重症哮喘的支气管扩张：临床特点及预后
2018/06/04
摘要
背景：目前在重症哮喘患者中越来越多地发现并发支气管扩张，并可能导致疾病愈发严重。
目的：我们目的是确定重症哮喘患者支气管扩张的患病率，并更好地了解这些患者的临床特征及其预后。
方法：我们回顾性分析了184例经过高分辨率胸部计算机断层扫描确诊的重症哮喘患者的医疗档案，并比较了有支气管扩张和无支气管扩张患者的特征和预后。
结果：我们在86名患者（47％）中发现支气管扩张症。这些患者对非甾体类抗炎药物（NSAIDs）的超敏反应（OR 2.24,95％CI 1.00-5.03）和伴发胃食管反流病（GERD）（OR 1.89,95％CI 1.05-3.41）比没有支气管扩张的患者更频繁，但较少发生过敏性皮炎（OR 0.188,95％CI 0.04-0.88）。伴有支气管扩张的受试者因哮喘急性加重而住院的比例更高（OR 2.09,95％CI 1.08-4.05），且血液嗜酸性粒细胞水平高于无支气管扩张的受试者（464 vs 338，p 0.005）。
结论：我们的研究表明，在重症哮喘患者中，支气管扩张的存在与更频繁的住院治疗，伴发GERD，对NSAIDs的超敏反应和更高的血液嗜酸性粒细胞增多有关。支气管扩张可能代表重症嗜酸细胞性哮喘的额外表型特征。
Bronchiectasis in severe asthma: clinical features and outcomes
Isabel Coman, et al
Abstract
BACKGROUND：Bronchiectasis are increasingly identified in subjects with severe asthma and could contribute to disease severity.
OBJECTIVE：We aimed to determine the prevalence of bronchiectasis in our population of subjects with severe asthma and to better characterize the clinical features of these patients and their outcomes.
METHODS：We retrospectively reviewed the medical files of 184 subjects with confirmed severe asthma who had undergone a high resolution thoracic computed tomography and compared the characteristics and outcomes of subjects with and without bronchiectasis.
RESULTS：Bronchiectasis were identified in 86 (47%) patients. These patients had concomitant hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (OR 2.24, 95% CI 1.00-5.03) and gastroesophageal reflux disease (GERD) (OR 1.89, 95% CI 1.05-3.41) more frequently than subjects without bronchiectasis, but less atopic dermatitis (OR 0.188, 95% CI 0.04-0.88). Subjects with bronchiectasis were more frequently hospitalized for asthma exacerbations (OR 2.09, 95% CI 1.08-4.05) and had higher blood eosinophil levels (464 vs 338, p 0.005) than subjects without bronchiectasis.
CONCLUSIONS：Our study suggests that in subjects with severe asthma, the presence of bronchiectasis is associated with more frequent hospitalizations, concomitant GERD, hypersensitivity to NSAIDs and higher blood eosinophilia. Bronchiectasis could represent an additional phenotypic feature of severe eosinophilic asthma.
背景：目前在重症哮喘患者中越来越多地发现并发支气管扩张，并可能导致疾病愈发严重。
目的：我们目的是确定重症哮喘患者支气管扩张的患病率，并更好地了解这些患者的临床特征及其预后。
方法：我们回顾性分析了184例经过高分辨率胸部计算机断层扫描确诊的重症哮喘患者的医疗档案，并比较了有支气管扩张和无支气管扩张患者的特征和预后。
结果：我们在86名患者（47％）中发现支气管扩张症。这些患者对非甾体类抗炎药物（NSAIDs）的超敏反应（OR 2.24,95％CI 1.00-5.03）和伴发胃食管反流病（GERD）（OR 1.89,95％CI 1.05-3.41）比没有支气管扩张的患者更频繁，但较少发生过敏性皮炎（OR 0.188,95％CI 0.04-0.88）。伴有支气管扩张的受试者因哮喘急性加重而住院的比例更高（OR 2.09,95％CI 1.08-4.05），且血液嗜酸性粒细胞水平高于无支气管扩张的受试者（464 vs 338，p 0.005）。
结论：我们的研究表明，在重症哮喘患者中，支气管扩张的存在与更频繁的住院治疗，伴发GERD，对NSAIDs的超敏反应和更高的血液嗜酸性粒细胞增多有关。支气管扩张可能代表重症嗜酸细胞性哮喘的额外表型特征。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（Ann Allergy Asthma Immunol, 2018 Feb 26.）
（Ann Allergy Asthma Immunol, 2018 Feb 26.）
Bronchiectasis in severe asthma: clinical features and outcomes
Isabel Coman, et al
Abstract
BACKGROUND：Bronchiectasis are increasingly identified in subjects with severe asthma and could contribute to disease severity.
OBJECTIVE：We aimed to determine the prevalence of bronchiectasis in our population of subjects with severe asthma and to better characterize the clinical features of these patients and their outcomes.
METHODS：We retrospectively reviewed the medical files of 184 subjects with confirmed severe asthma who had undergone a high resolution thoracic computed tomography and compared the characteristics and outcomes of subjects with and without bronchiectasis.
RESULTS：Bronchiectasis were identified in 86 (47%) patients. These patients had concomitant hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (OR 2.24, 95% CI 1.00-5.03) and gastroesophageal reflux disease (GERD) (OR 1.89, 95% CI 1.05-3.41) more frequently than subjects without bronchiectasis, but less atopic dermatitis (OR 0.188, 95% CI 0.04-0.88). Subjects with bronchiectasis were more frequently hospitalized for asthma exacerbations (OR 2.09, 95% CI 1.08-4.05) and had higher blood eosinophil levels (464 vs 338, p 0.005) than subjects without bronchiectasis.
CONCLUSIONS：Our study suggests that in subjects with severe asthma, the presence of bronchiectasis is associated with more frequent hospitalizations, concomitant GERD, hypersensitivity to NSAIDs and higher blood eosinophilia. Bronchiectasis could represent an additional phenotypic feature of severe eosinophilic asthma.
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与年龄相关的鼻炎-鼻窦炎及鼻息肉与哮喘发作的关系
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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
