以流感收入院的哮喘患者全身及局部炎症表现特点
2019/08/28
摘要
背景：哮喘患者院内感染流感的风险较高，但是这种易感性原因目前暂不清楚。
研究设定：在英国11家医院对通过PCR方法确诊流感的病人进行一项前瞻性横断面研究，此研究是通过测定鼻部、鼻咽部及全身系统免疫接到因子及全血基因表达进行的。
结果：在133名住院患者中，40名（30％）有哮喘病史;大部分是女性（70％对38.7％，OR 3.69,95％CI 1.67至8.18，p=0.0012），对比无哮喘病史者，需要机械通气（15％对37.6％，χ26.78，p=0.0338）及住院天数（平均8.3对15.3天，p = 0.0333）较少。在无哮喘病史的患者中，给予糖皮质激素的患者不良后果更容易出现（OR = 2.63,95％CI =1.02-6.96，p= 0.0466）或在疾病发生后持续时间大于4天（OR 5.49,95％CI 2.28-14.03， p=0.0002）。高危人群（包括哮喘）的流感疫苗接种率低于国家政策所作的预期，早期使用抗病毒药物的效果不尽人意。各组之间的粘膜免疫反应相当。哮喘患者血清IFN-α较高，但血清TNF、IL-5、IL-6、CXCL8、CXCL9、IL-10、IL-17和CCL2水平较低（均p <0.05）;两组均有相似的血清IL-13，总IgE、骨膜蛋白和血嗜酸粒细胞基因表达水平。哮喘的诊断与病毒负荷量、IFN-α、IFN-γ、IL-5或IL-13水平无关。
结论：哮喘在患有流感的住院患者中很常见，但可能并未表现出典型的Th2型反应。以流感收入院的患者女性较多，通常血清炎症反应较轻、血清IFN-α水平较高及良好的临床预后。
Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza.
Jha A,Dunning J,Tunstall T,Thwaites RS,Hoang LT;MOSAIC Investigators,Kon OM, Zambon MC,Hansel TT, Openshaw PJ
Abstract
BACKGROUND: Patients with asthma are at risk of hospitalisation with influenza ,but the reasons for this predisposition are unknown.
STUDY SETTING: A prospective observational study of adults with PCR-confirmed influenza in 11 UK hospitals, measuring nasal,nasopharyngeal and systemic immune mediators and whole-blood gene expression.
RESULTS: Of 133 admissions,40 (30%) had previous asthma; these were more often female (70% versus 38.7%, OR 3.69, 95% CI 1.67 to 8.18,p=0.0012), required less mechanical ventilation (15% versus 37.6%, χ26.78, p=0.0338) and had shorter hospital stays (mean 8.3 versus 15.3 d, p=0.0333) than those without. In patients without asthma, severe outcomes were more frequent in those given corticosteroids(OR=2.63, 95% CI=1.02-6.96, p=0.0466) or presenting >4 days after disease onset(OR 5.49, 95% CI 2.28-14.03, p=0.0002). Influenza vaccination in at-risk groups(including asthma) were lower than intended by national policy and the early use of antiviral medications were less than optimal. Mucosal immune responses were equivalent between groups. Those with asthma had higher serum IFN-α but lower serum TNF, IL-5, IL-6, CXCL8, CXCL9, IL-10, IL-17 and CCL2 levels (all p<0.05);both groups had similar serum IL-13, total IgE, periostin and blood eosinophil gene expression levels. Asthma diagnosis was unrelated to viral load, IFN-α,IFN-γ, IL-5 or IL-13 levels.
CONCLUSIONS: Asthma is common in those hospitalised with influenza, but may not represent classical Type 2-driven disease. Those admitted with influenza tend to be female with mild serum inflammatory responses, increased serum IFN-α levels and good clinical outcomes.
