现实生活中严重哮喘的不同方面:金黄色葡萄球菌肠毒素的作用和与合并症以及疾病严重程度的相关性
2022/08/19
摘要
背景：哮喘有几种表型和内型，被认为特别适合精准医疗。识别不同的非侵入性生物标志物可能有助于诊断和治疗。最近，金黄色葡萄球菌及其肠毒素(SE)被发现在严重哮喘中诱导持续的2型气道炎症，但也在慢性鼻-鼻窦炎合并鼻息肉(CRSwNP)等合并症中发挥作用。
方法：这项回顾性研究的目的是评估意大利多中心重症哮喘患者队列中SE-IgE致敏的发生率，并将其与人口统计学和临床特征联系起来。
结果：共249例患者纳入分析，其中25.3%为葡萄球菌肠毒素B(SEB)-IgE阳性。我们发现SEB-IgE与女性性别之间存在显著的相关性，CRS和CRSwNP之间也存在正相关。SEB-IgE致敏与特异反应、急性发作的发生和皮质类固醇剂量之间未发现显著相关性。在SEB-IgE阳性患者中，血嗜酸性粒细胞计数似乎与疾病的严重程度无关。SEB-IgE致敏的患者平均年龄较小，发病时间较早，这证实了将SEB-IgE致敏作为哮喘发生的独立危险因素的可能性。
结论：我们的数据证实，在这些患者的初始筛选阶段寻找SE有助于他们更好的表型化，可能能够预测合并症的进程，并形成有针对性的治疗选择;从这个角度来看，这代表了精准医疗的一个目标。
Different aspects of severe asthma in real life: Role of Staphylococcus aureus enterotoxins and correlation to comorbidities and disease severity
Cristiano Caruso, Stefania Colantuono, Gabriele Ciasca, et al.
Abstract
BACKGROUND：Asthma, with several phenotypes and endotypes, is considered particularly suited for precision medicine. The identification of different non-invasive biomarkers may facilitate diagnosis and treatment. Recently, Staphylococcus aureus and its enterotoxins (SE) have been found to have a role in inducing persistent type 2 airway inflammation in severe asthma, but also in such comorbidities as chronic rhinosinusitis with nasal polyposis (CRSwNP).
METHODS：The aim of this retrospective study was to evaluate the prevalence of SE-IgE sensitization in a multicentric Italian cohort of severe asthmatic patients and correlate it with demographic and clinical characteristics.
RESULTS：A total of 249 patients were included in the analysis, out of which 25.3% were staphylococcal enterotoxin B (SEB)-IgE positive. We found a meaningful association between SEB-IgE and female gender, a positive association was also measured between CRS and CRSwNP. No significant association was found between SEB-IgE sensitization and atopy, the occurrence of exacerbations and corticosteroid dosages. In the SEB-IgE-positive patient, blood eosinophil count does not appear to be correlated with the severity of the disease. Patients with SEB-IgE sensitization are, on average, younger and with an earlier disease onset, thus confirming the possibility to consider SEB-IgE sensitization as an independent risk factor for developing asthma.
CONCLUSIONS：Our data confirm that the search for SE in the initial screening phase of these patients is helpful to better phenotype them, may predict the evolution of comorbidities and lead to a targeted therapeutic choice; in this point of view this represents a goal of precision medicine.
背景：哮喘有几种表型和内型，被认为特别适合精准医疗。识别不同的非侵入性生物标志物可能有助于诊断和治疗。最近，金黄色葡萄球菌及其肠毒素(SE)被发现在严重哮喘中诱导持续的2型气道炎症，但也在慢性鼻-鼻窦炎合并鼻息肉(CRSwNP)等合并症中发挥作用。
方法：这项回顾性研究的目的是评估意大利多中心重症哮喘患者队列中SE-IgE致敏的发生率，并将其与人口统计学和临床特征联系起来。
结果：共249例患者纳入分析，其中25.3%为葡萄球菌肠毒素B(SEB)-IgE阳性。我们发现SEB-IgE与女性性别之间存在显著的相关性，CRS和CRSwNP之间也存在正相关。SEB-IgE致敏与特异反应、急性发作的发生和皮质类固醇剂量之间未发现显著相关性。在SEB-IgE阳性患者中，血嗜酸性粒细胞计数似乎与疾病的严重程度无关。SEB-IgE致敏的患者平均年龄较小，发病时间较早，这证实了将SEB-IgE致敏作为哮喘发生的独立危险因素的可能性。
结论：我们的数据证实，在这些患者的初始筛选阶段寻找SE有助于他们更好的表型化，可能能够预测合并症的进程，并形成有针对性的治疗选择;从这个角度来看，这代表了精准医疗的一个目标。
（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）
（Allergy. 2022;00:1–10 DOI: 10.1111/all.15466）
（Allergy. 2022;00:1–10 DOI: 10.1111/all.15466）
Different aspects of severe asthma in real life: Role of Staphylococcus aureus enterotoxins and correlation to comorbidities and disease severity
Cristiano Caruso, Stefania Colantuono, Gabriele Ciasca, et al.
Abstract
BACKGROUND：Asthma, with several phenotypes and endotypes, is considered particularly suited for precision medicine. The identification of different non-invasive biomarkers may facilitate diagnosis and treatment. Recently, Staphylococcus aureus and its enterotoxins (SE) have been found to have a role in inducing persistent type 2 airway inflammation in severe asthma, but also in such comorbidities as chronic rhinosinusitis with nasal polyposis (CRSwNP).
METHODS：The aim of this retrospective study was to evaluate the prevalence of SE-IgE sensitization in a multicentric Italian cohort of severe asthmatic patients and correlate it with demographic and clinical characteristics.
RESULTS：A total of 249 patients were included in the analysis, out of which 25.3% were staphylococcal enterotoxin B (SEB)-IgE positive. We found a meaningful association between SEB-IgE and female gender, a positive association was also measured between CRS and CRSwNP. No significant association was found between SEB-IgE sensitization and atopy, the occurrence of exacerbations and corticosteroid dosages. In the SEB-IgE-positive patient, blood eosinophil count does not appear to be correlated with the severity of the disease. Patients with SEB-IgE sensitization are, on average, younger and with an earlier disease onset, thus confirming the possibility to consider SEB-IgE sensitization as an independent risk factor for developing asthma.
CONCLUSIONS：Our data confirm that the search for SE in the initial screening phase of these patients is helpful to better phenotype them, may predict the evolution of comorbidities and lead to a targeted therapeutic choice; in this point of view this represents a goal of precision medicine.
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