺功能（FEV1占预计值%）[中位数（IQR）：71.5（59.0-88.75）vs 69（59.0-77.6）vs 68（60.0-85.5）vs 80.5（69.7-95.0），P =0. 009 ]分别对应嗜酸性、混合性、中性粒细胞性和寡细胞性，分别为P = 009）。SRA更多地发生在嗜酸性粒细胞型和混合型（分别为41.6%和43.7%）和较少发生于中性粒细胞型和寡细胞型（分别为25%和21.7%，P =0. 01）。FeNO，ECP、IL-8在寡细胞型哮喘的含量较低，而嗜酸粒细胞和混合型哮喘的FeNO和ECP含量较高，而IL-8在中性粒细胞型和混合型的哮喘患者中较高（与所有表型比，P<0.001）。有趣的是，寡细胞型哮喘有14.8%比例存在哮喘控制不佳。
结论：寡粒细胞哮喘最有可能代表的是一种“良性”哮喘表型，是对治疗反应良好的表现，而不是一个“真正的”表型哮喘。然而，对于尽管被给予了最佳的治疗，仍不能得到很好控制的这部分寡细胞型哮喘患者，仍需要进一步研究潜在的新的有针对性的干预措施。
Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes
P. Ntontsi | S. Loukides | P. Bakakos | K. Kostikas | G. Papatheodorou |E. Papathanassiou1 | G. Hillas | N. Koulouris | S. Papiris | A. I. Papaioannou
Abstract
Background: According to induced sputum cell count, four different asthma phenotypes have been recognized (eosinophilic, neutrophilic, mixed and paucigranulocytic).The aim of this study was to detect functional and inflammatory characteristics of patients with paucigranulocytic asthma.
Methods: A total of 240 asthmatic patients were categorized into the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of fraction of exhaled nitric oxide (FeNO). The levels of IL-8, IL-13 and eosinophilic cationic protein (ECP) were also measured in sputum supernatant. Treatment, asthma control and the presence of severe refractory asthma (SRA) were also recorded.
Results: Patients were categorized into the four phenotypes as follows: eosinophilic (40%), mixed (6.7%), neutrophilic (5.4%) and paucigranulocytic (47.9%). Although asthma control test did not differ between groups (P=.288), patients with paucigranulocytic asthma had better lung function (FEV1 % pred) [median (IQR): 71.5 (59.0-88.75) vs 69.0 (59.0-77.6) vs 68.0 (60.0-85.5) vs 80.5 (69.7-95.0), P=.009] for eosinophilic, mixed, neutrophilic and paucigranulocytic asthma, respectively, P=.009). SRA occurred more frequently in the eosinophilic and mixed phenotype (41.6% and 43.7%, respectively) and less frequently in the neutrophilic and paucigranulocytic phenotype (25% and 21.7%, respectively, P=.01). FeNO, ECP and IL-8 were all low in the paucigranulocytic, whereas as expected FeNO and ECP were higher in eosinophilic and mixed asthma, while IL-8 was higher in patients with neutrophilic and mixed asthma (P<.001 for all comparisons). Interestingly, 14.8% of patients with paucigranulocytic asthma had poor asthma control.
Conclusion: Paucigranulocytic asthma most likely represents a “benign” asthma phenotype, related to a good response to treatment, rather than a “true” phenotype of asthma. However, paucigranulocytic patients that remain not well controlled despite optimal treatment represent an asthmatic population that requires further study for potential novel targeted interventions.
