表型分析系统性糖皮质激素在哮喘发作管理中的反应（PRISMA）
2025/03/03
摘要
背景：哮喘发作是异质性的。目前尚不清楚在急性哮喘中，对口服糖皮质激素（OCS）的反应是否根据2型（T2）炎症生物标志物、血液嗜酸性粒细胞计数（BEC）和呼出一氧化氮（FeNO）而有所不同。我们的目标是探索T2生物标志物与急性哮喘对OCS反应之间的关系。
方法：我们对经历哮喘发作的人群进行了纵向观察研究，分别在7天OCS治疗前后进行了评估。主要结果是根据序数BEC-FeNO 3组类别（T2-Low/Low，BEC<0.15×109细胞·L-1且FeNO<25 ppb；T2-High/High，BEC≥0.30×109细胞·L-1且FeNO≥35 ppb；T2-Mid，不符合Low/Low-High/High标准）的支气管扩张剂（BD）后FEV1变化。关键的次要结果是哮喘控制问卷（ACQ-5）的变化。探索性结果包括与OCS相关的不良事件。
结果：共纳入53人，其中16人（30%）为T2-Low/Low，27人（51%）为T2-Mid，10人（19%）为T2-High/High哮喘发作。BD后FEV1变化随着BEC-FeNO联合升高而增加（p-for-interaction=0.007），在T2-High/High表型中达到峰值（0.390±0.512L，p-for-trend<0.0001）。相反，T2-Low/Low发作的FEV1变化不显著（0.017±0.153L）。在单变量和多变量分析中，只有序数BEC-FeNO分层，而不是症状或FEV1，是后续BD后FEV1改善的预测因子。所有患者的ACQ-5均有所改善，数值在T2-High/High表型中达到峰值（-1.58±0.60，p-for-trend=0.08）。所有组经历的与OCS相关的不良事件相似，有33名（62%）参与者报告了≥1起事件。
结论：我们发现，OCS后的客观改善仅限于T2-High/High事件。与慢性哮喘一样，更大的T2负担识别出一个独特的临床和治疗轨迹，而与OCS相关的不良事件则均匀分布。
背景：哮喘发作是异质性的。目前尚不清楚在急性哮喘中，对口服糖皮质激素（OCS）的反应是否根据2型（T2）炎症生物标志物、血液嗜酸性粒细胞计数（BEC）和呼出一氧化氮（FeNO）而有所不同。我们的目标是探索T2生物标志物与急性哮喘对OCS反应之间的关系。
方法：我们对经历哮喘发作的人群进行了纵向观察研究，分别在7天OCS治疗前后进行了评估。主要结果是根据序数BEC-FeNO 3组类别（T2-Low/Low，BEC<0.15×109细胞·L-1且FeNO<25 ppb；T2-High/High，BEC≥0.30×109细胞·L-1且FeNO≥35 ppb；T2-Mid，不符合Low/Low-High/High标准）的支气管扩张剂（BD）后FEV1变化。关键的次要结果是哮喘控制问卷（ACQ-5）的变化。探索性结果包括与OCS相关的不良事件。
结果：共纳入53人，其中16人（30%）为T2-Low/Low，27人（51%）为T2-Mid，10人（19%）为T2-High/High哮喘发作。BD后FEV1变化随着BEC-FeNO联合升高而增加（p-for-interaction=0.007），在T2-High/High表型中达到峰值（0.390±0.512L，p-for-trend<0.0001）。相反，T2-Low/Low发作的FEV1变化不显著（0.017±0.153L）。在单变量和多变量分析中，只有序数BEC-FeNO分层，而不是症状或FEV1，是后续BD后FEV1改善的预测因子。所有患者的ACQ-5均有所改善，数值在T2-High/High表型中达到峰值（-1.58±0.60，p-for-trend=0.08）。所有组经历的与OCS相关的不良事件相似，有33名（62%）参与者报告了≥1起事件。
结论：我们发现，OCS后的客观改善仅限于T2-High/High事件。与慢性哮喘一样，更大的T2负担识别出一个独特的临床和治疗轨迹，而与OCS相关的不良事件则均匀分布。
（中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校）
（Eur Respir J. 2025 Feb 13:2402391. doi: 10.1183/13993003.02391-2024.）
Phenotyping the Responses to Systemic Corticosteroids in the Management of Asthma Attacks (PRISMA)
Carlos Celis-Preciado, Simon Leclerc, Martine Duval, Dominic O Cliche, Lucie Brazeau, Félix-Antoine Vézina, Marylène Dussault, Pierre Larivée, Samuel Lemaire-Paquette, Simon Lévesque, Philippe Lachapelle, Simon Couillard
Abstract
Background:Asthma attacks are heterogeneous. It is not known whether the response to oral corticosteroids (OCS) in acute asthma varies according to type-2 (T2) inflammatory biomarkers, blood eosinophil count (BEC) and exhaled nitric oxide (FeNO). We aim to explore the relationship between T2 biomarkers and response to OCS in acute asthma.
