肥胖和肥胖性哮喘的外周气道功能障碍
2023/02/01
摘要
背景：本研究的目的是探讨肥胖患者哮喘的生理表型。支气管收缩时的生理反应能区分肥胖患者的不同哮喘组吗?也能区分与肥胖相关的反应吗?
方法：对肥胖患者进行横断面研究(31例有哮喘，22例无肺部疾病)。参与者进行了乙酰胆碱刺激试验，用振荡法测量呼吸系统阻抗和肺活量。
结果：参与者有III类肥胖(BMI 46.7±6.6对照组和47.2±8.2哮喘)。大多数参与者对乙酰胆碱的反应有显著的外周气道阻抗变化:在5Hz的对照组中，电阻R5增加了45±27%，电抗曲线下的面积AX在16 mg/ml乙酰胆碱的反应中增加了268±236%;在哮喘患者中，PC20剂量的甲基胆碱使R5增加52±38%，AX增加361±295 %。这些反应表明肥胖倾向于外周气道反应性。根据呼吸系统阻抗，出现了两组不同的哮喘:一组具有较低的抗抗(基线AX 11.8(IQR 9.9至23.4)cmH2O.L-1)和更协调的中央和外周气道支气管收缩;另一种为高抗(基线AX 46.7(IQR 23.2, 53.7) cmH2O.L-1)，中央和外周气道支气管收缩反应不一致。高抗哮喘组仅包括女性，与低抗组相比，高抗哮喘组报告了明显更多的胃食管反流疾病、更严重的胸闷、更多的喘息和更多的哮喘加重。
结论：通过振荡测量法检测外周气道反应性在肥胖对照组和肥胖哮喘患者中很常见。肥胖哮喘有一个亚组，其特征是周围气道功能障碍明显，其振荡测量与呼吸测量气道功能障碍不成比例。这种外周功能障碍是临床上重要的呼吸系统疾病，无法通过肺活量测定进行评估。
Peripheral airway dysfunction in obesity and obese asthma
Dixon AE, Poynter ME, Garrow OJ, Kaminsky DA, Tharp WG, Bates JH.
Abstract
BACKGROUNDS: The purpose of this study was to investigate physiologic phenotypes of asthma in obesity. Do physiologic responses during bronchoconstriction distinguish different groups of asthma in people with obesity, and also differentiate from responses simply related to obesity?
METHODS:Cross-sectional study of people with obesity (31 with asthma, and 22 without lung disease). Participants underwent methacholine challenge testing with measurement of spirometry and respiratory system impedance by oscillometry.
RESULTS: Participants had class III obesity (BMI 46.7 ± 6.6 controls and 47.2 ± 8.2 asthmatics). Most participants had significant changes in peripheral airway impedance in response to methacholine: in controls resistance at 5 Hz, R5, increased 45 ± 27 % and area under the reactance curve, AX, 268 ± 236% in response to 16 mg/ml methacholine; in people with asthma, R5 increased 52 ± 38 % and AX 361 ± 295 % in response to PC20 dose of methacholine. These responses suggest that obesity predisposes to peripheral airway reactivity. Two distinct groups of asthma emerged based on respiratory system impedance: one with lower reactance (baseline AX 11.8 (IQR 9.9 to 23.4) cmH2O.L-1) and more concordant bronchoconstriction in central and peripheral airways; the other with high reactance (baseline AX 46.7 (IQR 23.2, 53.7) cmH2O.L-1) and discordant bronchoconstriction responses in central and peripheral airways. The high reactance asthma group included only women, and reported significantly more gastroesophageal reflux disease, worse chest tightness, more wheeze and more asthma exacerbations than the low reactance group.
CONCLUSIONS: Peripheral airway reactivity detected by oscillometry is common in obese controls and obese people with asthma. There is a sub-group of obese asthma characterized by significant peripheral airway dysfunction by oscillometry out of proportion to spirometric airway dysfunction. This peripheral dysfunction represents clinically significant respiratory disease not readily assessed by spirometry.
背景：本研究的目的是探讨肥胖患者哮喘的生理表型。支气管收缩时的生理反应能区分肥胖患者的不同哮喘组吗?也能区分与肥胖相关的反应吗?
