年轻哮喘患者中血清IgE抗体的缺乏提示非2型超敏反应性疾病
2018/05/30
摘要
背景：特应性哮喘与2型超敏反应生物标志物升高有关，如呼出气一氧化氮（FeNO）和血液嗜酸性粒细胞（B-Eos）计数。 然而，也有报道称在传统定义的非特应性哮喘中也存在上述标志物升高。
目的：确定对排除2型哮喘的有临床意义的IgE水平。
方法：对参与研究的哮喘患者（总受试人数 N= 408;年龄10-35岁）进行多种变应原过筛实验和fx5检测法（ImmunoCAP）。 根据IgE抗体浓度将受试者分组：至少一次测试（n = 326）≥0.35kUA / L或两次测试（n = 82）<0.35 kUA / L。 将第二组进一步分成两组：IgE 0.10-0.34kUA / L（n = 34）和IgE <0.10kUA / L（n = 48）。 进一步确定2型生物标志物与哮喘控制不佳（ACT <20）、肺功能减低（FEV1 <80％），近期哮喘发作和气道对乙酰甲胆碱的高反应性（AHR）之间的关系。
结果：在单变量分析中，IgE≥0.35 kUA / L的受试者中至少有一种2型标记物与哮喘预后相关。 在IgE为0.10-0.34 kUA / L的患者中，FeNO升高与肺功能降低（P = 0.008）相关，B-Eos与AHR（P = 0.03）相关。 在IgE <0.10kUA / L的受试者中未发现关联。 多变量分析提示在IgE <0.35kUA / L（p = 0.03）的受试者中，FeNO与肺功能降低有关。
结论：IgE抗体<0.35 kUA / L的年轻哮喘患者中存在与临床预后相关的2型生物标志物升高，但IgE <0.10 kUA / L者中不存在这种现象。 通过致敏IgE抗体测量来定义非2型哮喘具有可行性。
Absence of serum IgE antibodies indicates non-type 2 disease in young asthmatics
Tsolakis N, Malinovschi A, Nordvall L, Janson C, Borres MP, Alving K.
Abstract
BACKGROUND:Atopic asthma is associated with elevated type-2 biomarkers such as fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count. However, increased type-2 markers have also been reported in traditionally-defined non-atopic asthma.
OBJECTIVE:To determine a clinically useful level of IgE sensitisation for ruling out type-2 asthma.
METHODS:Asthmatics (N = 408; age 10-35 years) were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP). Subjects were grouped based on IgE-antibody concentrations: ≥ 0.35 kUA /L for at least one test (n=326) or < 0.35 kUA /L for both tests (n=82). Τhe latter group was subsequently divided into two groups: IgE 0.10-0.34 kUA /L (n=34) and IgE < 0.10 kUA /L (n=48). The relationships between type-2 biomarkers, and inadequate asthma control (ACT < 20), reduced lung function (FEV1 < 80%), recent asthma attacks, and airway hyperresponsiveness (AHR) to methacholine were determined.
RESULTS:In univariate analyses, at least one type-2 marker related to each asthma outcome in subjects with IgE ≥ 0.35 kUA /L. In subjects with IgE 0.10-0.34 kUA /L, elevated FeNO related to reduced lung function (p=0.008) and B-Eos to AHR (p = 0.03). No associations were found in subjects with IgE < 0.10 kUA /L. In multivariate analysis, a relationship between FeNO and reduced lung function remained in subjects with IgE < 0.35 kUA /L (p = 0.03).
CONCLUSIONS:Clinically relevant elevation of type-2 biomarkers was seen in young asthmatics with IgE antibodies < 0.35 kUA /L, but not those with IgE < 0.10 kUA /L. It seems possible to define non-type 2 asthma through sensitive IgE-antibody measurement.
