预测支气管热成形术的疗效
2019/12/09
摘要
背景：并不是所有的患者都对支气管热成形术（BT）有反应，预测哮喘患者对BT的反应/无反应的因素在很大程度上是未知的。
目的：确定预测BT临床反应的基线因素。
方法：对77例进入澳大利亚支气管热成形术登记研究的患者进行基线临床特征检查，并在BT后6个月和12个月，对哮喘控制问卷（ACQ）评分的变化、急性发作频率，对短效β-2激动剂（SABA）和口服皮质类固醇的需求，以及肺功能的改善进行测定。
结果：这是一组重症哮喘患者：年龄57.7±11.4岁，57.1%女性，53.2%服用维持性口服类固醇，43%使用单克隆抗体治疗，平均FEV1为55.8%±19.8%。BT使ACQ评分从基线时的3.2±1.0提高到6个月时的1.6±1.1（P<0.001）。前6个月急性发作率由3.7±3.3降至0.7±1.2（P<0.001）。SABA需求量从9.3±7.1次/天下降到3.5±6.0次/天（P<0.001），48.8%的患者完全停用口服类固醇。FEV1明显改善。使用多元线性回归模型分析，基线ACQ评分强烈预测ACQ评分的改善（P<0.001）。在过去6个月内，急性发作频率大于两次的患者，其急性发作率下降幅度最大（-5.3±2.8；P<0.001）。每天使用10次以上SABA的患者的SABA需求量下降幅度最大（-12.4±10.5次，P<0.001）。
结论：哮喘更严重的患者在ACQ评分、急性发作频率和用药要求方面有最大的改善。
Predicting the Response to Bronchial Thermoplasty.
Langton D, Wang W, Sha J, Ing A, Fielding D, Hersch N, Plummer V, Thien F.
Abstract
BACKGROUND: Although it is established that not all patients respond to bronchial thermoplasty (BT), the factors that predict response/nonresponse are largely unknown.
OBJECTIVES: To identify baseline factors that predict clinical response.
METHODS: The records of 77 consecutive patients entered into the Australian Bronchial Thermoplasty Registry were examined for baseline clinical characteristics, and outcomes measured at 6 and 12 months after BT, such as change in the Asthma Control Questionnaire (ACQ) score, exacerbation frequency, the requirement for short-acting beta-2 agonist (SABA) medication and oral corticosteroids, and improvement in spirometry.
RESULTS: This was a cohort of patients with severe asthma: aged 57.7 ± 11.4 years, 57.1% females, 53.2% of patients taking maintenance oral steroids, 43% having been treated with an mAb, mean FEV1 of 55.8% ± 19.8% predicted.BT resulted in an improvement in the ACQ score from 3.2 ± 1.0 at baseline to 1.6 ± 1.1 at 6 months (P < .001). Exacerbation frequency in the previous 6 months reduced from 3.7 ± 3.3 to 0.7 ± 1.2 (P < .001). SABA requirement reduced from 9.3 ± 7.1 puffs/d to 3.5 ± 6.0 (P < .001), and 48.8% of patients were weaned completely off oral steroids. A significant improvement in FEV1 was observed. Using multiple linear regression models, baseline ACQ score strongly predicted improvement in ACQ score (P < .001). Patients with an exacerbation frequency greater than twice in the previous 6 months showed the greatest reduction in exacerbations (-5.3 ± 2.8; P < .001). Patients using more than 10 puffs/d of SABA experienced the greatest reduction in SABA requirement (-12.4 ± 10.5 puffs, P < .001).
CONCLUSIONS: The most severely afflicted patients had the greatest improvements in ACQ score, exacerbation frequency, and medication requirement.