背景：哮喘患者院内感染流感的风险较高，但是这种易感性原因目前暂不清楚。
研究设定：在英国11家医院对通过PCR方法确诊流感的病人进行一项前瞻性横断面研究，此研究是通过测定鼻部、鼻咽部及全身系统免疫接到因子及全血基因表达进行的。
结果：在133名住院患者中，40名（30％）有哮喘病史;大部分是女性（70％对38.7％，OR 3.69,95％CI 1.67至8.18，p=0.0012），对比无哮喘病史者，需要机械通气（15％对37.6％，χ26.78，p=0.0338）及住院天数（平均8.3对15.3天，p = 0.0333）较少。在无哮喘病史的患者中，给予糖皮质激素的患者不良后果更容易出现（OR = 2.63,95％CI =1.02-6.96，p= 0.0466）或在疾病发生后持续时间大于4天（OR 5.49,95％CI 2.28-14.03， p=0.0002）。高危人群（包括哮喘）的流感疫苗接种率低于国家政策所作的预期，早期使用抗病毒药物的效果不尽人意。各组之间的粘膜免疫反应相当。哮喘患者血清IFN-α较高，但血清TNF、IL-5、IL-6、CXCL8、CXCL9、IL-10、IL-17和CCL2水平较低（均p <0.05）;两组均有相似的血清IL-13，总IgE、骨膜蛋白和血嗜酸粒细胞基因表达水平。哮喘的诊断与病毒负荷量、IFN-α、IFN-γ、IL-5或IL-13水平无关。
结论：哮喘在患有流感的住院患者中很常见，但可能并未表现出典型的Th2型反应。以流感收入院的患者女性较多，通常血清炎症反应较轻、血清IFN-α水平较高及良好的临床预后。
（中日友好医院呼吸与危重症医学科 张 鑫 摘译 林江涛 审校）
（Eur Respir J. 2019 Aug 7. pii: 1900949. doi: 10.1183/13993003.00949-2019. [Epub ahead of print]）
（Eur Respir J. 2019 Aug 7. pii: 1900949. doi: 10.1183/13993003.00949-2019. [Epub ahead of print]）
Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza.
Jha A,Dunning J,Tunstall T,Thwaites RS,Hoang LT;MOSAIC Investigators,Kon OM, Zambon MC,Hansel TT, Openshaw PJ
Abstract
BACKGROUND: Patients with asthma are at risk of hospitalisation with influenza ,but the reasons for this predisposition are unknown.
STUDY SETTING: A prospective observational study of adults with PCR-confirmed influenza in 11 UK hospitals, measuring nasal,nasopharyngeal and systemic immune mediators and whole-blood gene expression.
RESULTS: Of 133 admissions,40 (30%) had previous asthma; these were more often female (70% versus 38.7%, OR 3.69, 95% CI 1.67 to 8.18,p=0.0012), required less mechanical ventilation (15% versus 37.6%, χ26.78, p=0.0338) and had shorter hospital stays (mean 8.3 versus 15.3 d, p=0.0333) than those without. In patients without asthma, severe outcomes were more frequent in those given corticosteroids(OR=2.63, 95% CI=1.02-6.96, p=0.0466) or presenting >4 days after disease onset(OR 5.49, 95% CI 2.28-14.03, p=0.0002). Influenza vaccination in at-risk groups(including asthma) were lower than intended by national policy and the early use of antiviral medications were less than optimal. Mucosal immune responses were equivalent between groups. Those with asthma had higher serum IFN-α but lower serum TNF, IL-5, IL-6, CXCL8, CXCL9, IL-10, IL-17 and CCL2 levels (all p<0.05);both groups had similar serum IL-13, total IgE, periostin and blood eosinophil gene expression levels. Asthma diagnosis was unrelated to viral load, IFN-α,IFN-γ, IL-5 or IL-13 levels.
CONCLUSIONS: Asthma is common in those hospitalised with influenza, but may not represent classical Type 2-driven disease. Those admitted with influenza tend to be female with mild serum inflammatory responses, increased serum IFN-α levels and good clinical outcomes.
上一篇：
重症哮喘患者长期使用阿奇霉素可降低流感嗜血杆菌的发病率、增加抗生素耐药性
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未控制的重度口服糖皮质激素依赖型哮喘患者中与强的松龙相关的2型生物标志物和细胞因子的变化：一项开放性干预研究
