探讨非侵入性Th2型炎症标志物在预测儿童和青少年严重哮喘恶化中的作用
2019/06/13
摘要
背景：非侵入性Th2型炎症标志物可用于确定可能受益于个体化生物治疗的儿童和青少年。
目的：我们假设血嗜酸性粒细胞计数可以预测一次或多次哮喘急性发作，并且可以通过添加第二种非侵入性Th2型炎症标志物来提高预测。
方法：对前一年因哮喘急性加重而进行全身皮质类固醇治疗的5～21岁的儿童和青少年（n=589），分别于6个月和12个月完成特征性随访和电话联系。主要终点是哮喘急性就诊并接受全身皮质类固醇治疗。通过病案回顾验证急性就诊。探索性结果包括首次急性就诊和住院时间。
结果：106名（35.5%）儿童和72名（24.8%）青少年出现急性就诊。血嗜酸性粒细胞升高与首次急性就诊的几率增加和时间缩短有关，但最佳切入点因年龄不同而不同（儿童与青少年分别为≥150与≥300细胞/微升）。增加Th2型炎症的第二个标志物并不能改善儿童的预测，但增加了青少年急性就诊的比值比和相对危险度，分别高达16.2%和11.9%。住院治疗也有类似的趋势。
结论：血嗜酸性粒细胞等Th2型炎症的非侵入性标志物可用于儿童和青少年哮喘的临床评价。然而，Th2型炎症的特征因年龄而异。儿童和青少年对Th 2型炎症的治疗是否也有不同的反应尚不清楚，需要进一步评估。
Exploring the utility of non-invasive Type-2 inflammatory markers for prediction of severe asthma exacerbations in children and adolescents.
Shah SP, Grunwell J, Shih J, Stephenson S, Fitzpatrick AM.
Abstract
BACKGROUND: Non-invasive markers of Type-2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy.
OBJECTIVE: We hypothesized that blood eosinophil counts would predict one or more acute visits for asthma and that prediction could be improved with the addition of a second, non-invasive Type-2 inflammatory biomarker.
METHODS: Children and adolescents 5 to 21 years (N=589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization.
RESULTS: Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (≥150 vs. ≥300 cells/microliter for children vs. adolescents, respectively). Addition of a second marker of Type-2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations.
CONCLUSION: Blood eosinophils and other non-invasive markers of Type-2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of Type-2 inflammation vary by age. Whether children and adolescents also respond differently to management of Type-2 inflammation is unclear and warrants further evaluation.
背景：非侵入性Th2型炎症标志物可用于确定可能受益于个体化生物治疗的儿童和青少年。
目的：我们假设血嗜酸性粒细胞计数可以预测一次或多次哮喘急性发作，并且可以通过添加第二种非侵入性Th2型炎症标志物来提高预测。
方法：对前一年因哮喘急性加重而进行全身皮质类固醇治疗的5～21岁的儿童和青少年（n=589），分别于6个月和12个月完成特征性随访和电话联系。主要终点是哮喘急性就诊并接受全身皮质类固醇治疗。通过病案回顾验证急性就诊。探索性结果包括首次急性就诊和住院时间。
结果：106名（35.5%）儿童和72名（24.8%）青少年出现急性就诊。血嗜酸性粒细胞升高与首次急性就诊的几率增加和时间缩短有关，但最佳切入点因年龄不同而不同（儿童与青少年分别为≥150与≥300细胞/微升）。增加Th2型炎症的第二个标志物并不能改善儿童的预测，但增加了青少年急性就诊的比值比和相对危险度，分别高达16.2%和11.9%。住院治疗也有类似的趋势。
结论：血嗜酸性粒细胞等Th2型炎症的非侵入性标志物可用于儿童和青少年哮喘的临床评价。然而，Th2型炎症的特征因年龄而异。儿童和青少年对Th 2型炎症的治疗是否也有不同的反应尚不清楚，需要进一步评估。
(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)
(J Allergy Clin Immunol Pract. 2019 May 14. pii: S2213-2198(19)30451-9. doi: 10.1016/j.jaip.2019.04.043.)
(J Allergy Clin Immunol Pract. 2019 May 14. pii: S2213-2198(19)30451-9. doi: 10.1016/j.jaip.2019.04.043.)
Exploring the utility of non-invasive Type-2 inflammatory markers for prediction of severe asthma exacerbations in children and adolescents.
Shah SP, Grunwell J, Shih J, Stephenson S, Fitzpatrick AM.
Abstract
BACKGROUND: Non-invasive markers of Type-2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy.
OBJECTIVE: We hypothesized that blood eosinophil counts would predict one or more acute visits for asthma and that prediction could be improved with the addition of a second, non-invasive Type-2 inflammatory biomarker.
METHODS: Children and adolescents 5 to 21 years (N=589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization.
RESULTS: Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (≥150 vs. ≥300 cells/microliter for children vs. adolescents, respectively). Addition of a second marker of Type-2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations.
CONCLUSION: Blood eosinophils and other non-invasive markers of Type-2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of Type-2 inflammation vary by age. Whether children and adolescents also respond differently to management of Type-2 inflammation is unclear and warrants further evaluation.
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哮喘气道的固有免疫串话：固有淋巴细胞调节肺巨噬细胞的极化
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小气道功能障碍可能是早期哮喘的预测指标：来自高分辨率CT的研究发现
