嗜酸性肉芽肿性多血管炎：长期哮喘严重程度的临床预测指标
2020/02/11
摘要
背景：嗜酸性肉芽肿性多血管炎（EGPA）患者长期支气管哮喘病程暂不清楚。我们的目的是确定EGPA患者长期哮喘特征并且确定长期哮喘严重程度的基线预测指标。
方法：在一单中心转诊中心对完全满足EGPA诊断的患者进行从1990年-2017年的回顾性队列研究。分析基线水平及3 (±1)年临床、实验室及肺功能随访数据。
结果：共计89位EGPA患者，记录哮喘的基线情况和从确诊之时起随访3年内数据。42.7%患者确诊时即为重症/难控制性哮喘并且与既往呼吸道免疫变态反应(p<0.01)、血清总IgE升高(p<0.05)、大剂量吸入糖皮质激素使用增加(ICS; p<0.05)、确诊EGPA前口服糖皮质激素以控制症状(OCS; p<0.001)具有相关性。随访过程中，12.3%哮喘患者病情改善，10.1%哮喘患者病情恶化。在长期随访过程中，无论是否进行ICS还是OCS治疗，肺功能检查无改善。利用多变量二元回归分析模型，重症鼻窦炎(p=0.038)、肺部阴影(p=0.011)、超重(BMI>25kg/m2; p=0.041)以及血管炎诊断同时确诊的重症/难控制性哮喘(p<0.001)独立预测3年后重症/难控制哮喘诊断。
结论：合并EGPA的哮喘患者，长期重症/难控制哮喘与基线肺功能及耳鼻喉症状表现相关，与血管炎特征无明显相关。
Eosinophilic Granulomatosis with Polyangiitis: clinical predictors of long-term asthma severity.
Berti A, Cornec D, Moura MC, Smyth RJ, Dagna L, Specks U, Keogh KA.
Chest. 2020 Jan 17. pii: S0012-3692(20)30023-4. doi: 10.1016/j.chest.2019.11.045.
Abstract
BACKGROUND: The long-term clinical course of asthma in patients with Eosinophilic Granulomatosis
with Polyangiitis (EGPA) remains unclear. We aimed to characterize long-term asthma in EGPA and to identify baseline predictors of long-term asthma severity.
METHODS:Retrospective cohort study of patients who fulfilled standardized criteria for EGPA that were followed in a single referral center between 1990-2017. Baseline and 3 (±1) years of follow-up clinical, laboratory and pulmonary function data were analyzed.
RESULTS:Eighty-nine patients with EGPA, and a documented asthma assessment at baseline and at 3 years from diagnosis were included. Severe/uncontrolled asthma was observed in 42.7% of patients at diagnosis and was associated with previous history of respiratory allergy (p<0.01), elevated serum total IgE levels (p<0.05), increased use of high dose inhaled (ICS; p<0.05) and oral corticosteroids (OCS; p<0.001) for respiratory symptoms the year before the diagnosis of EGPA. During follow-up, an improvement or worsening in asthma severity was noted in 12.3% and 10.1% of patients, respectively. Severe/uncontrolled asthma was present in 40.5% of patients at 3 years, and was associated with increased airway resistance on pulmonary function testing (p<0.05). Long-term PFTs did not improve during long-term follow-up regardless of ICS or OCS therapy. Using multivariate binary logistic regressions, severe rhinosinusitis (p=0.038), pulmonary infiltrates (p=0.011), overweight (BMI>25kg/m2; p=0.041) and severe/uncontrolled asthma at vasculitis diagnosis (p<0.001) independently predicted severe/uncontrolled asthma at the 3-year endpoint.
CONCLUSION:In asthmatic patients with EGPA, long-term severe/uncontrolled asthma is associated with baseline pulmonary and ENT manifestations, but not with clear-cut vasculitic features.
