成人发病哮喘患者中肺功能恶化的预测因子
2018/05/08
摘要
目前研究对于新发哮喘成人的预后知之甚少。横断面研究表明，这些患者的FEV1可能会出现加速恶化。然而，肺功能加速下降的危险因素尚未可知。我们的目的是在一项200例成人新发哮喘参加的前瞻性5年随访研究中确定这些风险因素。在目前的研究中，临床，功能和炎症参数每年评估1次，持续5年，使用线性混合效应模型来识别预测因子，141名患者的肺功能数据可用。使用支气管扩张剂后FEV1的中位数（四分位间距）变化为-17.5（-54.2至+22.4）mL /年。FEV1加速下降定义为低于四分位数（54.2 mL/年）。鼻息肉，血和痰中嗜酸性粒细胞数量，体重指数和呼出气一氧化氮水平均与肺功能下降有关，且只有后两者是独立相关的。所有呼出一氧化氮分数（FeNO）≥57ppb和体重指数（BMI）≤23kg·m2的患者，FEV1都出现了加速恶化。结论：伴有高水平的呼出一氧化氮和低BMI的哮喘患者有肺功能恶化的风险。
Predictors of accelerated decline in lung function in adult-onset asthma.
Coumou H, Westerhof GA, de Nijs SB, Zwinderman AH, Bel EH.
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 mixed-effects 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.
目前研究对于新发哮喘成人的预后知之甚少。横断面研究表明，这些患者的FEV1可能会出现加速恶化。然而，肺功能加速下降的危险因素尚未可知。我们的目的是在一项200例成人新发哮喘参加的前瞻性5年随访研究中确定这些风险因素。在目前的研究中，临床，功能和炎症参数每年评估1次，持续5年，使用线性混合效应模型来识别预测因子，141名患者的肺功能数据可用。使用支气管扩张剂后FEV1的中位数（四分位间距）变化为-17.5（-54.2至+22.4）mL /年。FEV1加速下降定义为低于四分位数（54.2 mL/年）。鼻息肉，血和痰中嗜酸性粒细胞数量，体重指数和呼出气一氧化氮水平均与肺功能下降有关，且只有后两者是独立相关的。所有呼出一氧化氮分数（FeNO）≥57ppb和体重指数（BMI）≤23kg·m2的患者，FEV1都出现了加速恶化。结论：伴有高水平的呼出一氧化氮和低BMI的哮喘患者有肺功能恶化的风险。
(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)
(Eur Respir J. 2018 Feb 14;51(2). pii: 1701785.)
(Eur Respir J. 2018 Feb 14;51(2). pii: 1701785.)
Predictors of accelerated decline in lung function in adult-onset asthma.
Coumou H, Westerhof GA, de Nijs SB, Zwinderman AH, Bel EH.
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 mixed-effects 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.
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在症状未控制的持续哮喘患者中吸入性糖皮质激素联合长效毒蕈碱受体拮抗剂与哮喘控制的关系：一项系统性回顾 Meta 分析
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