背景：特应性哮喘与2型超敏反应生物标志物升高有关，如呼出气一氧化氮（FeNO）和血液嗜酸性粒细胞（B-Eos）计数。 然而，也有报道称在传统定义的非特应性哮喘中也存在上述标志物升高。
目的：确定对排除2型哮喘的有临床意义的IgE水平。
方法：对参与研究的哮喘患者（总受试人数 N= 408;年龄10-35岁）进行多种变应原过筛实验和fx5检测法（ImmunoCAP）。 根据IgE抗体浓度将受试者分组：至少一次测试（n = 326）≥0.35kUA / L或两次测试（n = 82）<0.35 kUA / L。 将第二组进一步分成两组：IgE 0.10-0.34kUA / L（n = 34）和IgE <0.10kUA / L（n = 48）。 进一步确定2型生物标志物与哮喘控制不佳（ACT <20）、肺功能减低（FEV1 <80％），近期哮喘发作和气道对乙酰甲胆碱的高反应性（AHR）之间的关系。
结果：在单变量分析中，IgE≥0.35 kUA / L的受试者中至少有一种2型标记物与哮喘预后相关。 在IgE为0.10-0.34 kUA / L的患者中，FeNO升高与肺功能降低（P = 0.008）相关，B-Eos与AHR（P = 0.03）相关。 在IgE <0.10kUA / L的受试者中未发现关联。 多变量分析提示在IgE <0.35kUA / L（p = 0.03）的受试者中，FeNO与肺功能降低有关。
结论：IgE抗体<0.35 kUA / L的年轻哮喘患者中存在与临床预后相关的2型生物标志物升高，但IgE <0.10 kUA / L者中不存在这种现象。 通过致敏IgE抗体测量来定义非2型哮喘具有可行性。
(中日友好医院呼吸与危重症医学科 张科文 摘译 林江涛 审校)
(Clin Exp Allergy. 2018 Jan 29. doi: 10.1111/cea.13103)
(Clin Exp Allergy. 2018 Jan 29. doi: 10.1111/cea.13103)
Absence of serum IgE antibodies indicates non-type 2 disease in young asthmatics
Tsolakis N, Malinovschi A, Nordvall L, Janson C, Borres MP, Alving K.
Abstract
BACKGROUND:Atopic asthma is associated with elevated type-2 biomarkers such as fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count. However, increased type-2 markers have also been reported in traditionally-defined non-atopic asthma.
OBJECTIVE:To determine a clinically useful level of IgE sensitisation for ruling out type-2 asthma.
METHODS:Asthmatics (N = 408; age 10-35 years) were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP). Subjects were grouped based on IgE-antibody concentrations: ≥ 0.35 kUA /L for at least one test (n=326) or < 0.35 kUA /L for both tests (n=82). Τhe latter group was subsequently divided into two groups: IgE 0.10-0.34 kUA /L (n=34) and IgE < 0.10 kUA /L (n=48). The relationships between type-2 biomarkers, and inadequate asthma control (ACT < 20), reduced lung function (FEV1 < 80%), recent asthma attacks, and airway hyperresponsiveness (AHR) to methacholine were determined.
RESULTS:In univariate analyses, at least one type-2 marker related to each asthma outcome in subjects with IgE ≥ 0.35 kUA /L. In subjects with IgE 0.10-0.34 kUA /L, elevated FeNO related to reduced lung function (p=0.008) and B-Eos to AHR (p = 0.03). No associations were found in subjects with IgE < 0.10 kUA /L. In multivariate analysis, a relationship between FeNO and reduced lung function remained in subjects with IgE < 0.35 kUA /L (p = 0.03).
CONCLUSIONS:Clinically relevant elevation of type-2 biomarkers was seen in young asthmatics with IgE antibodies < 0.35 kUA /L, but not those with IgE < 0.10 kUA /L. It seems possible to define non-type 2 asthma through sensitive IgE-antibody measurement.
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种族对FeNO值有重大影响
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生物加重群表明不同介质和微生物组的哮喘和COPD的重叠
