检测重症哮喘患者气道骨膜素：是否有助于T2内型的聚类？
2019/02/27
摘要
背景：重症哮喘具有临床与生物学异质性，故通常难以得到控制。特别是，重症哮喘的2型免疫内型（type 2，T2）正在获得越来越多的关注，因为它容易受到新开发生物治疗的影响，这些治疗可以改变这类患者的生活质量。本研究旨在通过分析重症哮喘患者气道中骨膜素浓度，来评估其在T2型哮喘聚类中的作用。
方法：连续纳入40例重症哮喘患者（T2型：n=25；non-T2型：n=15）,21例轻-中度哮喘患者，和15例健康对照组。所有受试者均进行了呼出气冷凝液（exhaled breath condensate，EBC）、诱导痰、血嗜酸粒细胞计数、FeNO和IgE的检测。EBC和诱导痰（IS）上清液的骨膜素用酶联免疫吸附法（ELISA）进行评估。
结果：我们发现重症哮喘组与轻-中度哮喘组和健康对照组比较，EBC和IS中骨膜素水平更高（EBC：0.75 ±0.46 vs 0.70 ±0.19 vs 0.11±0.05 ng/mL, P < .05 and P < .01； 0.55 ±0.23 vs 0.31±0.13 vs 0.16 ±0.120 ng/ mL, P < .05 and P < .01)。我们进一步发现重症哮喘中T2型比non-T2型EBC和IS中的骨膜素水平更高(EBC:0.86 ±0.46 vs 0.44 ± 0.27 ng/mL, P < .05; IS:0.69 ±0.19 vs 0.39±0.16 ng/mL, P < .05),并且发现EBC与诱导痰中的骨膜素存在相关性。
结论：我们发现在重症哮喘，特别是T2型重症哮喘患者中，气道骨膜素水平增高且能够被检测到。血清骨膜素可能源自肺外的几种来源，与血清骨膜素不同，气道骨膜素是重症嗜酸粒细胞性哮喘的有用标志物，它可能有助于我们分类识别对生物制剂能够产生应答反应的哮喘表型。
Looking for Airways Periostin in Severe Asthma: Could It Be Useful for Clustering Type 2 Endotype?
Carpagnano GE, Scioscia G, Lacedonia D, Soccio P, Lepore G, Saetta M, Foschino Barbaro MP, Barnes PJ.
Chest. 2018 Nov;154(5):1083-1090.
Abstract
BACKGROUND: Severe asthma is heterogeneous clinically and biologically and is often difficult to control. In particular, the type 2 (T2) immunity endotype of severe asthma is gaining increasing interest because it is susceptible to newly developed biologic treatments that can transform the quality of life of these patients. The aim of this study was to analyze periostin concentrations in the airways of patients with severe asthma, evaluating its role in clustering the T2 endotype.
METHODS: We enrolled 40 consecutive patients with severe asthma (T2 endotype: n = 25; non-T2 endotype: n = 15), 21 patients with mild to moderate asthma, and 15 healthy control subjects. All subjects enrolled underwent exhaled breath condensate (EBC) and sputum collection, eosinophil count in blood, fractional exhaled nitric oxide, and IgE measurement. Periostin was assessed by an enzyme-linked immunosorbent assay kit on EBC and induced sputum (IS) supernatant.
RESULTS: We were able to detect higher periostin levels in the EBC (0.75 ± 0.46 vs 0.70 ± 0.19 vs 0.11 ± 0.05 ng/mL, P < .05 and P < .01) and in IS (0.55 ± 0.23 vs 0.31 ± 0.13 vs 0.16 ± 0.120 ng/mL, P < .05 and P < .01) of patients with severe asthma compared with patients with mild to moderate asthma and healthy control subjects, respectively. We further found an increase of periostin levels in both samples in T2 endotype compared with non-T2 endotype (EBC: 0.88 ± 0.46 vs 0.52 ± 0.46 ng/mL; IS: 0.69 ± 0.19 vs 0.39 ± 0.16 ng/mL; P < .05) and a correlation between periostin levels in EBC and sputum.
CONCLUSIONS: We found that periostin is measurable in the airways and increased in patients with severe asthma, especially in those from the T2 endotype. Unlike serum periostin, which may be derived from several sources outside the lung, airways periostin is a useful marker of severe eosinophilic asthma and may help to phenotype patients that will respond to the biologic agents.
