应用糖皮质激素毒性指数量化严重哮喘患者的糖皮质激素相关并发症率
2020/09/18
摘要
背景：重症哮喘（SA）患者的糖皮质激素（GC）相关并发症已被充分认知，但在个体患者中有所不同；系统评价GC毒性对于持续使用类固醇激素的患者衡量病情改善非常重要。
目的：首次用糖皮质激素毒性指数（GTI）描述激素依赖性SA患者的GC毒性。
方法：在英国一家区域性SA专科医院进行观察性队列研究，在常规临床护理中使用GTI对GC相关发病率进行系统评估。GTI与常用的患者报告结果指标相关。介绍了GTI评分的方法、MCID的计算以及数字GTI在临床常规护理中的应用。
结果：所有患者都有明显的口服GC暴露（累积泼尼松龙/上一年4280mg[3083，5475]），且在个体患者中具有广泛的毒性分布（平均GTI评分177.5（73.7））。GTI评分与最近的泼尼松龙服用仅存在适度相关性；维持泼尼松龙剂量（rho=0.26，p=0.01）、累积暴露量/上一年（rho=0.38，p<0.001）和GC增加/上一年（rho=0.25，p=0.01）之间存在一定的相关性。GTI毒性与哮喘相关生活质量的相关性更强（mini-AQLQ r=-0.50，p<0.001和SGRQ r=0.42，p<0.001）。GTI MCID按10分计算。多元线性回归显示年龄和mini-AQLQ是GC毒性的最强预测因子。
结论：GTI是一个可以系统地捕捉和量化个体患者GC毒性有效工具。不同SA患者的GC毒性差异很大，仅与上一年GC暴露量相关。年龄和mini-AQLQ是GC毒性的较好预测因子。GTI和MCID将有助于临床试验和日常护理中评估个体SA对类固醇的反应。
Quantification of Glucocorticoid-associated morbidity in Severe Asthma using the Glucocorticoid Toxicity Index
P Jane McDowell , John H Stone , Yuqing Zhang , Kirsty Honeyford , Louise Dunn , R Jayne Logan , Claire A Butler , Lorcan Pa McGarvey , Liam G Heaney
Abstract
Background: Glucocorticoid (GC)-associated morbidity in severe asthma (SA) is well recognised but varies in individual patients; systematic measurement of GC-toxicity is important to measure improvement with steroid-sparing monoclonal antibodies.
Objective: Describe for the first time individual patient GC-toxicity in steroid-dependent SA using the glucocorticoid toxicity index (GTI).
Methods: Observational consecutive patient cohort study at a UK Regional SA Specialist clinic undergoing systematic assessment of GC-associated morbidity using the GTI in routine clinical care. GTI was correlated with commonly used patient reported outcome measures. Approach to GTI scoring, calculation of MCID and development of digital GTI application in routine clinical care are described.
Results: All patients had significant oral GC-exposure (cumulative prednisolone/prior year 4280mg [3083, 5475]) with wide distribution of toxicity in individual patients (mean GTI score 177.5 (73.7)). GTI score had only modest correlation with recent prednisolone exposure; maintenance prednisolone dose (rho=0.26, p=0.01), cumulative exposure/prior year (rho=0.38, p<0.001) and GC boosts/prior year (rho=0.25, p=0.01). GTI-toxicity demonstrated stronger associations with asthma-related quality-of-life (mini-AQLQ r=-0.50, p<0.001 and SGRQ r=0.42, p<0.001). GTI MCID was calculated as 10 points. Multiple linear regression demonstrated that age and mini-AQLQ were strongest predictors of GC-toxicity.
Conclusions: The GTI is a useful tool to systematically capture and quantify GC-toxicity at the individual patient level. GC-toxicity varies widely between individual SA patients and correlated only modestly with GC exposure over the preceding year. Age and mini-AQLQ are better predictors of GC-toxicity. The GTI and MCID will facilitate assessment of individual SA response to steroid-sparing agents in clinical trials and routine care.