背景：根据诱导痰细胞计数，四种不同的哮喘表型已被确认（嗜酸性、中性、混合、寡细胞性）。本研究的目的是检测寡粒细胞哮喘患者气道炎症及功能特征。
方法：将240例哮喘患者按诱导痰细胞计数分为四种表型。所有患者均行肺功能检查，和呼出气一氧化氮（FENO）检查。在痰上清液中测定IL-8、IL-13和嗜酸细胞阳离子蛋白（ECP）。治疗，哮喘控制和严重的难治性哮喘的存在（SRA）情况也被记录。
结果：患者分为四种表型：嗜酸性粒细胞型（40%），混合型（6.7%），嗜中性粒细胞型（5.4%）、寡细胞型（47.9%）。虽然哮喘控制水平各组之间无显著性差异（P = 0.288），但寡粒细胞哮喘患者有较好的肺功能（FEV1占预计值%）[中位数（IQR）：71.5（59.0-88.75）vs 69（59.0-77.6）vs 68（60.0-85.5）vs 80.5（69.7-95.0），P =0. 009 ]分别对应嗜酸性、混合性、中性粒细胞性和寡细胞性，分别为P = 009）。SRA更多地发生在嗜酸性粒细胞型和混合型（分别为41.6%和43.7%）和较少发生于中性粒细胞型和寡细胞型（分别为25%和21.7%，P =0. 01）。FeNO，ECP、IL-8在寡细胞型哮喘的含量较低，而嗜酸粒细胞和混合型哮喘的FeNO和ECP含量较高，而IL-8在中性粒细胞型和混合型的哮喘患者中较高（与所有表型比，P<0.001）。有趣的是，寡细胞型哮喘有14.8%比例存在哮喘控制不佳。
结论：寡粒细胞哮喘最有可能代表的是一种“良性”哮喘表型，是对治疗反应良好的表现，而不是一个“真正的”表型哮喘。然而，对于尽管被给予了最佳的治疗，仍不能得到很好控制的这部分寡细胞型哮喘患者，仍需要进一步研究潜在的新的有针对性的干预措施。
（中日友好医院呼吸与危重症医学科 李红雯 摘译林江涛 审校）
（Allergy. 2017;00:1–7.https://doi.org/10.1111/all.13184）
（Allergy. 2017;00:1–7.https://doi.org/10.1111/all.13184）
Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes
P. Ntontsi | S. Loukides | P. Bakakos | K. Kostikas | G. Papatheodorou |E. Papathanassiou1 | G. Hillas | N. Koulouris | S. Papiris | A. I. Papaioannou
Abstract
Background: According to induced sputum cell count, four different asthma phenotypes have been recognized (eosinophilic, neutrophilic, mixed and paucigranulocytic).The aim of this study was to detect functional and inflammatory characteristics of patients with paucigranulocytic asthma.
Methods: A total of 240 asthmatic patients were categorized into the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of fraction of exhaled nitric oxide (FeNO). The levels of IL-8, IL-13 and eosinophilic cationic protein (ECP) were also measured in sputum supernatant. Treatment, asthma control and the presence of severe refractory asthma (SRA) were also recorded.
Results: Patients were categorized into the four phenotypes as follows: eosinophilic (40%), mixed (6.7%), neutrophilic (5.4%) and paucigranulocytic (47.9%). Although asthma control test did not differ between groups (P=.288), patients with paucigranulocytic asthma had better lung function (FEV1 % pred) [median (IQR): 71.5 (59.0-88.75) vs 69.0 (59.0-77.6) vs 68.0 (60.0-85.5) vs 80.5 (69.7-95.0), P=.009] for eosinophilic, mixed, neutrophilic and paucigranulocytic asthma, respectively, P=.009). SRA occurred more frequently in the eosinophilic and mixed phenotype (41.6% and 43.7%, respectively) and less frequently in the neutrophilic and paucigranulocytic phenotype (25% and 21.7%, respectively, P=.01). FeNO, ECP and IL-8 were all low in the paucigranulocytic, whereas as expected FeNO and ECP were higher in eosinophilic and mixed asthma, while IL-8 was higher in patients with neutrophilic and mixed asthma (P<.001 for all comparisons). Interestingly, 14.8% of patients with paucigranulocytic asthma had poor asthma control.
Conclusion: Paucigranulocytic asthma most likely represents a “benign” asthma phenotype, related to a good response to treatment, rather than a “true” phenotype of asthma. However, paucigranulocytic patients that remain not well controlled despite optimal treatment represent an asthmatic population that requires further study for potential novel targeted interventions.
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妊娠期哮喘对不同性别婴儿肠道菌群影响差异
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对医生曾经诊断的成人哮喘患者重新评估其诊断
