根据嗜酸细胞标志物（呼出一氧化氮或痰嗜酸细胞）进行哮喘治疗：一项系统回顾和荟萃分析
2020/01/02
摘要
背景：哮喘指南指导健康从业者将治疗调整到控制哮喘所需的最低水平。由于许多哮喘患者具有嗜酸性粒细胞内皮型，因此根据气道嗜酸性粒细胞水平（痰嗜酸性粒细胞或呼出一氧化氮，FeNO）精确使用哮喘药物可能会改善哮喘的预后。
目的：将我们更新的来自Cochrane的系统综述证据进行汇总，根据嗜酸性粒细胞炎症标志物（痰液分析和FeNO）精确使用哮喘药物，以改善儿童和成人的哮喘相关结果。数据源：对截至2017年2月的Cochrane综述进行标准化搜索。研究选择：Cochrane综述包括实验组与对照组之间基于痰分析或FeNO（主要为临床症状和/或肺活量测定/峰值流量）的关于精确使用哮喘药物的随机对照比较。
结果：所纳入的16例基于FeNO治疗（其中7例面向成人）的研究和6例基于痰液治疗（其中5例面向成人）的研究是临床异质性的。在随访中，随机采用基于痰嗜酸性粒细胞的治疗的参与者与对照组相比发生急性加重的可能性显着降低（参与者中62vs 82/100出现≥1例急性加重; OR为0.36,95％CI 0.21-0.62）。对于基于FeNO的治疗，相应的数字是成人OR为0.60（95％CI 0.43-0.84），儿童OR为0.58（95％CI 0.45-0.75）。然而，每日吸入皮质类固醇剂量（在研究结束时），哮喘控制以及肺功能状况在不同管理方式中没有显着的组间差异。
结论：根据气道嗜酸性粒细胞标志调整治疗可降低哮喘恶化的可能性，但对控制哮喘或肺功能没有显著影响。
Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis.
Helen L Petsky, Chris J Cates, Kayleigh M Kew, Anne B Chang.2018 Dec.
Abstract
Background：Asthma guidelines guide health practitioners to adjust treatments to the minimum level required for asthma control. As many people with asthma have an eosinophilic endotype, tailoring asthma medications based on airway eosinophilic levels (sputum eosinophils or exhaled nitric oxide, FeNO) may improve asthma outcomes.
Objective：To synthesise the evidence from our updated Cochrane systematic reviews, for tailoring asthma medication based on eosinophilic inflammatory markers (sputum analysis and FeNO) for improving asthmarelated outcomes in children and adults.
Data sources：Cochrane reviews with standardised searches up to February 2017.
Study selection ：The Cochrane reviews included randomised controlled comparisons of tailoring asthma medications based on sputum analysis or FeNO compared with controls (primarily clinical symptoms and/or spirometry/peak flow).
Results：The 16 included studies of FeNO-based management (seven in adults) and 6 of sputumbased management (five in adults) were clinically heterogeneous. On follow-up, participants randomised to the sputum eosinophils strategy (compared with controls) were significantly less likely to have exacerbations (62 vs 82/100 participants with ≥1 exacerbation; OR 0.36, 95% CI 0.21 to 0.62). For the FeNO strategy, the respective numbers were adults OR 0.60 (95% CI 0.43 to 0.84) and children 0.58 (95% CI 0.45 to 0.75). However,there were no significant group differences for either strategy on daily inhaled corticosteroids dose (at end of study), asthma control or lung function.
Conclusion ：Adjusting treatment based on airway eosinophilic markers reduced the likelihood of asthma exacerbations but had no significant impact on asthma control or lung function.
背景：哮喘指南指导健康从业者将治疗调整到控制哮喘所需的最低水平。由于许多哮喘患者具有嗜酸性粒细胞内皮型，因此根据气道嗜酸性粒细胞水平（痰嗜酸性粒细胞或呼出一氧化氮，FeNO）精确使用哮喘药物可能会改善哮喘的预后。
目的：将我们更新的来自Cochrane的系统综述证据进行汇总，根据嗜酸性粒细胞炎症标志物（痰液分析和FeNO）精确使用哮喘药物，以改善儿童和成人的哮喘相关结果。数据源：对截至2017年2月的Cochrane综述进行标准化搜索。研究选择：Cochrane综述包括实验组与对照组之间基于痰分析或FeNO（主要为临床症状和/或肺活量测定/峰值流量）的关于精确使用哮喘药物的随机对照比较。
结果：所纳入的16例基于FeNO治疗（其中7例面向成人）的研究和6例基于痰液治疗（其中5例面向成人）的研究是临床异质性的。在随访中，随机采用基于痰嗜酸性粒细胞的治疗的参与者与对照组相比发生急性加重的可能性显着降低（参与者中62vs 82/100出现≥1例急性加重; OR为0.36,95％CI 0.21-0.62）。对于基于FeNO的治疗，相应的数字是成人OR为0.60（95％CI 0.43-0.84），儿童OR为0.58（95％CI 0.45-0.75）。然而，每日吸入皮质类固醇剂量（在研究结束时），哮喘控制以及肺功能状况在不同管理方式中没有显着的组间差异。
结论：根据气道嗜酸性粒细胞标志调整治疗可降低哮喘恶化的可能性，但对控制哮喘或肺功能没有显著影响。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(Helen L Petsky, Chris J Cates, Kayleigh M Kew, Anne B Chang.2018 Dec.)
(Helen L Petsky, Chris J Cates, Kayleigh M Kew, Anne B Chang.2018 Dec.)
Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis.
Helen L Petsky, Chris J Cates, Kayleigh M Kew, Anne B Chang.2018 Dec.
Abstract
Background：Asthma guidelines guide health practitioners to adjust treatments to the minimum level required for asthma control. As many people with asthma have an eosinophilic endotype, tailoring asthma medications based on airway eosinophilic levels (sputum eosinophils or exhaled nitric oxide, FeNO) may improve asthma outcomes.
Objective：To synthesise the evidence from our updated Cochrane systematic reviews, for tailoring asthma medication based on eosinophilic inflammatory markers (sputum analysis and FeNO) for improving asthmarelated outcomes in children and adults.
Data sources：Cochrane reviews with standardised searches up to February 2017.
Study selection ：The Cochrane reviews included randomised controlled comparisons of tailoring asthma medications based on sputum analysis or FeNO compared with controls (primarily clinical symptoms and/or spirometry/peak flow).
Results：The 16 included studies of FeNO-based management (seven in adults) and 6 of sputumbased management (five in adults) were clinically heterogeneous. On follow-up, participants randomised to the sputum eosinophils strategy (compared with controls) were significantly less likely to have exacerbations (62 vs 82/100 participants with ≥1 exacerbation; OR 0.36, 95% CI 0.21 to 0.62). For the FeNO strategy, the respective numbers were adults OR 0.60 (95% CI 0.43 to 0.84) and children 0.58 (95% CI 0.45 to 0.75). However,there were no significant group differences for either strategy on daily inhaled corticosteroids dose (at end of study), asthma control or lung function.
Conclusion ：Adjusting treatment based on airway eosinophilic markers reduced the likelihood of asthma exacerbations but had no significant impact on asthma control or lung function.
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室内尘螨驱动了促炎的花生四烯酸重组和巨噬细胞效应功能
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应用三维CT断层扫描评价哮喘和哮喘-慢阻肺重叠患者的气道结构变化的差异