Methods:We conducted a longitudinal observational study of people experiencing an asthma attack evaluated before and after a 7-day OCS course. The primary outcome was post-bronchodilator (BD) FEV1change according to ordinal BEC-FeNO 3-group categories (T2-Low/Low, BEC <0.15×109cells·L-1and FeNO <25 ppb; T2-High/High, BEC ≥0.30×109cells·L-1and FeNO ≥35 ppb and T2-Mid, not meeting Low/Low-High/High criteria). A key secondary outcome was the Asthma Control Questionnaire (ACQ-5) change. Exploratory outcomes included OCS-attributable adverse events.
Results:Fifty-three people were enrolled with 16 (30%) T2-Low/Low, 27 (51%) T2-Mid and 10 (19%) T2-High/High asthma attacks. Post-BD FEV1changes increased with combined BEC-FeNO elevation (p-for-interaction=0.007), peaking in the T2-High/High phenotype (0.390±0.512L, p-for-trend<0.0001). Conversely, T2-Low/Low attacked achieved nonsignificant FEV1changes (0.017±0.153L). In univariable and multivariable analyses, only ordinal BEC-FeNO stratification - not symptoms nor FEV1- was a predictor of subsequent post-BD FEV1improvement. All patients improved ACQ-5, numerically peaking in the T2-High/High phenotype (-1.58±0.60, p-for-trend=0.08). All groups experienced similar OCS-attributable adverse events, with n=33 (62%) participants reporting ≥1 event.
Conclusions:We found that objective improvement following OCS is confined to T2-High/High events. As in chronic asthma, greater T2 burden identifies a distinct clinical and therapeutic trajectory, whereas OCS-related adverse events are uniformly distributed.
Carlos Celis-Preciado, Simon Leclerc, Martine Duval, Dominic O Cliche, Lucie Brazeau, Félix-Antoine Vézina, Marylène Dussault, Pierre Larivée, Samuel Lemaire-Paquette, Simon Lévesque, Philippe Lachapelle, Simon Couillard
Abstract
Background:Asthma attacks are heterogeneous. It is not known whether the response to oral corticosteroids (OCS) in acute asthma varies according to type-2 (T2) inflammatory biomarkers, blood eosinophil count (BEC) and exhaled nitric oxide (FeNO). We aim to explore the relationship between T2 biomarkers and response to OCS in acute asthma.
Methods:We conducted a longitudinal observational study of people experiencing an asthma attack evaluated before and after a 7-day OCS course. The primary outcome was post-bronchodilator (BD) FEV1change according to ordinal BEC-FeNO 3-group categories (T2-Low/Low, BEC <0.15×109cells·L-1and FeNO <25 ppb; T2-High/High, BEC ≥0.30×109cells·L-1and FeNO ≥35 ppb and T2-Mid, not meeting Low/Low-High/High criteria). A key secondary outcome was the Asthma Control Questionnaire (ACQ-5) change. Exploratory outcomes included OCS-attributable adverse events.
Results:Fifty-three people were enrolled with 16 (30%) T2-Low/Low, 27 (51%) T2-Mid and 10 (19%) T2-High/High asthma attacks. Post-BD FEV1changes increased with combined BEC-FeNO elevation (p-for-interaction=0.007), peaking in the T2-High/High phenotype (0.390±0.512L, p-for-trend<0.0001). Conversely, T2-Low/Low attacked achieved nonsignificant FEV1changes (0.017±0.153L). In univariable and multivariable analyses, only ordinal BEC-FeNO stratification - not symptoms nor FEV1- was a predictor of subsequent post-BD FEV1improvement. All patients improved ACQ-5, numerically peaking in the T2-High/High phenotype (-1.58±0.60, p-for-trend=0.08). All groups experienced similar OCS-attributable adverse events, with n=33 (62%) participants reporting ≥1 event.
Conclusions:We found that objective improvement following OCS is confined to T2-High/High events. As in chronic asthma, greater T2 burden identifies a distinct clinical and therapeutic trajectory, whereas OCS-related adverse events are uniformly distributed.
上一篇：
度普利尤单抗治疗呼吸系统疾病患者血液嗜酸性粒细胞增多症的分析：一个真实的快照
下一篇：
Dupilumab对2型哮喘患者呼出一氧化氮、黏液栓和功能性呼吸成像的影响（VESTIGE）：一项随机、双盲、安慰剂对照
