呼吸道变应原的累积IgE水平作为预测以抗IgE为基础的重症哮喘治疗疗效的生物标志物
2022/10/17
摘要
背景：包括抗IgE、生物制品和小分子在内的分子疗法越来越多地用于哮喘的治疗。这些疗法的有效性可以通过生物标记物来提高。
目的：探讨检测呼吸道变应原特异性IgE累积水平对提高重症哮喘抗-IgE治疗效果的价值。
方法：选择2016年至2022年间收治的137例重症哮喘患者。Phadiatop™进行标准的经验性变态反应诊断(即病历、皮肤测试、变应原特异性免疫球蛋白E测定)、血嗜酸粒细胞计数、总免疫球蛋白E和呼吸道变应原累积特异性免疫球蛋白E的测定。采用三种诊断方法对34例重症过敏性哮喘患者按Phadiatop™检测呼吸道变应原的累积IgE水平进行分层，分析抗-IgE治疗的疗效。
结果：第 1组患者(n = 8) 的累积特异性IgE值≥0.35和 < 1.53 PAU/L, 第2组患者(n = 26)累积特异性IgE值≥1.53 PAU/L。使用Omalizumab治疗至少12个月。哮喘控制水平(ACT问卷)、哮喘加重次数、生活质量(AQLQ问卷)、全身皮质类固醇的需用情况和呼吸功能(FEV1)通过各组“前后”分析确定，然后比较组间动态。在初始过敏原特异性IgE水平≥1.53 kUA/L的第2组患者中，Omalizumab治疗在哮喘控制、加重次数和生活质量方面优于第1组患者。
结论：我们的研究提供了证据，表明测量呼吸道变应原特异性IgE的累积水平可能是检测重症哮喘过敏表型的一种有用的筛查方法，并可能作为提高IgE靶向治疗成功的生物标志物。
Cumulative IgE-levels specific for respiratory allergens as biomarker to predict efficacy of anti-IgE-based treatment of severe asthma.
Naumova V, Beltyukov E, Niespodziana K.
Abstrast
Background: Molecular therapies, including anti-IgE, biologicals and small molecules are increasingly used for treatment of asthma. The effectiveness of these therapies may be increased with biomarkers.
Objective：Aim of this study was to assess the value of measuring cumulative IgE levels specific for respiratory allergens to increase the efficacy of anti-IgE therapy for severe bronchial asthma.
Methods: One hundred and thirty seven patients with severe asthma were recruited from 2016 to 2022. Standard empirical allergy diagnosis (i.e., anamnesis, skin testing, allergen-specific IgE measurement), blood eosinophil counting, measurement of total IgE and of cumulative IgE-specific for respiratory allergens by Phadiatop™ were performed. Thirty four patients with severe allergic asthma, for whom all three diagnostic methods were performed, were then used to analyze the efficacy of anti-IgE treatment in patients stratified in two groups according to cumulative IgE levels specific for respiratory allergens determined by Phadiatop™.
Results: Group #1 patients (n = 8) had cumulative specific IgE values ≥ 0.35 and < 1.53 PAU/L while in group #2 patients (n = 26) they were ≥ 1.53 PAU/L. Treatment with Omalizumab was performed for at least 12 months. The level of asthma control (ACT questionnaire), the number of asthma exacerbations, the quality of life (AQLQ questionnaire), the need for systemic corticosteroids, and the respiratory function (FEV1) was determined by "before-after" analysis for each group, followed by a comparison of the dynamics between groups. In group 2 patients with an initial allergen-specific IgE level ≥ 1.53 kUA/L, the efficacy of Omalizumab treatment was better regarding asthma control, number of exacerbations, and quality of life than in group 1 patients.
Conclusions: Our study provides evidence that measuring cumulative levels of IgE specific for respiratory allergens could be a useful screening method for detecting an allergic phenotype of severe asthma and may serve as biomarker to enhance the success of IgE-targeted therapy.
