血液中的类胰蛋白酶和胸腺基质淋巴细胞生成素水平可预测严重哮喘加重的风险
2021/05/26
摘要
背景：一些重度哮喘患者尽管接受了多种治疗，但仍病情加重。恶化和对治疗的异质性反应的风险可能与对皮质类固醇有反应性或耐药性的特定炎症分子有关。
目的：我们旨在确定预测严重哮喘患者未来加重风险的独立因素。
方法：在这项多中心前瞻性观察研究中，招募了132例重度哮喘患者，并根据1年随访后的恶化率将其分为急性发作（n = 52）和非急性发作（n = 80）组。
结果：我们发现先前的严重加重病史、基线血嗜酸性粒细胞计数（≥291cells/μL）和血清类胰蛋白酶（≤1448 pg/mL）和胸腺基质淋巴细胞生成素（TSLP）水平（≥25pg / mL）独立存在预测加重后的未来发展，调整后的优势比（AOR）分别为3.27、6.04、2.53和8.67。值得注意的是，血液嗜酸性粒细胞计数高和类胰蛋白酶水平低的患者可能比血液嗜酸粒细胞计数低和类胰蛋白酶水平高的患者病情加重（AOR 16.9）。
结论：TSLP可能在不同的哮喘表型之间发挥致病作用。TSLP和类胰蛋白酶水平可能与哮喘炎症过程中的类固醇耐药性和反应性有关。血嗜酸性粒细胞计数高和血清类胰蛋白酶水平低预示着未来哮喘加重的可能性很高。
Blood tryptase and thymic stromal lymphopoietin levels predict the risk of exacerbation in severe asthma
Ko HK, Cheng SL, Lin CH, et al.
Abstract
BACKGROUND:Some patients with severe asthma experience exacerbations despite receiving multiple therapy. The risk of exacerbation and heterogeneous response to treatment may be associated with specific inflammatory molecules that are responsive or resistant to corticosteroids.
OBJECTIVE:We aimed to identify the independent factors predictive for the future risk of exacerbation in patients with severe asthma.
METHODS: In this multi-center prospective observational study, 132 patients with severe asthma were enrolled and divided into exacerbation (n= 52) and non-exacerbation (n= 80) groups on the basis of exacerbation rate after a 1-year follow-up period.
RESULTS: We found that previous history of severe-to-serious exacerbation, baseline blood eosinophil counts (≥291cells/μL), and serum tryptase (≤ 1448 pg/mL) and thymic stromal lymphopoietin (TSLP) levels (≥25 pg/mL) independently predicted the future development of exacerbation with adjusted odds ratios (AOR) of 3.27, 6.04, 2.53 and 8.67, respectively. Notably, the patients with high blood eosinophil counts and low tryptase levels were likely to have more exacerbations than those with low blood eosinophil counts and high tryptase levels (AOR 16.9).
CONCLUSIONS: TSLP potentially played the pathogenic role across different asthma phenotypes. TSLP and tryptase levels may be implicated in steroid resistance and responsiveness in the asthma inflammatory process. High blood eosinophil counts and low serum tryptase levels predict a high probability of future asthma exacerbation.
背景：一些重度哮喘患者尽管接受了多种治疗，但仍病情加重。恶化和对治疗的异质性反应的风险可能与对皮质类固醇有反应性或耐药性的特定炎症分子有关。
目的：我们旨在确定预测严重哮喘患者未来加重风险的独立因素。
方法：在这项多中心前瞻性观察研究中，招募了132例重度哮喘患者，并根据1年随访后的恶化率将其分为急性发作（n = 52）和非急性发作（n = 80）组。
结果：我们发现先前的严重加重病史、基线血嗜酸性粒细胞计数（≥291cells/μL）和血清类胰蛋白酶（≤1448 pg/mL）和胸腺基质淋巴细胞生成素（TSLP）水平（≥25pg / mL）独立存在预测加重后的未来发展，调整后的优势比（AOR）分别为3.27、6.04、2.53和8.67。值得注意的是，血液嗜酸性粒细胞计数高和类胰蛋白酶水平低的患者可能比血液嗜酸粒细胞计数低和类胰蛋白酶水平高的患者病情加重（AOR 16.9）。
结论：TSLP可能在不同的哮喘表型之间发挥致病作用。TSLP和类胰蛋白酶水平可能与哮喘炎症过程中的类固醇耐药性和反应性有关。血嗜酸性粒细胞计数高和血清类胰蛋白酶水平低预示着未来哮喘加重的可能性很高。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Sci Rep, 2021, 11(1): 8425.）
（Sci Rep, 2021, 11(1): 8425.）
Blood tryptase and thymic stromal lymphopoietin levels predict the risk of exacerbation in severe asthma
Ko HK, Cheng SL, Lin CH, et al.
Abstract
BACKGROUND:Some patients with severe asthma experience exacerbations despite receiving multiple therapy. The risk of exacerbation and heterogeneous response to treatment may be associated with specific inflammatory molecules that are responsive or resistant to corticosteroids.
OBJECTIVE:We aimed to identify the independent factors predictive for the future risk of exacerbation in patients with severe asthma.
METHODS: In this multi-center prospective observational study, 132 patients with severe asthma were enrolled and divided into exacerbation (n= 52) and non-exacerbation (n= 80) groups on the basis of exacerbation rate after a 1-year follow-up period.
RESULTS: We found that previous history of severe-to-serious exacerbation, baseline blood eosinophil counts (≥291cells/μL), and serum tryptase (≤ 1448 pg/mL) and thymic stromal lymphopoietin (TSLP) levels (≥25 pg/mL) independently predicted the future development of exacerbation with adjusted odds ratios (AOR) of 3.27, 6.04, 2.53 and 8.67, respectively. Notably, the patients with high blood eosinophil counts and low tryptase levels were likely to have more exacerbations than those with low blood eosinophil counts and high tryptase levels (AOR 16.9).
CONCLUSIONS: TSLP potentially played the pathogenic role across different asthma phenotypes. TSLP and tryptase levels may be implicated in steroid resistance and responsiveness in the asthma inflammatory process. High blood eosinophil counts and low serum tryptase levels predict a high probability of future asthma exacerbation.
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采用低剂量吸入糖皮质激素和长效β2激动剂得以控制的患者的哮喘控制治疗降级的实用性随机对照试验：SIGMA研究
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