英国成人哮喘患者急性发作模式：一项基于人群的研究
2020/01/02
摘要
目的：哮喘的发病机制是异质性的，并且目前针对其急性发作模式的知识是缺乏的。此前的研究跟踪时间相对较短并且关注的重点是重症哮喘。本研究的目的在于描述不同疾病严重程度的患者在长期随访期间的恶化模式。
方法：采用电子病历对2007-2015年18-55岁哮喘患者的病情进行统计分析。一个拥有≥7年数据的队列被用来研究不同严重程度哮喘的加重模式（通过药物的使用情况来定义）。使用逻辑回归计算了散发性(单年加重)和复发性(>1年)加重模式下的各个危险因素的权重值。在病例对照设计中，我们研究了5年间的恶化史与未来恶化之间的关系。
结果：51462例患者符合7年队列研究的标准，64%没有恶化。在病情恶化的人群中，51%的人只发作过一次，病情恶化频率随病情严重程度的增加而增加。只有370名患者(0.7%)表现为频繁发作型(每年发作一次)，其中58%为轻度/中度哮喘。恶化危险因素与特定的恶化模式并不是一对一相关的。过去的恶化比所有其他因素都更容易增加未来恶化的风险，尽管这种影响在未来5年间逐渐消失。
结论：在7年的随访中，约三分之一的患者出现了病情恶化。在病情恶化的人群中，有一半人不会再次出现恶化。未来恶化的时机在很大程度上是不可预测的。只有2%的人表现出频繁恶化的表现型。“过去的恶化模式”是预测未来恶化最具信息量以及权重最高的风险因素。
Exacerbation Patterns in Adults with Asthma in England: A Population Based Study.
Am J Respir Crit Care Med. 2019 Feb 15;199(4):446-453. doi: 10.1164/rccm.201808-1516OC.
Abstract
Rationale Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease. Objectives Describe exacerbation patterns over a prolonged follow-up in a population including patients of all disease severity. Methods We used electronic healthcare records to identify asthma patients aged 18-55 years and their exacerbations, 2007-2015. A cohort with ≥7-years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 year) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5-years, and a future exacerbation was examined. Measurements and Main Results 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterised by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5-years. Conclusions During 7-years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
目的：哮喘的发病机制是异质性的，并且目前针对其急性发作模式的知识是缺乏的。此前的研究跟踪时间相对较短并且关注的重点是重症哮喘。本研究的目的在于描述不同疾病严重程度的患者在长期随访期间的恶化模式。
方法：采用电子病历对2007-2015年18-55岁哮喘患者的病情进行统计分析。一个拥有≥7年数据的队列被用来研究不同严重程度哮喘的加重模式（通过药物的使用情况来定义）。使用逻辑回归计算了散发性(单年加重)和复发性(>1年)加重模式下的各个危险因素的权重值。在病例对照设计中，我们研究了5年间的恶化史与未来恶化之间的关系。
结果：51462例患者符合7年队列研究的标准，64%没有恶化。在病情恶化的人群中，51%的人只发作过一次，病情恶化频率随病情严重程度的增加而增加。只有370名患者(0.7%)表现为频繁发作型(每年发作一次)，其中58%为轻度/中度哮喘。恶化危险因素与特定的恶化模式并不是一对一相关的。过去的恶化比所有其他因素都更容易增加未来恶化的风险，尽管这种影响在未来5年间逐渐消失。
结论：在7年的随访中，约三分之一的患者出现了病情恶化。在病情恶化的人群中，有一半人不会再次出现恶化。未来恶化的时机在很大程度上是不可预测的。只有2%的人表现出频繁恶化的表现型。“过去的恶化模式”是预测未来恶化最具信息量以及权重最高的风险因素。
(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)
(Am J Respir Crit Care Med. 2019 Feb 15;199(4):446-453. doi: 10.1164/rccm.201808-1516OC.)
(Am J Respir Crit Care Med. 2019 Feb 15;199(4):446-453. doi: 10.1164/rccm.201808-1516OC.)
Exacerbation Patterns in Adults with Asthma in England: A Population Based Study.
Am J Respir Crit Care Med. 2019 Feb 15;199(4):446-453. doi: 10.1164/rccm.201808-1516OC.
Abstract
Rationale Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease. Objectives Describe exacerbation patterns over a prolonged follow-up in a population including patients of all disease severity. Methods We used electronic healthcare records to identify asthma patients aged 18-55 years and their exacerbations, 2007-2015. A cohort with ≥7-years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 year) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5-years, and a future exacerbation was examined. Measurements and Main Results 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterised by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5-years. Conclusions During 7-years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
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肠道微生物群与过敏致敏，湿疹和哮喘之间的关联：一项系统评价
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胃食管反流病与哮喘双向关联：利用一种国家样本队列进行的两项纵向随访研究
