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伴或不伴哮喘的成人中血嗜酸性粒细胞计数和肺功能下降的相关性

2018/06/04

   摘要
   嗜酸性粒细胞炎症和气道重塑是哮喘的特征,但两者之间的关系尚不清楚。我们在基于人群的青年队列中评估其血嗜酸性粒细胞计数(EOS)与肺功能下降之间的关系。我们采用混合线性模型在校正性别、吸烟、哮喘情况、肺功能(以18岁人群肺功能为基值)等因素后分析了21、26、32和38岁青年人中血EOS计数与肺活量测定之间的关系。我们进一步分析了平均EOS与21至38岁肺功能变化值之间的相关性。吸入支气管舒张剂前或后,高EOS与低FEV1/FVC比值及低FEV1预测值百分比值相关,(p≤0.048)。虽然哮喘患者中EOS水平较高,但EOS与肺活量之间的相关性与无哮喘或喘息者中的相似。年龄在21-38岁之间的患者中,平均EOS> 0.4×109 / L者FEV1/FVC比值(变化值=1.8%,95%CI [0.7-2.9]; p = 0.001)和FEV1值(变化值=3.4%预测值,95 %CI[1.5-5.4])较EOS低者下降更明显。血EOS与气道阻塞和肺功能下降相关,独立于哮喘和吸烟。EOS增多是气道阻塞的危险因素,即使是在无症状的人群中。

 
(中国医科大学附属第一医院呼吸与危重症医学科 李文扬 摘译 杨冬 审校)
(Hancox RJ, et al. Eur Respir J. 2018 Mar 21.)

 
 
 
Associations between blood eosinophils and decline in lung function among adults with and without asthma.
 
Hancox RJ, et al. Eur Respir J. 2018 Mar 21.
 
Abstract
Eosinophilic inflammation and airway remodelling are characteristic features of asthma, but the association between them is unclear. We assessed associations between blood eosinophils and lung function decline in a population-based cohort of young adults.We used linear mixed models to analyse associations between blood eosinophils and spirometry at 21, 26, 32, and 38 years adjusting for sex, smoking, asthma, and spirometry at age 18. We further analysed associations between mean eosinophil counts and changes in spirometry from ages 21 to 38 years.Higher eosinophils were associated with lower FEV1/FVC ratios and lower percent-predicted FEV1 values for both pre- and post-bronchodilator spirometry (all p values≤0.048). Although eosinophil counts were higher in participants with asthma, the associations between eosinophils and spirometry were similar among participants without asthma or wheeze. Participants with mean eosinophil counts >0.4×109/L between ages 21 and 38 had greater declines in FEV1/FVC ratios (difference 1.8%; 95% CI 0.7, 2.9; p=0.001) and FEV1 values (difference 3.4%predicted; 95% CI 1.5, 5.4); p=0.001) than those with lower counts.Blood eosinophils are associated with airflow obstruction and enhanced decline in lung function independently of asthma and smoking. Eosinophilia is a risk factor for airflow obstruction even in those without symptoms.




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