血嗜酸性粒细胞预测学龄前儿童反复喘息加重
2023/02/20
摘要
背景：已发现在复发性喘息的学龄前儿童中，2型炎症的临床特征与纵向预后较差相关，但仍难以预测哪些儿童在常规临床治疗中预后较差的风险最高。
目的：本研究验证了预设血嗜酸性粒细胞计数分界点可以预测复发性喘息的学龄前儿童的病情恶化和治疗反应结果，并且增加第二个生物标志物可改进预测水平。
方法：本研究合并了来自三项关于1074名12-71个月龄罹患复发性喘息的学龄前儿童的临床试验数据。主要结果包括随访期间出现任何病情恶化。次要结果包括哮喘年发作率和需要住院治疗的任何发作的发生率。探索性分析侧重于吸入糖皮质激素治疗开始后的病情加重结果、离线呼出一氧化氮浓度以及护理者报告的哮喘控制分数。
结果：在复发性喘息的学龄前儿童中，每一个血嗜酸性粒细胞分界点与病情加重概率增加、加重率增加及住院率增加有关。然而，在血嗜酸性粒细胞计数升高的儿童中，结果检测得到改善。在探索性分析中，增加第二种2型炎症生物标志物可改善结果检测，并进一步提高与日吸入糖皮质激素初始治疗反应的相关性。然而，血液嗜酸性粒细胞的特异性较差。
结论：尽管有必要进行验证性研究，但血嗜酸性粒细胞分界点可能有助于临床评估和未来研究复发性喘息的学龄前儿童的病情加重和治疗反应。
Blood eosinophils for prediction of exacerbation in preschool children with recurrent wheezing.
Fitzpatrick AM, Grunwell JR, Cottrill KA, Mutic AD, Mauger DT
Abstract
BACKGROUND:Although clinical features of Type 2 inflammation have been associated with poorer longitudinal outcomes in preschool children with recurrent wheezing, it remains difficult to predict which children are at highest risk for poor outcomes during a routine clinical encounter.
OBJECTIVES: We tested the hypothesis that pre-specified cut points of blood eosinophil counts would predict exacerbation and treatment response outcomes in preschool children with recurrent wheezing and that prediction could be improved with the addition of a second biomarker.
METHODS:Data from three clinical trials of 1,074 preschool children aged 12-71 months with recurrent wheezing were merged. The primary outcome was the occurrence of any exacerbation during follow-up. Secondary outcomes included the annualized rate of wheezing exacerbations and the occurrence of any exacerbation requiring hospitalization. Exploratory analyses focused on exacerbation outcomes, offline exhaled nitric oxide concentrations and caregiver reported asthma control scores after inhaled corticosteroid treatment initiation.
RESULTS:Each blood eosinophil cut-point was associated with increased odds of exacerbation, higher exacerbation rate and greater hospitalization occurrence in preschool children with recurrent wheezing. However, outcome detection was improved with in children with more elevated blood eosinophil counts. Addition of a second biomarker of Type 2 inflammation improved outcome detection and was further associated with an improved response to initiation of daily inhaled corticosteroids in exploratory analyses. However, the specificity of blood eosinophils was poor.
CONCLUSIONS:Although validation studies are warranted, blood eosinophil cut points may be useful for clinical assessment and future studies of exacerbation and treatment response in preschool children with recurrent wheezing.
背景：已发现在复发性喘息的学龄前儿童中，2型炎症的临床特征与纵向预后较差相关，但仍难以预测哪些儿童在常规临床治疗中预后较差的风险最高。
目的：本研究验证了预设血嗜酸性粒细胞计数分界点可以预测复发性喘息的学龄前儿童的病情恶化和治疗反应结果，并且增加第二个生物标志物可改进预测水平。
方法：本研究合并了来自三项关于1074名12-71个月龄罹患复发性喘息的学龄前儿童的临床试验数据。主要结果包括随访期间出现任何病情恶化。次要结果包括哮喘年发作率和需要住院治疗的任何发作的发生率。探索性分析侧重于吸入糖皮质激素治疗开始后的病情加重结果、离线呼出一氧化氮浓度以及护理者报告的哮喘控制分数。
结果：在复发性喘息的学龄前儿童中，每一个血嗜酸性粒细胞分界点与病情加重概率增加、加重率增加及住院率增加有关。然而，在血嗜酸性粒细胞计数升高的儿童中，结果检测得到改善。在探索性分析中，增加第二种2型炎症生物标志物可改善结果检测，并进一步提高与日吸入糖皮质激素初始治疗反应的相关性。然而，血液嗜酸性粒细胞的特异性较差。
结论：尽管有必要进行验证性研究，但血嗜酸性粒细胞分界点可能有助于临床评估和未来研究复发性喘息的学龄前儿童的病情加重和治疗反应。
(中日友好医院呼吸与危重症医学科 张婧媛 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2023 Feb 2:S2213-2198(23)00123-X. doi: 10.1016/j.jaip.2023.01.037.)
(J Allergy Clin Immunol Pract. 2023 Feb 2:S2213-2198(23)00123-X. doi: 10.1016/j.jaip.2023.01.037.)
Blood eosinophils for prediction of exacerbation in preschool children with recurrent wheezing.
Fitzpatrick AM, Grunwell JR, Cottrill KA, Mutic AD, Mauger DT
Abstract
BACKGROUND:Although clinical features of Type 2 inflammation have been associated with poorer longitudinal outcomes in preschool children with recurrent wheezing, it remains difficult to predict which children are at highest risk for poor outcomes during a routine clinical encounter.
OBJECTIVES: We tested the hypothesis that pre-specified cut points of blood eosinophil counts would predict exacerbation and treatment response outcomes in preschool children with recurrent wheezing and that prediction could be improved with the addition of a second biomarker.
METHODS:Data from three clinical trials of 1,074 preschool children aged 12-71 months with recurrent wheezing were merged. The primary outcome was the occurrence of any exacerbation during follow-up. Secondary outcomes included the annualized rate of wheezing exacerbations and the occurrence of any exacerbation requiring hospitalization. Exploratory analyses focused on exacerbation outcomes, offline exhaled nitric oxide concentrations and caregiver reported asthma control scores after inhaled corticosteroid treatment initiation.
RESULTS:Each blood eosinophil cut-point was associated with increased odds of exacerbation, higher exacerbation rate and greater hospitalization occurrence in preschool children with recurrent wheezing. However, outcome detection was improved with in children with more elevated blood eosinophil counts. Addition of a second biomarker of Type 2 inflammation improved outcome detection and was further associated with an improved response to initiation of daily inhaled corticosteroids in exploratory analyses. However, the specificity of blood eosinophils was poor.
CONCLUSIONS:Although validation studies are warranted, blood eosinophil cut points may be useful for clinical assessment and future studies of exacerbation and treatment response in preschool children with recurrent wheezing.
上一篇：
数字化用药依从性和肺功能测量在指导未控制哮喘治疗中的应用（INCA Sun）：一项多中心、单盲、随机临床试验
下一篇：
成人哮喘患者脉冲振荡法的最小临床重要差异
