基于生物制剂时代未控制重度哮喘相关因素分析
2024/11/29
摘要
背景：尽管治疗重度哮喘的生物制剂在不断发展，但仍存在未控制的重度哮喘个体，这是个重大的社会难题。
目的：本研究为多中心前瞻性研究，运用哮喘控制问卷（ACQ）评估，旨在确定生物制剂时代重度哮喘未控制状态相关因素。
方法：本研究共纳入11家医院，所有受试者均经呼吸科专家确诊为重度哮喘。通过收集临床数据和问卷，本研究比较了控制组（ACQ-5<1.5）和未控制组（AC Q-5≥1.5）重度哮喘之间的差异，并采用逻辑回归分析评估了与未控制重度哮喘相关的因素。
结果：本研究共纳入154名患者并进行分析（中位年龄66岁；62.3%为女性；52.6%应用生物制剂）。其中，56名患者（36.4%）罹患未控制重度哮喘（ACQ-5≥1.5）。与控制组相比，未控制组的急性发作更频繁（前一年≥2次），且外周血中性粒细胞数更高。将患者分为两组：接受生物制剂治疗组和未接受生物制剂治疗组，分析总体人群中与未控制状态相关的因素。多变量分析显示，在总体人群和没未接受生物制剂的患者中，频繁的急性发作和外周血中性粒细胞数升高与未控制状态有关，而在接受生物制剂的患者中，外周血中性粒细胞数升高与未控制状态显著相关。
结论：外周血中性粒细胞数升高和频繁发作与重度哮喘失未控制独立相关。具体而言，无论是否接受生物制剂，外周血中性粒细胞数升高都是未控制状态相关的重要因素，这表明它们有望在生物制剂时代用作生物标志物。
Factors Associated with Uncontrolled Severe Asthma in the Biologic Era.
Yasui H, Oishi K, Nihashi F, Furuhashi K, Fujisawa T, Inoue Y, Karayama M, Hozumi H, Suzuki Y, Enomoto N, Kojima S, Niwa M, Harada M, Kato M, Hashimoto D, Yokomura K, Koshimizu N, Toyoshima M, Shirai M, Shirai T, Inui N, Suda T.
Abstract
BACKGROUND:Despite the development of biologics for severe asthma, individuals with uncontrolled status persist, posing a significant social problem.
OBJECTIVES：This multicenter prospective study aimed to identify factors associated with the uncontrolled status of patients with severe asthma in the biologic era assessed using the Asthma Control Questionnaire (ACQ).
METHODS:Subjects with severe asthma diagnosed by respiratory specialists were enrolled from 11 hospitals. Clinical data and questionnaires were collected. We compared controlled (ACQ-5 <1.5) with uncontrolled severe asthma (ACQ-5 ≥1.5) and assessed factors linked to uncontrolled severe asthma using logistic regression analysis.
RESULTS:One hundred fifty-four patients were analyzed (median age, 66 years; 62.3% female; 52.6% administered biologics). Among them, 56 patients (36.4%) had uncontrolled severe asthma (ACQ-5 ≥1.5). The uncontrolled group had more frequent exacerbations (≥2 times in the previous year) and elevated blood neutrophil counts compared with the controlled group. Factors associated with uncontrolled status were analyzed in the overall population, with patients stratified into two groups: those receiving biologics and those not receiving biologics. Multivariate analysis revealed that frequent exacerbations and elevated blood neutrophil counts were associated with uncontrolled status in the overall population and in patients without biologics, whereas elevated blood neutrophil counts were significantly associated with uncontrolled status in patients receiving biologics.
CONCLUSION:Conclusion: Elevated blood neutrophil counts and frequent exacerbations were independently associated with uncontrolled severe asthma. Specifically, elevated blood neutrophil counts were a significant factor related to uncontrolled status irrespective of biologics, suggesting their potential utility as a biomarker in the biologic era.
