中年人群中支气管高反应性与肥胖的关系：一项澳大利亚队列研究的结果
2017/12/29
摘要
背景：肥胖与支气管高反应性(BHR)的关系仍未完全阐明。塔斯马尼亚纵向健康研究是从2006年起开始随访的，在该项研究中，我们调查了肥胖与BHR的关系，并研究这种关系是否是由小气道闭塞所介导或由哮喘和病人性别所影响。
方法：采用乙酰甲胆碱激发试验测量BHR。在调整性别、哮喘、吸烟史、糖皮质激素使用情况、家族史和肺功能等因素的情况下，采用多因素回归模型研究体重指数（BMI）与BHR的关系，并判断气道闭塞的介导作用。
结果：BMI每增加1 kg·m−2，就增加5%的BHR几率(OR 1.05, 95% CI 1.01–1.09), 而这种联系有43%都是由气道闭塞所介导的。在多因素模型中, BMI (OR 1.06, 95% CI 1.00–1.16)是除女性性别(OR 3.26, 95% CI1.95–5.45)，过敏 (OR 2.30, 95% CI 1.34–3.94)，现时哮喘 (OR 5.74, 95% CI 2.79–11.82)，哮喘缓解 (OR 2.35, 95% CI 1.27–4.35)，低社会经济地位(OR 2.11, 95% CI 1.03–4.31)和 FEV1/FVC (OR 0.86, 95% CI 0.82–0.91)等的BHR独立影响因素。只有在非哮喘患者或哮喘缓解的患者中，哮喘才会影响随BMI增加，BHR几率加大的这种联系。
结论：BMI与BHR有关，而气道闭塞的介导作用在这种关系中占了很重要的一部分。既往存在矛盾的研究可能是由于没有考虑到气道闭塞的这一中间介导作用。
Bronchial hyperresponsiveness and obesity in middle age: insights from an Australian cohort
Burgess JA, Matheson MC, Diao F, et al.
Abstract
BACKGROUND:The association between obesity and bronchial hyperresponsiveness (BHR) is incompletely characterised. Using the 2006 follow-up of the Tasmanian Longitudinal Health Study, we measured the association between obesity and BHR and whether it was mediated by small airway closure or modified by asthma and sex of the patient.
Methods:A methacholine challenge measured BHR. Multivariable logistic regression measured associations between body mass index (BMI) and BHR, adjusting for sex, asthma, smoking, corticosteroid use, family history and lung function. Mediation by airway closure was also measured.
Results:Each increase in BMI of 1 kg·m−2 was associated with a 5% increase in the odds of BHR (OR 1.05, 95% CI 1.01–1.09) and 43% of this association was mediated by airway closure. In a multivariable model, BMI (OR 1.06, 95% CI 1.00–1.16) was associated with BHR independent of female sex (OR 3.26, 95% CI 1.95–5.45), atopy (OR 2.30, 95% CI 1.34–3.94), current asthma (OR 5.74, 95% CI 2.79–11.82), remitted asthma (OR 2.35, 95% CI 1.27–4.35), low socioeconomic status (OR 2.11, 95% CI 1.03–4.31) and forced expiratory volume in 1 s/forced vital capacity (OR 0.86, 95% CI 0.82–0.91). Asthma modified the association with an increasing probability of BHR as BMI increased, only in those with no or remitted asthma.
Conclusions：An important fraction of the BMI/BHR association was mediated via airway closure. Conflicting findings in previous studies could be explained by failure to consider this intermediate step.
背景：肥胖与支气管高反应性(BHR)的关系仍未完全阐明。塔斯马尼亚纵向健康研究是从2006年起开始随访的，在该项研究中，我们调查了肥胖与BHR的关系，并研究这种关系是否是由小气道闭塞所介导或由哮喘和病人性别所影响。
方法：采用乙酰甲胆碱激发试验测量BHR。在调整性别、哮喘、吸烟史、糖皮质激素使用情况、家族史和肺功能等因素的情况下，采用多因素回归模型研究体重指数（BMI）与BHR的关系，并判断气道闭塞的介导作用。
结果：BMI每增加1 kg·m−2，就增加5%的BHR几率(OR 1.05, 95% CI 1.01–1.09), 而这种联系有43%都是由气道闭塞所介导的。在多因素模型中, BMI (OR 1.06, 95% CI 1.00–1.16)是除女性性别(OR 3.26, 95% CI1.95–5.45)，过敏 (OR 2.30, 95% CI 1.34–3.94)，现时哮喘 (OR 5.74, 95% CI 2.79–11.82)，哮喘缓解 (OR 2.35, 95% CI 1.27–4.35)，低社会经济地位(OR 2.11, 95% CI 1.03–4.31)和 FEV1/FVC (OR 0.86, 95% CI 0.82–0.91)等的BHR独立影响因素。只有在非哮喘患者或哮喘缓解的患者中，哮喘才会影响随BMI增加，BHR几率加大的这种联系。
结论：BMI与BHR有关，而气道闭塞的介导作用在这种关系中占了很重要的一部分。既往存在矛盾的研究可能是由于没有考虑到气道闭塞的这一中间介导作用。
(复旦大学附属中山医院 呼吸科 胡湘麟 摘译 杨冬 审校)
(European Respiratory Journal 2017,50(3))
(European Respiratory Journal 2017,50(3))
Bronchial hyperresponsiveness and obesity in middle age: insights from an Australian cohort
Burgess JA, Matheson MC, Diao F, et al.
Abstract
BACKGROUND:The association between obesity and bronchial hyperresponsiveness (BHR) is incompletely characterised. Using the 2006 follow-up of the Tasmanian Longitudinal Health Study, we measured the association between obesity and BHR and whether it was mediated by small airway closure or modified by asthma and sex of the patient.
Methods:A methacholine challenge measured BHR. Multivariable logistic regression measured associations between body mass index (BMI) and BHR, adjusting for sex, asthma, smoking, corticosteroid use, family history and lung function. Mediation by airway closure was also measured.
Results:Each increase in BMI of 1 kg·m−2 was associated with a 5% increase in the odds of BHR (OR 1.05, 95% CI 1.01–1.09) and 43% of this association was mediated by airway closure. In a multivariable model, BMI (OR 1.06, 95% CI 1.00–1.16) was associated with BHR independent of female sex (OR 3.26, 95% CI 1.95–5.45), atopy (OR 2.30, 95% CI 1.34–3.94), current asthma (OR 5.74, 95% CI 2.79–11.82), remitted asthma (OR 2.35, 95% CI 1.27–4.35), low socioeconomic status (OR 2.11, 95% CI 1.03–4.31) and forced expiratory volume in 1 s/forced vital capacity (OR 0.86, 95% CI 0.82–0.91). Asthma modified the association with an increasing probability of BHR as BMI increased, only in those with no or remitted asthma.
Conclusions：An important fraction of the BMI/BHR association was mediated via airway closure. Conflicting findings in previous studies could be explained by failure to consider this intermediate step.
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法国COBRA研究：成年哮喘患者的临床生物学特征
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在中年人中，五年以上的交通相关空气污染暴露可增加哮喘风险并损害肺功能
