重症嗜酸性粒细胞性哮喘或嗜酸性肉芽肿性多血管炎:为新诊断策略探索潜在生物标志物

2024/08/28

   摘要
   背景:重症嗜酸性粒细胞性哮喘(SEA)可能是嗜酸性肉芽肿性多血管炎(EGPA)的前驱期。然而,很少有研究尝试在疾病早期识别EGPA。
   目的:本研究通过识别一组临床和生物标志物,以鉴别可能处于EGPA前驱期的重症哮喘患者,并制定诊断决策策略。
   方法:本研究共纳入30例EGPA和49例SEA患者,进行全面的肺、耳、鼻、喉(ENT)和风湿免疫方面的评估,包括血液(嗜酸性粒细胞计数、嗜酸性阳离子蛋白(ECP)、IL-5、IL-4、总IgE、IgG4、抗中性粒细胞胞浆抗体(ANCA))、痰液(嗜酸性粒细胞计数、骨膜蛋白、IL-8和粒细胞-巨噬细胞集落刺激因子(GMCSF))和鼻拭子涂片(嗜酸性粒细胞增多症)生物标志物,并采用哮喘控制测试、简表-36、SinoNasal结果测试-22和哮喘生活质量问卷。
   结果:SEA患者的哮喘控制较差(p<0.001),痰液嗜酸性粒细胞水平较高(p<0.002),而据既往报道EGPA患者的血嗜酸性粒细胞水平较高。与SEA相比,EGPA患者的痰GMCSF是唯一显著增加的生物标志物(p<0.0001)。在SEA患者中,与其他患者相比,符合提示性标准但不符合EGPA诊断标准的患者,尤存在嗜酸性粒细胞组织浸润的患者,其痰液GMCSF(p<0.0005)、血液(p<0.0006)和痰液嗜酸性粒细胞(p<0.011)水平更高。
   结论:痰GMCSF和嗜酸性粒细胞可能是支持疑似EGPA的SEA患者早期诊断和治疗选择的有用生物标志物。
 
(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. 2024 Aug 8:S2213-2198(24)00827-4. doi: 10.1016/j.jaip.2024.08.011.)

 
 
Severe Eosinophilic Asthma or Eosinophilic Granulomatosis with Polyangitis: potential biomarkers for novel diagnostic strategies
 
Latorre M, Seccia V, Puxeddu I, Pisani F, Statuti E, Cristofani-Mencacci L, Celi A, Cianchetti S, Cardini C, Di Carluccio E, Ferro F, Paggiaro P, Baldini C.
 
Abstract
BACKGROUND:Severe Eosinophilic Asthma (SEA) may be the prodromal phase of Eosinophilic Granulomatosis with Polyangiitis (EGPA). Nevertheless, few studies have tried to recognize EGPA in the early stages of the disease.
OBJECTIVESTo identify a panel of clinical and biological markers to detect which severe asthmatic patient might be considered in a prodromal phase of EGPA and crafting a strategy for diagnostic decision-making.
METHODS:30 patients with EGPA and 49 with SEA were enrolled. A complete pulmonary, ear, nose and Throat (ENT) and rheumatologic assessment were made. Blood (eosinophil count, eosinophilic cationic protein-ECP, IL5, IL4, total-IgE, IgG4, anti-neutrophil cytoplasmic antibody (ANCA), sputum (eosinophils count, periostin, IL8 and GMCSF) and nasal smear (eosinophilia) biomarkers were assessed. Asthma Control Test, Short Form-36, SinoNasalOutcome Test-22, and Asthma Quality of Life Questionnaire were also used.
RESULTS:SEA patients had poorer asthma control (p<0.001) and higher level of sputum eosinophils (p<0.002) while EGPA patients reported higher levels of blood eosinophils in the past. Sputum GMCSF was the only biomarker significantly increased in EGPA patients compared with SEA (p<0.0001). Among SEA patients, those with some suggestive but not diagnostic criteria of EGPA, particularly tissue eosinophilic infiltrates, presented higher levels of sputum GMCSF (p<0.0005), blood and sputum eosinophils (p<0.0006, p<0.011) in comparison with the other patients.
CONCLUSION:Sputum GMCSF and eosinophils might be useful biomarkers to support early diagnosis and treatment choices in SEA patients, suspected of having EGPA.



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