背景：包括抗IgE、生物制品和小分子在内的分子疗法越来越多地用于哮喘的治疗。这些疗法的有效性可以通过生物标记物来提高。
目的：探讨检测呼吸道变应原特异性IgE累积水平对提高重症哮喘抗-IgE治疗效果的价值。
方法：选择2016年至2022年间收治的137例重症哮喘患者。Phadiatop™进行标准的经验性变态反应诊断(即病历、皮肤测试、变应原特异性免疫球蛋白E测定)、血嗜酸粒细胞计数、总免疫球蛋白E和呼吸道变应原累积特异性免疫球蛋白E的测定。采用三种诊断方法对34例重症过敏性哮喘患者按Phadiatop™检测呼吸道变应原的累积IgE水平进行分层，分析抗-IgE治疗的疗效。
结果：第 1组患者(n = 8) 的累积特异性IgE值≥0.35和 < 1.53 PAU/L, 第2组患者(n = 26)累积特异性IgE值≥1.53 PAU/L。使用Omalizumab治疗至少12个月。哮喘控制水平(ACT问卷)、哮喘加重次数、生活质量(AQLQ问卷)、全身皮质类固醇的需用情况和呼吸功能(FEV1)通过各组“前后”分析确定，然后比较组间动态。在初始过敏原特异性IgE水平≥1.53 kUA/L的第2组患者中，Omalizumab治疗在哮喘控制、加重次数和生活质量方面优于第1组患者。
结论：我们的研究提供了证据，表明测量呼吸道变应原特异性IgE的累积水平可能是检测重症哮喘过敏表型的一种有用的筛查方法，并可能作为提高IgE靶向治疗成功的生物标志物。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(Front Immunol 2022;13. 10.3389/fimmu.2022.941492. IF: 5.085)
(Front Immunol 2022;13. 10.3389/fimmu.2022.941492. IF: 5.085)
Cumulative IgE-levels specific for respiratory allergens as biomarker to predict efficacy of anti-IgE-based treatment of severe asthma.
Naumova V, Beltyukov E, Niespodziana K.
Abstrast
Background: Molecular therapies, including anti-IgE, biologicals and small molecules are increasingly used for treatment of asthma. The effectiveness of these therapies may be increased with biomarkers.
Objective：Aim of this study was to assess the value of measuring cumulative IgE levels specific for respiratory allergens to increase the efficacy of anti-IgE therapy for severe bronchial asthma.
Methods: One hundred and thirty seven patients with severe asthma were recruited from 2016 to 2022. Standard empirical allergy diagnosis (i.e., anamnesis, skin testing, allergen-specific IgE measurement), blood eosinophil counting, measurement of total IgE and of cumulative IgE-specific for respiratory allergens by Phadiatop™ were performed. Thirty four patients with severe allergic asthma, for whom all three diagnostic methods were performed, were then used to analyze the efficacy of anti-IgE treatment in patients stratified in two groups according to cumulative IgE levels specific for respiratory allergens determined by Phadiatop™.
Results: Group #1 patients (n = 8) had cumulative specific IgE values ≥ 0.35 and < 1.53 PAU/L while in group #2 patients (n = 26) they were ≥ 1.53 PAU/L. Treatment with Omalizumab was performed for at least 12 months. The level of asthma control (ACT questionnaire), the number of asthma exacerbations, the quality of life (AQLQ questionnaire), the need for systemic corticosteroids, and the respiratory function (FEV1) was determined by "before-after" analysis for each group, followed by a comparison of the dynamics between groups. In group 2 patients with an initial allergen-specific IgE level ≥ 1.53 kUA/L, the efficacy of Omalizumab treatment was better regarding asthma control, number of exacerbations, and quality of life than in group 1 patients.
Conclusions: Our study provides evidence that measuring cumulative levels of IgE specific for respiratory allergens could be a useful screening method for detecting an allergic phenotype of severe asthma and may serve as biomarker to enhance the success of IgE-targeted therapy.
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体外膜氧合(ECMO)治疗难治性哮喘加重合并呼吸衰竭
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严重哮喘研究计划（SARP）中的骨骼肌脂肪沉积和肺功能轨迹