背景：重症哮喘（SA）患者的糖皮质激素（GC）相关并发症已被充分认知，但在个体患者中有所不同；系统评价GC毒性对于持续使用类固醇激素的患者衡量病情改善非常重要。
目的：首次用糖皮质激素毒性指数（GTI）描述激素依赖性SA患者的GC毒性。
方法：在英国一家区域性SA专科医院进行观察性队列研究，在常规临床护理中使用GTI对GC相关发病率进行系统评估。GTI与常用的患者报告结果指标相关。介绍了GTI评分的方法、MCID的计算以及数字GTI在临床常规护理中的应用。
结果：所有患者都有明显的口服GC暴露（累积泼尼松龙/上一年4280mg[3083，5475]），且在个体患者中具有广泛的毒性分布（平均GTI评分177.5（73.7））。GTI评分与最近的泼尼松龙服用仅存在适度相关性；维持泼尼松龙剂量（rho=0.26，p=0.01）、累积暴露量/上一年（rho=0.38，p<0.001）和GC增加/上一年（rho=0.25，p=0.01）之间存在一定的相关性。GTI毒性与哮喘相关生活质量的相关性更强（mini-AQLQ r=-0.50，p<0.001和SGRQ r=0.42，p<0.001）。GTI MCID按10分计算。多元线性回归显示年龄和mini-AQLQ是GC毒性的最强预测因子。
结论：GTI是一个可以系统地捕捉和量化个体患者GC毒性有效工具。不同SA患者的GC毒性差异很大，仅与上一年GC暴露量相关。年龄和mini-AQLQ是GC毒性的较好预测因子。GTI和MCID将有助于临床试验和日常护理中评估个体SA对类固醇的反应。
(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. 2020 Aug 31;S2213-2198(20)30864-3. doi: 10.1016/j.jaip.2020.08.032.)
(J Allergy Clin Immunol Pract. 2020 Aug 31;S2213-2198(20)30864-3. doi: 10.1016/j.jaip.2020.08.032.)
Quantification of Glucocorticoid-associated morbidity in Severe Asthma using the Glucocorticoid Toxicity Index
P Jane McDowell , John H Stone , Yuqing Zhang , Kirsty Honeyford , Louise Dunn , R Jayne Logan , Claire A Butler , Lorcan Pa McGarvey , Liam G Heaney
Abstract
Background: Glucocorticoid (GC)-associated morbidity in severe asthma (SA) is well recognised but varies in individual patients; systematic measurement of GC-toxicity is important to measure improvement with steroid-sparing monoclonal antibodies.
Objective: Describe for the first time individual patient GC-toxicity in steroid-dependent SA using the glucocorticoid toxicity index (GTI).
Methods: Observational consecutive patient cohort study at a UK Regional SA Specialist clinic undergoing systematic assessment of GC-associated morbidity using the GTI in routine clinical care. GTI was correlated with commonly used patient reported outcome measures. Approach to GTI scoring, calculation of MCID and development of digital GTI application in routine clinical care are described.
Results: All patients had significant oral GC-exposure (cumulative prednisolone/prior year 4280mg [3083, 5475]) with wide distribution of toxicity in individual patients (mean GTI score 177.5 (73.7)). GTI score had only modest correlation with recent prednisolone exposure; maintenance prednisolone dose (rho=0.26, p=0.01), cumulative exposure/prior year (rho=0.38, p<0.001) and GC boosts/prior year (rho=0.25, p=0.01). GTI-toxicity demonstrated stronger associations with asthma-related quality-of-life (mini-AQLQ r=-0.50, p<0.001 and SGRQ r=0.42, p<0.001). GTI MCID was calculated as 10 points. Multiple linear regression demonstrated that age and mini-AQLQ were strongest predictors of GC-toxicity.
Conclusions: The GTI is a useful tool to systematically capture and quantify GC-toxicity at the individual patient level. GC-toxicity varies widely between individual SA patients and correlated only modestly with GC exposure over the preceding year. Age and mini-AQLQ are better predictors of GC-toxicity. The GTI and MCID will facilitate assessment of individual SA response to steroid-sparing agents in clinical trials and routine care.
上一篇：
哮喘及哮喘药物治疗对COVID-19患者预后的影响
下一篇：
哮喘的多维评估确定临床相关表型重叠：一项横断面研究
