性别对重症哮喘的影响：英国初级和专科护理的横断面回顾性分析
2024/01/26
摘要
简介：青春期后，女性比男性更容易患哮喘，病情更严重。哮喘与性别之间的关系是复杂的，有多种内在和外在因素。
目的：评估现实世界中重症哮喘（SA）患者特征和治疗的性别差异。
方法：采用单变量和多变量逻辑回归分析，按性别对英国严重哮喘登记处（UKSAR）和最佳患者护理研究数据库（OPCRD）中SA患者的人口统计学、临床和治疗特征进行回顾性分析，并根据年份、年龄和医院/实践进行调整。
结果：纳入了3679名（60.9%女性）UKSAR患者和18369名（67.9%女性）OPCRD SA患者。女性更有可能出现哮喘控制问卷-6（UKSAR调整OR（aOR）1.14，95%CI 1.09至1.18）和皇家医学院-3问题得分（OPCRD aOR 1.29，95%CI 1.13至1.47）增加的症状。然而，他们预测的1秒用力呼气量（FEV1%）更高（UKSAR 68.7%vs 64.8%，p＜0.001），呼气峰值流量没有显著差异。2型生物标志物IgE（UKSAR 129 IU/mL vs 208 IU/mL，p＜0.001）和FeNO（UKSAR 36ppb vs 46ppb，p＜001）在女性中较低，在血液嗜酸性粒细胞或生物治疗方面没有显著差异。雌性维持口服皮质类固醇的可能性较低（UKSAR aOR 0.86，95%CI 0.75至0.99），但更可能肥胖（UKSAR a OR 1.67，95%CI 145至1.93；OPCRD SA aOR 1.46，95%CI 1.34至1.58）。
结论：尽管预测的FEV1%较高，2型生物标志物较低，但女性症状更重，更容易肥胖，这两个数据集之间存在一致且具有临床意义的差异。
Impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care
Lola Loewenthal, John Busby, Ronald McDowell, Thomas Brown, Hassan Burhan, Rekha Chaudhuri, Paddy Dennison, James William Dodd, Simon Doe, Shoaib Faruqi, Robin Gore, Elfatih Idris, David Joshua Jackson, Mitesh Patel, Thomas Pantin, Ian Pavord, Paul E Pfeffer, David B Price, Hitasha Rupani, Salman Siddiqui, Liam G Heaney, Andrew Menzies-Gow; UK Severe Asthma Registry
Abstract
Introduction: After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors.
Aim: To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting.
Methods: Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice.
Results: 3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV1%) predicted (UKSAR 68.7% vs 64.8%, p<0.001) with no significant difference in peak expiratory flow. Type 2 biomarkers IgE (UKSAR 129 IU/mL vs 208 IU/mL, p<0.001) and FeNO (UKSAR 36ppb vs 46ppb, p<0.001) were lower in females with no significant difference in blood eosinophils or biological therapy. Females were less likely to be on maintenance oral corticosteroids (UKSAR aOR 0.86, 95% CI 0.75 to 0.99) but more likely to be obese (UKSAR aOR 1.67, 95% CI 145 to 1.93; OPCRD SA aOR 1.46, 95% CI 1.34 to 1.58).
Conclusions: Females had increased symptoms and were more likely to be obese despite higher FEV1% predicted and lower type 2 biomarkers with consistent and clinically important differences across both datasets.
简介：青春期后，女性比男性更容易患哮喘，病情更严重。哮喘与性别之间的关系是复杂的，有多种内在和外在因素。
目的：评估现实世界中重症哮喘（SA）患者特征和治疗的性别差异。
方法：采用单变量和多变量逻辑回归分析，按性别对英国严重哮喘登记处（UKSAR）和最佳患者护理研究数据库（OPCRD）中SA患者的人口统计学、临床和治疗特征进行回顾性分析，并根据年份、年龄和医院/实践进行调整。
结果：纳入了3679名（60.9%女性）UKSAR患者和18369名（67.9%女性）OPCRD SA患者。女性更有可能出现哮喘控制问卷-6（UKSAR调整OR（aOR）1.14，95%CI 1.09至1.18）和皇家医学院-3问题得分（OPCRD aOR 1.29，95%CI 1.13至1.47）增加的症状。然而，他们预测的1秒用力呼气量（FEV1%）更高（UKSAR 68.7%vs 64.8%，p＜0.001），呼气峰值流量没有显著差异。2型生物标志物IgE（UKSAR 129 IU/mL vs 208 IU/mL，p＜0.001）和FeNO（UKSAR 36ppb vs 46ppb，p＜001）在女性中较低，在血液嗜酸性粒细胞或生物治疗方面没有显著差异。雌性维持口服皮质类固醇的可能性较低（UKSAR aOR 0.86，95%CI 0.75至0.99），但更可能肥胖（UKSAR a OR 1.67，95%CI 145至1.93；OPCRD SA aOR 1.46，95%CI 1.34至1.58）。
结论：尽管预测的FEV1%较高，2型生物标志物较低，但女性症状更重，更容易肥胖，这两个数据集之间存在一致且具有临床意义的差异。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Thorax. 2023 Dec 16:thorax-2023-220512. doi: 10.1136/thorax-2023-220512.)
(Thorax. 2023 Dec 16:thorax-2023-220512. doi: 10.1136/thorax-2023-220512.)
Impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care
Lola Loewenthal, John Busby, Ronald McDowell, Thomas Brown, Hassan Burhan, Rekha Chaudhuri, Paddy Dennison, James William Dodd, Simon Doe, Shoaib Faruqi, Robin Gore, Elfatih Idris, David Joshua Jackson, Mitesh Patel, Thomas Pantin, Ian Pavord, Paul E Pfeffer, David B Price, Hitasha Rupani, Salman Siddiqui, Liam G Heaney, Andrew Menzies-Gow; UK Severe Asthma Registry
Abstract
Introduction: After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors.
Aim: To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting.
Methods: Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice.
Results: 3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV1%) predicted (UKSAR 68.7% vs 64.8%, p<0.001) with no significant difference in peak expiratory flow. Type 2 biomarkers IgE (UKSAR 129 IU/mL vs 208 IU/mL, p<0.001) and FeNO (UKSAR 36ppb vs 46ppb, p<0.001) were lower in females with no significant difference in blood eosinophils or biological therapy. Females were less likely to be on maintenance oral corticosteroids (UKSAR aOR 0.86, 95% CI 0.75 to 0.99) but more likely to be obese (UKSAR aOR 1.67, 95% CI 145 to 1.93; OPCRD SA aOR 1.46, 95% CI 1.34 to 1.58).
Conclusions: Females had increased symptoms and were more likely to be obese despite higher FEV1% predicted and lower type 2 biomarkers with consistent and clinically important differences across both datasets.