背景：尽管治疗重度哮喘的生物制剂在不断发展，但仍存在未控制的重度哮喘个体，这是个重大的社会难题。
目的：本研究为多中心前瞻性研究，运用哮喘控制问卷（ACQ）评估，旨在确定生物制剂时代重度哮喘未控制状态相关因素。
方法：本研究共纳入11家医院，所有受试者均经呼吸科专家确诊为重度哮喘。通过收集临床数据和问卷，本研究比较了控制组（ACQ-5<1.5）和未控制组（AC Q-5≥1.5）重度哮喘之间的差异，并采用逻辑回归分析评估了与未控制重度哮喘相关的因素。
结果：本研究共纳入154名患者并进行分析（中位年龄66岁；62.3%为女性；52.6%应用生物制剂）。其中，56名患者（36.4%）罹患未控制重度哮喘（ACQ-5≥1.5）。与控制组相比，未控制组的急性发作更频繁（前一年≥2次），且外周血中性粒细胞数更高。将患者分为两组：接受生物制剂治疗组和未接受生物制剂治疗组，分析总体人群中与未控制状态相关的因素。多变量分析显示，在总体人群和没未接受生物制剂的患者中，频繁的急性发作和外周血中性粒细胞数升高与未控制状态有关，而在接受生物制剂的患者中，外周血中性粒细胞数升高与未控制状态显著相关。
结论：外周血中性粒细胞数升高和频繁发作与重度哮喘失未控制独立相关。具体而言，无论是否接受生物制剂，外周血中性粒细胞数升高都是未控制状态相关的重要因素，这表明它们有望在生物制剂时代用作生物标志物。
(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)
(Respir Med. 2024 Nov 21:107881. doi: 10.1016/j.rmed.2024.107881.)
(Respir Med. 2024 Nov 21:107881. doi: 10.1016/j.rmed.2024.107881.)
Factors Associated with Uncontrolled Severe Asthma in the Biologic Era.
Yasui H, Oishi K, Nihashi F, Furuhashi K, Fujisawa T, Inoue Y, Karayama M, Hozumi H, Suzuki Y, Enomoto N, Kojima S, Niwa M, Harada M, Kato M, Hashimoto D, Yokomura K, Koshimizu N, Toyoshima M, Shirai M, Shirai T, Inui N, Suda T.
Abstract
BACKGROUND:Despite the development of biologics for severe asthma, individuals with uncontrolled status persist, posing a significant social problem.
OBJECTIVES：This multicenter prospective study aimed to identify factors associated with the uncontrolled status of patients with severe asthma in the biologic era assessed using the Asthma Control Questionnaire (ACQ).
METHODS:Subjects with severe asthma diagnosed by respiratory specialists were enrolled from 11 hospitals. Clinical data and questionnaires were collected. We compared controlled (ACQ-5 <1.5) with uncontrolled severe asthma (ACQ-5 ≥1.5) and assessed factors linked to uncontrolled severe asthma using logistic regression analysis.
RESULTS:One hundred fifty-four patients were analyzed (median age, 66 years; 62.3% female; 52.6% administered biologics). Among them, 56 patients (36.4%) had uncontrolled severe asthma (ACQ-5 ≥1.5). The uncontrolled group had more frequent exacerbations (≥2 times in the previous year) and elevated blood neutrophil counts compared with the controlled group. Factors associated with uncontrolled status were analyzed in the overall population, with patients stratified into two groups: those receiving biologics and those not receiving biologics. Multivariate analysis revealed that frequent exacerbations and elevated blood neutrophil counts were associated with uncontrolled status in the overall population and in patients without biologics, whereas elevated blood neutrophil counts were significantly associated with uncontrolled status in patients receiving biologics.
CONCLUSION:Conclusion: Elevated blood neutrophil counts and frequent exacerbations were independently associated with uncontrolled severe asthma. Specifically, elevated blood neutrophil counts were a significant factor related to uncontrolled status irrespective of biologics, suggesting their potential utility as a biomarker in the biologic era.
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儿童哮喘患者启动孟鲁司特治疗后神经精神诊断分析
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气候和环境因素对儿童和青少年哮喘的影响： 基于时空分析证据的系统综述
