成人起病哮喘肺功能加速下降的预测因素
2018/05/03
摘要
对于成人新发哮喘的预后目前我们所知甚少。横断面研究表明这些患者的1秒用力呼气容积（FEV1）可能会加速下降。然而，肺功能加速下降的危险因素尚未明确。我们旨在对200名新诊断的成人哮喘患者进行前瞻性5年随访研究，以明确这些危险因素。在本研究中，临床信息、功能检测、炎症指标每年评估一次，并进行了5年。线性混合效应模型被用来确定预测因素。 141例患者有可用于评估的肺功能资料。使用支气管扩张药物后的FEV1下降的中位数（四分位距） 是17.5（从-54.2到+22.4）mL/年。FEV1加速下降定义为下降超过四分位数的下限 （每年> 54.2 mL）。鼻息肉，血液和痰液嗜酸性粒细胞数量，体重指数和呼出气一氧化氮水平均与肺功能下降有关。但只有后两者是独立相关的。我们使用截断值识别FEV1加速下降的风险最高的患者为同时具备所有呼出气一氧化氮（FeNO）≥57ppb和体重指数（BMI）≤23kg·m-2的患者。结论：成人新发哮喘伴有高水平的呼出气一氧化氮和低BMI的患者有肺功能加速下降的风险。
Predictors of accelerated decline in lung function in adult-onset asthma.
Coumou H et al.
Abstract
Little is known about the prognosis of adults with new-onset asthma. Cross-sectional studies suggest that these patients may exhibit accelerated decline in forced expiratory volume in 1 s (FEV1). However, risk factors for accelerated decline in lung function have not yet been identified.We aimed to identify these risk factors in a prospective 5-year follow-up study in 200 adults with newly diagnosed asthma. In the current study, clinical, functional and inflammatory parameters were assessed annually for 5 years. Linear mixedeffects models were used to identify predictors.Evaluable lung function sets of 141 patients were available. Median (interquartile range) change in post-bronchodilator FEV1 was -17.5 (-54.2 to +22.4) mL
per year. Accelerated decline in FEV1 was defined by the lower quartile of decline (>54.2 mL per year). Nasal polyps, number of blood and sputum eosinophils, body mass index, and level of exhaled nitric oxide were univariably associated with decline in lung function. Only the latter two were independently associated. Using cut-off values to identify patients at highest risk showed accelerated decline in FEV1 in all patients with combined exhaled nitric oxide fraction (FeNO) ≥57 ppb and body mass index (BMI) ≤23 kg·m-2We conclude that adults with new-onset asthma with both high levels of exhaled nitric oxide and low BMI are at risk of accelerated decline in lung function.
对于成人新发哮喘的预后目前我们所知甚少。横断面研究表明这些患者的1秒用力呼气容积（FEV1）可能会加速下降。然而，肺功能加速下降的危险因素尚未明确。我们旨在对200名新诊断的成人哮喘患者进行前瞻性5年随访研究，以明确这些危险因素。在本研究中，临床信息、功能检测、炎症指标每年评估一次，并进行了5年。线性混合效应模型被用来确定预测因素。 141例患者有可用于评估的肺功能资料。使用支气管扩张药物后的FEV1下降的中位数（四分位距） 是17.5（从-54.2到+22.4）mL/年。FEV1加速下降定义为下降超过四分位数的下限 （每年> 54.2 mL）。鼻息肉，血液和痰液嗜酸性粒细胞数量，体重指数和呼出气一氧化氮水平均与肺功能下降有关。但只有后两者是独立相关的。我们使用截断值识别FEV1加速下降的风险最高的患者为同时具备所有呼出气一氧化氮（FeNO）≥57ppb和体重指数（BMI）≤23kg·m-2的患者。结论：成人新发哮喘伴有高水平的呼出气一氧化氮和低BMI的患者有肺功能加速下降的风险。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（Eur Respir J. 2018 Feb 14;51(2)）
（Eur Respir J. 2018 Feb 14;51(2)）
Predictors of accelerated decline in lung function in adult-onset asthma.
Coumou H et al.
Abstract
Little is known about the prognosis of adults with new-onset asthma. Cross-sectional studies suggest that these patients may exhibit accelerated decline in forced expiratory volume in 1 s (FEV1). However, risk factors for accelerated decline in lung function have not yet been identified.We aimed to identify these risk factors in a prospective 5-year follow-up study in 200 adults with newly diagnosed asthma. In the current study, clinical, functional and inflammatory parameters were assessed annually for 5 years. Linear mixedeffects models were used to identify predictors.Evaluable lung function sets of 141 patients were available. Median (interquartile range) change in post-bronchodilator FEV1 was -17.5 (-54.2 to +22.4) mL
per year. Accelerated decline in FEV1 was defined by the lower quartile of decline (>54.2 mL per year). Nasal polyps, number of blood and sputum eosinophils, body mass index, and level of exhaled nitric oxide were univariably associated with decline in lung function. Only the latter two were independently associated. Using cut-off values to identify patients at highest risk showed accelerated decline in FEV1 in all patients with combined exhaled nitric oxide fraction (FeNO) ≥57 ppb and body mass index (BMI) ≤23 kg·m-2We conclude that adults with new-onset asthma with both high levels of exhaled nitric oxide and low BMI are at risk of accelerated decline in lung function.
