从医院治疗哮喘急性加重恢复期间获得的参数定义的哮喘表型
2018/03/05
摘要
背景：哮喘是一种异质性疾病，具有不同的临床表现和炎症病理加重症状。本文旨在描述急性加重住院治疗的哮喘患者的临床和炎症特征。
方法：获得320名接受哮喘急性加重治疗的成年患者的数据。其中218份具有完整的数据，我们使用沃德层次聚类法获得聚类。在住院期间测量肺功能，血细胞计数，痰细胞计数，血清IgE水平和呼气一氧化氮。我们选择了13个变量，使用沃德最小方差层次聚类。
结果:共分为四组。 第1组（24.5％）和第3组（36.7％）以女性为主的痰中性粒细胞型哮喘患者，其中第1组伴有气流阻塞程度小和哮喘早期发作，而第3组FEV1中度降低。第2组（22.0％）和第4组（16.5％）以痰嗜酸性粒细胞和重度气流阻塞为主，其中第4组仅由男性吸烟受试者组成，第2组主要为FEV1，FEF25 -75（预测值%）和动脉血氧分压（PaO2）最差的女性非吸烟受试者。各组之间在异质性，血清IgE，鼻腔疾病患病率，维持吸入皮质类固醇，口服/全身性皮质类固醇激素使用和哮喘急性加重方面无明显差异。
结论：哮喘急性加重恢复过程中各组在气流阻塞和嗜中性，嗜酸性或混合性炎症方面不同。吸烟和非吸烟哮喘患者在急性加重期间表现为嗜酸性粒细胞炎症。
Asthma phenotypes defined from parameters obtained during recovery from a hospital-treated exacerbation.
Qiu R1, Xie J2, Chung KF3, Li N2, Yang Z2, He M2, Li J2, Chen R2, Zhong N2, Zhang Q4.
Abstract
BACKGROUND:Asthma is a heterogeneous disease with diverse clinical manifestations and inflammatory pathologies that is punctuated by exacerbations. To describe the clinical and inflammatory characteristics of asthma patients treated in hospital for an acute exacerbation.
METHODS:Data from 320 adult patients receiving treatment for an acute exacerbation of asthma were obtained. In 218 with complete data , we used Ward's hierarchical clustering to obtain clusters. Pulmonary function, blood counts, sputum cell counts, serum IgE levels, and fractional exhaled nitric oxide were measured during the hospital admission. We selected 13 variables with which we performed Ward's minimum variance hierarchical clustering.
RESULTS:Four clusters were defined. Clusters 1(24.5%) and 3(36.7%) were characterized by predominantly-female asthmatics with sputum neutrophilia, with Cluster 1 associated with small degree of airflow obstruction and early onset of asthma while Cluster 3 had a moderate degree of reduction in FEV1. Clusters 2(22.0%) and 4(16.5%) were associated with high sputum eosinophilia and severe airflow obstruction, but Cluster 4 was made up exclusively of male smoking subjects while Cluster 2 of predominantly female non-smoking subjects with the worst FEV1, FEF25-75 (% predicted) and arterial partial pressure of oxygen (PaO2) on admission. There were no differences between clusters in terms of atopy, serum IgE, prevalence of nasal disease, maintenance inhaled corticosteroids, or oral/systemic corticosteroid use and asthma exacerbations.
CONCLUSIONS:The clusters during recovery from an exacerbation of asthma were distinguished by airflow obstruction and a neutrophilic, eosinophilic or mixed inflammation. Eosinophilic inflammation was found in smoking and non-smoking asthmatics during an exacerbation.
背景：哮喘是一种异质性疾病，具有不同的临床表现和炎症病理加重症状。本文旨在描述急性加重住院治疗的哮喘患者的临床和炎症特征。
方法：获得320名接受哮喘急性加重治疗的成年患者的数据。其中218份具有完整的数据，我们使用沃德层次聚类法获得聚类。在住院期间测量肺功能，血细胞计数，痰细胞计数，血清IgE水平和呼气一氧化氮。我们选择了13个变量，使用沃德最小方差层次聚类。
结果:共分为四组。 第1组（24.5％）和第3组（36.7％）以女性为主的痰中性粒细胞型哮喘患者，其中第1组伴有气流阻塞程度小和哮喘早期发作，而第3组FEV1中度降低。第2组（22.0％）和第4组（16.5％）以痰嗜酸性粒细胞和重度气流阻塞为主，其中第4组仅由男性吸烟受试者组成，第2组主要为FEV1，FEF25 -75（预测值%）和动脉血氧分压（PaO2）最差的女性非吸烟受试者。各组之间在异质性，血清IgE，鼻腔疾病患病率，维持吸入皮质类固醇，口服/全身性皮质类固醇激素使用和哮喘急性加重方面无明显差异。
结论：哮喘急性加重恢复过程中各组在气流阻塞和嗜中性，嗜酸性或混合性炎症方面不同。吸烟和非吸烟哮喘患者在急性加重期间表现为嗜酸性粒细胞炎症。
(中日友好医院呼吸与危重症医学科 王圆方 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2018 Feb 22. pii: S2213-2198(18)30104-1.)
(J Allergy Clin Immunol Pract. 2018 Feb 22. pii: S2213-2198(18)30104-1.)
Asthma phenotypes defined from parameters obtained during recovery from a hospital-treated exacerbation.
Qiu R1, Xie J2, Chung KF3, Li N2, Yang Z2, He M2, Li J2, Chen R2, Zhong N2, Zhang Q4.
Abstract
BACKGROUND:Asthma is a heterogeneous disease with diverse clinical manifestations and inflammatory pathologies that is punctuated by exacerbations. To describe the clinical and inflammatory characteristics of asthma patients treated in hospital for an acute exacerbation.
METHODS:Data from 320 adult patients receiving treatment for an acute exacerbation of asthma were obtained. In 218 with complete data , we used Ward's hierarchical clustering to obtain clusters. Pulmonary function, blood counts, sputum cell counts, serum IgE levels, and fractional exhaled nitric oxide were measured during the hospital admission. We selected 13 variables with which we performed Ward's minimum variance hierarchical clustering.
RESULTS:Four clusters were defined. Clusters 1(24.5%) and 3(36.7%) were characterized by predominantly-female asthmatics with sputum neutrophilia, with Cluster 1 associated with small degree of airflow obstruction and early onset of asthma while Cluster 3 had a moderate degree of reduction in FEV1. Clusters 2(22.0%) and 4(16.5%) were associated with high sputum eosinophilia and severe airflow obstruction, but Cluster 4 was made up exclusively of male smoking subjects while Cluster 2 of predominantly female non-smoking subjects with the worst FEV1, FEF25-75 (% predicted) and arterial partial pressure of oxygen (PaO2) on admission. There were no differences between clusters in terms of atopy, serum IgE, prevalence of nasal disease, maintenance inhaled corticosteroids, or oral/systemic corticosteroid use and asthma exacerbations.
CONCLUSIONS:The clusters during recovery from an exacerbation of asthma were distinguished by airflow obstruction and a neutrophilic, eosinophilic or mixed inflammation. Eosinophilic inflammation was found in smoking and non-smoking asthmatics during an exacerbation.
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吸气和呼气 CT 之间的流明区域变化作为衡量哮喘严重后果的指标
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