重症哮喘患者血液嗜酸性粒细胞的变异性
2018/12/17
摘要
背景：血嗜酸性粒细胞水平是非控制性哮喘患者中IL-5靶向药物的用药指征。然而，对于这些患者在治疗开始前血嗜酸性粒细胞水平的变异性知之甚少。
目的：探讨重症哮喘患者血液嗜酸性粒细胞水平的变异性及其变化规律。
方法：回顾性调查了5年间在城市诊所就诊的患者的血液嗜酸性粒细胞水平。重复测量个体的血液嗜酸性粒细胞水平，并进行聚类分析，以表征患者的嗜酸性粒细胞模式。对与嗜酸性粒细胞水平相关的临床特征和变异模式进行分析。
结果： 收集3个月内在Bellevue医院哮喘诊所治疗的患者（n=219）。获得过去5年中的血液嗜酸性粒细胞水平。只有6%（n=13）的患者的嗜酸性粒细胞水平持续高于300细胞/μL。将近50%（n=104）的嗜酸性粒细胞水平超过300细胞/μL的阈值。相比之下，102例（46%）的患者的嗜酸性粒细胞水平从未达到300细胞/μL的阈值。聚类分析显示三个具有不同水平和变异性的聚类。有迹象表明，血嗜酸性粒细胞测量变异性最大的群组中伴有临床控制水平减低及特应性增加。
结论： 在一家诊所针对未控制哮喘患者的研究中，嗜酸性粒细胞的血液测量是可变的，并且显示出不同的变异模式。这些数据加强了反复进行嗜酸性粒细胞血液测量以适当指定治疗干预的必要性。
Variability of blood eosinophils in patients in a clinic for severe asthma.
Rakowski E, Zhao S, Liu M, Bajaj S, Durmus N, Grunig G, de Lafaille MC, Wu Y2 Reibman J1.
Abstract
BACKGROUND: Blood eosinophils are used to determine eligibility for agents targeting IL-5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in these patients before treatment initiation.
OBJECTIVE: To characterize variability and patterns of variability of blood eosinophil levels in a real-world clinic for severe asthmatics.
METHODS: Retrospective review of blood eosinophils measured over a 5-year period in patients enrolled in an urban clinic. Repeated measures of blood eosinophil levels in individuals were evaluated and cluster analysis was performed to characterize patients by eosinophil patterns. Clinical characteristics associated with eosinophil levels and patterns of variability were analyzed.
RESULTS: Patients treated in the Bellevue Hospital Asthma Clinic within a 3-month period were identified (n = 219). Blood eosinophil measures were obtained over the previous 5 years. Only 6% (n= 13) of patients had levels that were consistently above 300 cells/μL. Nearly 50% (n = 104) had eosinophil levels that traversed the threshold of 300 cells/μL. In contrast, 102 (46%) had levels that never reached the threshold of 300 cells/μL. Cluster analyses revealed three clusters with differing patterns of levels and variability. There was a suggestion of decreased clinical control and increased atopy in the cluster with the greatest variability in blood eosinophil measures.
CONCLUSION: In an urban clinic for patients referred for uncontrolled asthma, blood measures of eosinophils were variable and showed differing patterns of variability. These data reinforce the need to perform repeated eosinophil blood measures for appropriate designation for therapeutic intervention. This article is protected by copyright. All rights reserved.
背景：血嗜酸性粒细胞水平是非控制性哮喘患者中IL-5靶向药物的用药指征。然而，对于这些患者在治疗开始前血嗜酸性粒细胞水平的变异性知之甚少。
目的：探讨重症哮喘患者血液嗜酸性粒细胞水平的变异性及其变化规律。
方法：回顾性调查了5年间在城市诊所就诊的患者的血液嗜酸性粒细胞水平。重复测量个体的血液嗜酸性粒细胞水平，并进行聚类分析，以表征患者的嗜酸性粒细胞模式。对与嗜酸性粒细胞水平相关的临床特征和变异模式进行分析。
结果： 收集3个月内在Bellevue医院哮喘诊所治疗的患者（n=219）。获得过去5年中的血液嗜酸性粒细胞水平。只有6%（n=13）的患者的嗜酸性粒细胞水平持续高于300细胞/μL。将近50%（n=104）的嗜酸性粒细胞水平超过300细胞/μL的阈值。相比之下，102例（46%）的患者的嗜酸性粒细胞水平从未达到300细胞/μL的阈值。聚类分析显示三个具有不同水平和变异性的聚类。有迹象表明，血嗜酸性粒细胞测量变异性最大的群组中伴有临床控制水平减低及特应性增加。
结论： 在一家诊所针对未控制哮喘患者的研究中，嗜酸性粒细胞的血液测量是可变的，并且显示出不同的变异模式。这些数据加强了反复进行嗜酸性粒细胞血液测量以适当指定治疗干预的必要性。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Clin Exp Allergy. 2018 Nov 11. doi: 10.1111/cea.13310. [Epub ahead of print])
(Clin Exp Allergy. 2018 Nov 11. doi: 10.1111/cea.13310. [Epub ahead of print])
Variability of blood eosinophils in patients in a clinic for severe asthma.
Rakowski E, Zhao S, Liu M, Bajaj S, Durmus N, Grunig G, de Lafaille MC, Wu Y2 Reibman J1.
Abstract
BACKGROUND: Blood eosinophils are used to determine eligibility for agents targeting IL-5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in these patients before treatment initiation.
OBJECTIVE: To characterize variability and patterns of variability of blood eosinophil levels in a real-world clinic for severe asthmatics.
METHODS: Retrospective review of blood eosinophils measured over a 5-year period in patients enrolled in an urban clinic. Repeated measures of blood eosinophil levels in individuals were evaluated and cluster analysis was performed to characterize patients by eosinophil patterns. Clinical characteristics associated with eosinophil levels and patterns of variability were analyzed.
RESULTS: Patients treated in the Bellevue Hospital Asthma Clinic within a 3-month period were identified (n = 219). Blood eosinophil measures were obtained over the previous 5 years. Only 6% (n= 13) of patients had levels that were consistently above 300 cells/μL. Nearly 50% (n = 104) had eosinophil levels that traversed the threshold of 300 cells/μL. In contrast, 102 (46%) had levels that never reached the threshold of 300 cells/μL. Cluster analyses revealed three clusters with differing patterns of levels and variability. There was a suggestion of decreased clinical control and increased atopy in the cluster with the greatest variability in blood eosinophil measures.
CONCLUSION: In an urban clinic for patients referred for uncontrolled asthma, blood measures of eosinophils were variable and showed differing patterns of variability. These data reinforce the need to perform repeated eosinophil blood measures for appropriate designation for therapeutic intervention. This article is protected by copyright. All rights reserved.
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