背景：并不是所有的患者都对支气管热成形术（BT）有反应，预测哮喘患者对BT的反应/无反应的因素在很大程度上是未知的。
目的：确定预测BT临床反应的基线因素。
方法：对77例进入澳大利亚支气管热成形术登记研究的患者进行基线临床特征检查，并在BT后6个月和12个月，对哮喘控制问卷（ACQ）评分的变化、急性发作频率，对短效β-2激动剂（SABA）和口服皮质类固醇的需求，以及肺功能的改善进行测定。
结果：这是一组重症哮喘患者：年龄57.7±11.4岁，57.1%女性，53.2%服用维持性口服类固醇，43%使用单克隆抗体治疗，平均FEV1为55.8%±19.8%。BT使ACQ评分从基线时的3.2±1.0提高到6个月时的1.6±1.1（P<0.001）。前6个月急性发作率由3.7±3.3降至0.7±1.2（P<0.001）。SABA需求量从9.3±7.1次/天下降到3.5±6.0次/天（P<0.001），48.8%的患者完全停用口服类固醇。FEV1明显改善。使用多元线性回归模型分析，基线ACQ评分强烈预测ACQ评分的改善（P<0.001）。在过去6个月内，急性发作频率大于两次的患者，其急性发作率下降幅度最大（-5.3±2.8；P<0.001）。每天使用10次以上SABA的患者的SABA需求量下降幅度最大（-12.4±10.5次，P<0.001）。
结论：哮喘更严重的患者在ACQ评分、急性发作频率和用药要求方面有最大的改善。
(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 Nov 8. pii: S2213-2198(19)30925-0. doi: 10.1016/j.jaip.2019.10.034.)
(J Allergy Clin Immunol Pract. 2019 Nov 8. pii: S2213-2198(19)30925-0. doi: 10.1016/j.jaip.2019.10.034.)
Predicting the Response to Bronchial Thermoplasty.
Langton D, Wang W, Sha J, Ing A, Fielding D, Hersch N, Plummer V, Thien F.
Abstract
BACKGROUND: Although it is established that not all patients respond to bronchial thermoplasty (BT), the factors that predict response/nonresponse are largely unknown.
OBJECTIVES: To identify baseline factors that predict clinical response.
METHODS: The records of 77 consecutive patients entered into the Australian Bronchial Thermoplasty Registry were examined for baseline clinical characteristics, and outcomes measured at 6 and 12 months after BT, such as change in the Asthma Control Questionnaire (ACQ) score, exacerbation frequency, the requirement for short-acting beta-2 agonist (SABA) medication and oral corticosteroids, and improvement in spirometry.
RESULTS: This was a cohort of patients with severe asthma: aged 57.7 ± 11.4 years, 57.1% females, 53.2% of patients taking maintenance oral steroids, 43% having been treated with an mAb, mean FEV1 of 55.8% ± 19.8% predicted.BT resulted in an improvement in the ACQ score from 3.2 ± 1.0 at baseline to 1.6 ± 1.1 at 6 months (P < .001). Exacerbation frequency in the previous 6 months reduced from 3.7 ± 3.3 to 0.7 ± 1.2 (P < .001). SABA requirement reduced from 9.3 ± 7.1 puffs/d to 3.5 ± 6.0 (P < .001), and 48.8% of patients were weaned completely off oral steroids. A significant improvement in FEV1 was observed. Using multiple linear regression models, baseline ACQ score strongly predicted improvement in ACQ score (P < .001). Patients with an exacerbation frequency greater than twice in the previous 6 months showed the greatest reduction in exacerbations (-5.3 ± 2.8; P < .001). Patients using more than 10 puffs/d of SABA experienced the greatest reduction in SABA requirement (-12.4 ± 10.5 puffs, P < .001).
CONCLUSIONS: The most severely afflicted patients had the greatest improvements in ACQ score, exacerbation frequency, and medication requirement.
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儿童、青少年和成人哮喘控制和严重程度的现实评估：与医疗机构和共患病的关系
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妊娠期哮喘加重对哮喘妇女的影响：一项基于人群的队列研究