背景：重症哮喘具有临床与生物学异质性，故通常难以得到控制。特别是，重症哮喘的2型免疫内型（type 2，T2）正在获得越来越多的关注，因为它容易受到新开发生物治疗的影响，这些治疗可以改变这类患者的生活质量。本研究旨在通过分析重症哮喘患者气道中骨膜素浓度，来评估其在T2型哮喘聚类中的作用。
方法：连续纳入40例重症哮喘患者（T2型：n=25；non-T2型：n=15）,21例轻-中度哮喘患者，和15例健康对照组。所有受试者均进行了呼出气冷凝液（exhaled breath condensate，EBC）、诱导痰、血嗜酸粒细胞计数、FeNO和IgE的检测。EBC和诱导痰（IS）上清液的骨膜素用酶联免疫吸附法（ELISA）进行评估。
结果：我们发现重症哮喘组与轻-中度哮喘组和健康对照组比较，EBC和IS中骨膜素水平更高（EBC：0.75 ±0.46 vs 0.70 ±0.19 vs 0.11±0.05 ng/mL, P < .05 and P < .01； 0.55 ±0.23 vs 0.31±0.13 vs 0.16 ±0.120 ng/ mL, P < .05 and P < .01)。我们进一步发现重症哮喘中T2型比non-T2型EBC和IS中的骨膜素水平更高(EBC:0.86 ±0.46 vs 0.44 ± 0.27 ng/mL, P < .05; IS:0.69 ±0.19 vs 0.39±0.16 ng/mL, P < .05),并且发现EBC与诱导痰中的骨膜素存在相关性。
结论：我们发现在重症哮喘，特别是T2型重症哮喘患者中，气道骨膜素水平增高且能够被检测到。血清骨膜素可能源自肺外的几种来源，与血清骨膜素不同，气道骨膜素是重症嗜酸粒细胞性哮喘的有用标志物，它可能有助于我们分类识别对生物制剂能够产生应答反应的哮喘表型。
(吴雯雯1张红萍1王刚2 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Chest. 2018 Nov;154(5):1083-1090.）
（Chest. 2018 Nov;154(5):1083-1090.）
Looking for Airways Periostin in Severe Asthma: Could It Be Useful for Clustering Type 2 Endotype?
Carpagnano GE, Scioscia G, Lacedonia D, Soccio P, Lepore G, Saetta M, Foschino Barbaro MP, Barnes PJ.
Chest. 2018 Nov;154(5):1083-1090.
Abstract
BACKGROUND: Severe asthma is heterogeneous clinically and biologically and is often difficult to control. In particular, the type 2 (T2) immunity endotype of severe asthma is gaining increasing interest because it is susceptible to newly developed biologic treatments that can transform the quality of life of these patients. The aim of this study was to analyze periostin concentrations in the airways of patients with severe asthma, evaluating its role in clustering the T2 endotype.
METHODS: We enrolled 40 consecutive patients with severe asthma (T2 endotype: n = 25; non-T2 endotype: n = 15), 21 patients with mild to moderate asthma, and 15 healthy control subjects. All subjects enrolled underwent exhaled breath condensate (EBC) and sputum collection, eosinophil count in blood, fractional exhaled nitric oxide, and IgE measurement. Periostin was assessed by an enzyme-linked immunosorbent assay kit on EBC and induced sputum (IS) supernatant.
RESULTS: We were able to detect higher periostin levels in the EBC (0.75 ± 0.46 vs 0.70 ± 0.19 vs 0.11 ± 0.05 ng/mL, P < .05 and P < .01) and in IS (0.55 ± 0.23 vs 0.31 ± 0.13 vs 0.16 ± 0.120 ng/mL, P < .05 and P < .01) of patients with severe asthma compared with patients with mild to moderate asthma and healthy control subjects, respectively. We further found an increase of periostin levels in both samples in T2 endotype compared with non-T2 endotype (EBC: 0.88 ± 0.46 vs 0.52 ± 0.46 ng/mL; IS: 0.69 ± 0.19 vs 0.39 ± 0.16 ng/mL; P < .05) and a correlation between periostin levels in EBC and sputum.
CONCLUSIONS: We found that periostin is measurable in the airways and increased in patients with severe asthma, especially in those from the T2 endotype. Unlike serum periostin, which may be derived from several sources outside the lung, airways periostin is a useful marker of severe eosinophilic asthma and may help to phenotype patients that will respond to the biologic agents.
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文化适应与拉丁裔青年的哮喘负担和肺功能相关：GALA II研究
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基于学校的远程医疗哮喘强化管理项目（SB-TEAM）对哮喘病情的影响一项随机临床试验
