流感住院哮喘患者全身和局部炎症的模式
2020/02/11
摘要
背景：哮喘患者有患流感住院的风险，但这种易感性的原因尚不清楚。
实验设计：前瞻性观察性研究在英国的11家医院中进行了PCR确诊的成人流感的检测，并测量了鼻、鼻咽和全身免疫介质以及全血基因表达。
结果：在133名患者中，有40名（30％）曾患有哮喘；这些患者中女性较多（70％比38.7％，OR 3.69，95％CI 1.67至8.18，p = 0.0012），需要较少的机械通气（15％vs 37.6％，χ2 6.78，p = 0.0338），住院时间短（分别为8.3对15.3 d，p = 0.0333）。在没有哮喘的患者中，接受皮质类固醇激素治疗的患者（OR = 2.63，95％CI = 1.02-6.96，p = 0.0466）或在疾病持续> 4天者出现的严重后果更为频繁（OR 5.49，95％CI 2.28-14.03 p = 0.0002）。高危人群（包括哮喘患者）的流感疫苗接种低于国家政策的预期，抗病毒药物的早期使用也不是最佳选择。两组之间的粘膜免疫反应相同。哮喘患者的血清IFN-α较高，而血清TNF，IL-5，IL-6，CXCL8，CXCL9，IL-10，IL-17和CCL2水平较低（均p <0.05）；两组的血清IL-13，总IgE，骨膜素和血液嗜酸性粒细胞基因表达水平相似。哮喘的诊断与病毒载量，IFN-α，IFN-γ，IL-5或IL-13水平无关。
结论：哮喘在流感住院患者中很常见，但这可能并不能代表经典的2型哮喘。 那些被诊断为流感的人往往为具有轻微的血清炎症反应，血清IFN-α水平升高和预后良好的女性患者。
Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza.
Jha Aet al. Eur Respir J. 2019 Aug 07.
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%, χ2 6.78, 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：哮喘患者有患流感住院的风险，但这种易感性的原因尚不清楚。
实验设计：前瞻性观察性研究在英国的11家医院中进行了PCR确诊的成人流感的检测，并测量了鼻、鼻咽和全身免疫介质以及全血基因表达。
结果：在133名患者中，有40名（30％）曾患有哮喘；这些患者中女性较多（70％比38.7％，OR 3.69，95％CI 1.67至8.18，p = 0.0012），需要较少的机械通气（15％vs 37.6％，χ2 6.78，p = 0.0338），住院时间短（分别为8.3对15.3 d，p = 0.0333）。在没有哮喘的患者中，接受皮质类固醇激素治疗的患者（OR = 2.63，95％CI = 1.02-6.96，p = 0.0466）或在疾病持续> 4天者出现的严重后果更为频繁（OR 5.49，95％CI 2.28-14.03 p = 0.0002）。高危人群（包括哮喘患者）的流感疫苗接种低于国家政策的预期，抗病毒药物的早期使用也不是最佳选择。两组之间的粘膜免疫反应相同。哮喘患者的血清IFN-α较高，而血清TNF，IL-5，IL-6，CXCL8，CXCL9，IL-10，IL-17和CCL2水平较低（均p <0.05）；两组的血清IL-13，总IgE，骨膜素和血液嗜酸性粒细胞基因表达水平相似。哮喘的诊断与病毒载量，IFN-α，IFN-γ，IL-5或IL-13水平无关。
结论：哮喘在流感住院患者中很常见，但这可能并不能代表经典的2型哮喘。 那些被诊断为流感的人往往为具有轻微的血清炎症反应，血清IFN-α水平升高和预后良好的女性患者。
（中国医科大学附属第一医院 李文扬 摘译 杨冬 审校）
（Jha Aet al. Eur Respir J. 2019 Aug 07.）
（Jha Aet al. Eur Respir J. 2019 Aug 07.）
Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza.
Jha Aet al. Eur Respir J. 2019 Aug 07.
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%, χ2 6.78, 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.