方法：对肥胖患者进行横断面研究(31例有哮喘，22例无肺部疾病)。参与者进行了乙酰胆碱刺激试验，用振荡法测量呼吸系统阻抗和肺活量。
结果：参与者有III类肥胖(BMI 46.7±6.6对照组和47.2±8.2哮喘)。大多数参与者对乙酰胆碱的反应有显著的外周气道阻抗变化:在5Hz的对照组中，电阻R5增加了45±27%，电抗曲线下的面积AX在16 mg/ml乙酰胆碱的反应中增加了268±236%;在哮喘患者中，PC20剂量的甲基胆碱使R5增加52±38%，AX增加361±295 %。这些反应表明肥胖倾向于外周气道反应性。根据呼吸系统阻抗，出现了两组不同的哮喘:一组具有较低的抗抗(基线AX 11.8(IQR 9.9至23.4)cmH2O.L-1)和更协调的中央和外周气道支气管收缩;另一种为高抗(基线AX 46.7(IQR 23.2, 53.7) cmH2O.L-1)，中央和外周气道支气管收缩反应不一致。高抗哮喘组仅包括女性，与低抗组相比，高抗哮喘组报告了明显更多的胃食管反流疾病、更严重的胸闷、更多的喘息和更多的哮喘加重。
结论：通过振荡测量法检测外周气道反应性在肥胖对照组和肥胖哮喘患者中很常见。肥胖哮喘有一个亚组，其特征是周围气道功能障碍明显，其振荡测量与呼吸测量气道功能障碍不成比例。这种外周功能障碍是临床上重要的呼吸系统疾病，无法通过肺活量测定进行评估。
（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）
（Chest. 2023 Jan 4;S0012-3692(23)00005-3 doi: 10.1016/j.chest.2022.12.030）
（Chest. 2023 Jan 4;S0012-3692(23)00005-3 doi: 10.1016/j.chest.2022.12.030）
Peripheral airway dysfunction in obesity and obese asthma
Dixon AE, Poynter ME, Garrow OJ, Kaminsky DA, Tharp WG, Bates JH.
Abstract
BACKGROUNDS: The purpose of this study was to investigate physiologic phenotypes of asthma in obesity. Do physiologic responses during bronchoconstriction distinguish different groups of asthma in people with obesity, and also differentiate from responses simply related to obesity?
METHODS:Cross-sectional study of people with obesity (31 with asthma, and 22 without lung disease). Participants underwent methacholine challenge testing with measurement of spirometry and respiratory system impedance by oscillometry.
RESULTS: Participants had class III obesity (BMI 46.7 ± 6.6 controls and 47.2 ± 8.2 asthmatics). Most participants had significant changes in peripheral airway impedance in response to methacholine: in controls resistance at 5 Hz, R5, increased 45 ± 27 % and area under the reactance curve, AX, 268 ± 236% in response to 16 mg/ml methacholine; in people with asthma, R5 increased 52 ± 38 % and AX 361 ± 295 % in response to PC20 dose of methacholine. These responses suggest that obesity predisposes to peripheral airway reactivity. Two distinct groups of asthma emerged based on respiratory system impedance: one with lower reactance (baseline AX 11.8 (IQR 9.9 to 23.4) cmH2O.L-1) and more concordant bronchoconstriction in central and peripheral airways; the other with high reactance (baseline AX 46.7 (IQR 23.2, 53.7) cmH2O.L-1) and discordant bronchoconstriction responses in central and peripheral airways. The high reactance asthma group included only women, and reported significantly more gastroesophageal reflux disease, worse chest tightness, more wheeze and more asthma exacerbations than the low reactance group.
CONCLUSIONS: Peripheral airway reactivity detected by oscillometry is common in obese controls and obese people with asthma. There is a sub-group of obese asthma characterized by significant peripheral airway dysfunction by oscillometry out of proportion to spirometric airway dysfunction. This peripheral dysfunction represents clinically significant respiratory disease not readily assessed by spirometry.
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持续性哮喘患者呼吸系统阻力和电抗受损与支气管壁增厚相关
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黄体微球菌衍生的细胞外囊泡通过调节气道上皮细胞中的miRNA来减轻中性粒细胞性哮喘