背景：嗜酸性肉芽肿性多血管炎（EGPA）患者长期支气管哮喘病程暂不清楚。我们的目的是确定EGPA患者长期哮喘特征并且确定长期哮喘严重程度的基线预测指标。
方法：在一单中心转诊中心对完全满足EGPA诊断的患者进行从1990年-2017年的回顾性队列研究。分析基线水平及3 (±1)年临床、实验室及肺功能随访数据。
结果：共计89位EGPA患者，记录哮喘的基线情况和从确诊之时起随访3年内数据。42.7%患者确诊时即为重症/难控制性哮喘并且与既往呼吸道免疫变态反应(p<0.01)、血清总IgE升高(p<0.05)、大剂量吸入糖皮质激素使用增加(ICS; p<0.05)、确诊EGPA前口服糖皮质激素以控制症状(OCS; p<0.001)具有相关性。随访过程中，12.3%哮喘患者病情改善，10.1%哮喘患者病情恶化。在长期随访过程中，无论是否进行ICS还是OCS治疗，肺功能检查无改善。利用多变量二元回归分析模型，重症鼻窦炎(p=0.038)、肺部阴影(p=0.011)、超重(BMI>25kg/m2; p=0.041)以及血管炎诊断同时确诊的重症/难控制性哮喘(p<0.001)独立预测3年后重症/难控制哮喘诊断。
结论：合并EGPA的哮喘患者，长期重症/难控制哮喘与基线肺功能及耳鼻喉症状表现相关，与血管炎特征无明显相关。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Chest. 2020 Jan 17. pii: S0012-3692(20)30023-4. doi: 10.1016/j.chest.2019.11.045.）
（Chest. 2020 Jan 17. pii: S0012-3692(20)30023-4. doi: 10.1016/j.chest.2019.11.045.）
Eosinophilic Granulomatosis with Polyangiitis: clinical predictors of long-term asthma severity.
Berti A, Cornec D, Moura MC, Smyth RJ, Dagna L, Specks U, Keogh KA.
Chest. 2020 Jan 17. pii: S0012-3692(20)30023-4. doi: 10.1016/j.chest.2019.11.045.
Abstract
BACKGROUND: The long-term clinical course of asthma in patients with Eosinophilic Granulomatosis
with Polyangiitis (EGPA) remains unclear. We aimed to characterize long-term asthma in EGPA and to identify baseline predictors of long-term asthma severity.
METHODS:Retrospective cohort study of patients who fulfilled standardized criteria for EGPA that were followed in a single referral center between 1990-2017. Baseline and 3 (±1) years of follow-up clinical, laboratory and pulmonary function data were analyzed.
RESULTS:Eighty-nine patients with EGPA, and a documented asthma assessment at baseline and at 3 years from diagnosis were included. Severe/uncontrolled asthma was observed in 42.7% of patients at diagnosis and was associated with previous history of respiratory allergy (p<0.01), elevated serum total IgE levels (p<0.05), increased use of high dose inhaled (ICS; p<0.05) and oral corticosteroids (OCS; p<0.001) for respiratory symptoms the year before the diagnosis of EGPA. During follow-up, an improvement or worsening in asthma severity was noted in 12.3% and 10.1% of patients, respectively. Severe/uncontrolled asthma was present in 40.5% of patients at 3 years, and was associated with increased airway resistance on pulmonary function testing (p<0.05). Long-term PFTs did not improve during long-term follow-up regardless of ICS or OCS therapy. Using multivariate binary logistic regressions, severe rhinosinusitis (p=0.038), pulmonary infiltrates (p=0.011), overweight (BMI>25kg/m2; p=0.041) and severe/uncontrolled asthma at vasculitis diagnosis (p<0.001) independently predicted severe/uncontrolled asthma at the 3-year endpoint.
CONCLUSION:In asthmatic patients with EGPA, long-term severe/uncontrolled asthma is associated with baseline pulmonary and ENT manifestations, but not with clear-cut vasculitic features.
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