持续性儿童哮喘的缓解：成人结局的早期预测因子
2018/12/17
摘要
背景：北美成年早期哮喘缓解预测因素的数据很少。成人哮喘缓解的预测因素是在轻中度持续性儿童哮喘患者的多民族人群中确定的。
方法：成人早期的哮喘缓解使用两个定义来测量，即临床定义和严格定义。两者都包括正常肺功能和没有症状，恶化和药物使用。严格定义还包括正常的气道反应。使用多变量逻辑回归从23个基线测量中识别出预测因子。使用决策树分析对缓解概率进行建模。
结果：在879名受试者中，平均基线年龄为8.8岁（SD±2.1），59.4％为男性，68.7％为高加索人。到成年时，879名参与者中有229名（26.0％）处于临床缓解期，741名参与者中有111名（15.0％）处于严格缓解期。一秒钟内用力呼气量与用力肺活量（FEV1 / FVC）损伤是哮喘缓解的最大预测因子。超过一半的男孩和三分之二的基线FEV1 /FVC≥90％的女孩在成年期处于缓解期。降低的气道反应性也是两种缓解定义的预测因子（临床缓解OR 1.23,95％CI 1.09-1.39;严格缓解OR 1.52,95％CI 1.26-1.84）。正常FEV1 / FVC，气道反应性和基线血清嗜酸性粒细胞计数的组合在成年期产生> 80％的缓解概率。
结论：持续性儿童哮喘患者在成年后疾病缓解的数量是很少的。从早期就可以看到哮喘缓解的临床预后指标，包括基线肺功能。
Remission of persistent childhood asthma: early predictors of adult outcomes.
Wang AL, Datta S, Weiss ST, Tantisira KG.
Abstract
BACKGROUND:Few data exist on the predictors of asthma remission by early adulthood in North America. The predictors of adult asthma remission were determined in a multiethnic population of mild-to-moderate persistent childhood asthmatics.
METHODS:Asthma remission in early adulthood was measured using two definitions, a clinical and a strict definition. Both included normal lung function and the absence of symptoms, exacerbations, and medication use. The strict definition also included normal airways responsiveness. Predictors were identified from 23 baseline measures using multivariate logistic regression. The probability of remission was modeled using decision tree analysis.
RESULTS:In 879 subjects, mean baseline age was 8.8 years (SD ± 2.1), 59.4% were males, and 68.7% were Caucasian. By adulthood, 229 (26.0%) of 879 participants were in clinical remission and 111 (15.0%) of 741 participants were in strict remission. The degree of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) impairment was the largest predictor of asthma remission. Over half of boys and two-thirds of girls with baseline FEV1/FVC ≥ 90% were in remission at adulthood. Decreased airways responsiveness was also a predictor for both remission definitions (clinical remission OR 1.23, 95% CI 1.09-1.39; strict remission OR 1.52, 95% CI 1.26-1.84). The combination of normal FEV1/FVC, airways responsiveness, and serum eosinophil count at baseline yielded > 80% probability of remission by adulthood.
CONCLUSIONS:A considerable minority of persistent childhood asthmatics will develop disease remission by adulthood. Clinical prognostic indicators of asthma remission, including baseline lung function, can be seen from an early age.
背景：北美成年早期哮喘缓解预测因素的数据很少。成人哮喘缓解的预测因素是在轻中度持续性儿童哮喘患者的多民族人群中确定的。
方法：成人早期的哮喘缓解使用两个定义来测量，即临床定义和严格定义。两者都包括正常肺功能和没有症状，恶化和药物使用。严格定义还包括正常的气道反应。使用多变量逻辑回归从23个基线测量中识别出预测因子。使用决策树分析对缓解概率进行建模。
结果：在879名受试者中，平均基线年龄为8.8岁（SD±2.1），59.4％为男性，68.7％为高加索人。到成年时，879名参与者中有229名（26.0％）处于临床缓解期，741名参与者中有111名（15.0％）处于严格缓解期。一秒钟内用力呼气量与用力肺活量（FEV1 / FVC）损伤是哮喘缓解的最大预测因子。超过一半的男孩和三分之二的基线FEV1 /FVC≥90％的女孩在成年期处于缓解期。降低的气道反应性也是两种缓解定义的预测因子（临床缓解OR 1.23,95％CI 1.09-1.39;严格缓解OR 1.52,95％CI 1.26-1.84）。正常FEV1 / FVC，气道反应性和基线血清嗜酸性粒细胞计数的组合在成年期产生> 80％的缓解概率。
结论：持续性儿童哮喘患者在成年后疾病缓解的数量是很少的。从早期就可以看到哮喘缓解的临床预后指标，包括基线肺功能。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2018 Nov 13. pii: S0091-6749(18)31590-2. doi: 10.1016/j.jaci.2018.09.038. [Epub ahead of print])
(J Allergy Clin Immunol. 2018 Nov 13. pii: S0091-6749(18)31590-2. doi: 10.1016/j.jaci.2018.09.038. [Epub ahead of print])
Remission of persistent childhood asthma: early predictors of adult outcomes.
Wang AL, Datta S, Weiss ST, Tantisira KG.
Abstract
BACKGROUND:Few data exist on the predictors of asthma remission by early adulthood in North America. The predictors of adult asthma remission were determined in a multiethnic population of mild-to-moderate persistent childhood asthmatics.
METHODS:Asthma remission in early adulthood was measured using two definitions, a clinical and a strict definition. Both included normal lung function and the absence of symptoms, exacerbations, and medication use. The strict definition also included normal airways responsiveness. Predictors were identified from 23 baseline measures using multivariate logistic regression. The probability of remission was modeled using decision tree analysis.
RESULTS:In 879 subjects, mean baseline age was 8.8 years (SD ± 2.1), 59.4% were males, and 68.7% were Caucasian. By adulthood, 229 (26.0%) of 879 participants were in clinical remission and 111 (15.0%) of 741 participants were in strict remission. The degree of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) impairment was the largest predictor of asthma remission. Over half of boys and two-thirds of girls with baseline FEV1/FVC ≥ 90% were in remission at adulthood. Decreased airways responsiveness was also a predictor for both remission definitions (clinical remission OR 1.23, 95% CI 1.09-1.39; strict remission OR 1.52, 95% CI 1.26-1.84). The combination of normal FEV1/FVC, airways responsiveness, and serum eosinophil count at baseline yielded > 80% probability of remission by adulthood.
CONCLUSIONS:A considerable minority of persistent childhood asthmatics will develop disease remission by adulthood. Clinical prognostic indicators of asthma remission, including baseline lung function, can be seen from an early age.
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JAK1/JAK2抑制剂鲁索利替尼可抑制肥大细胞脱颗粒和细胞因子释放
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FEV1速效支气管扩张反应作为成人哮喘的诊断标准
