黏液栓帮助预测重度哮喘对生物制剂的治疗反应性
2025/04/06
摘要
背景：黏液栓形成已被确定为重度哮喘的重要特征，可导致气道阻塞和加重病情。最近研究发现，多种生物疗法可改善黏液堵塞。
目的：分析重度哮喘患者的基线特征与黏液堵塞评分（MPS）的相关性，并确定基线MPS是否可预测这类患者对生物制剂治疗的临床和肺功能应答。
方法：作者回顾性分析了基线时有CT检查且未接受过生物制剂治疗的患者。计算MPS并分析其与基线资料、生物标志物、肺功能和4个月生物制剂治疗后临床参数改善的相关性。
结果：共纳入了113例患者，其中101例患者在4个月生物治疗后有足够的数据用于随访分析。CT显示77%的患者存在黏液栓形成（中位MPS为4）。多元回归分析显示，MPS与基线FEV1降低（ρ = -0.24；P = .009）和一氧化碳弥散能力下降（ρ = -0.26；P = .01)、FeNO水平升高 (ρ = .36；P = .0003）相关。患者常规接受抗IgE（8.8%）、抗IL -5（27.4%）、抗IL – 5R（37.2%）、抗IL – 4R（25.7%）和抗-TSLP（0.9%）治疗。基线MPS与FEV1 改善（β = 0.72；P = .01）和哮喘控制测试（ACT）评分（β = 0.24；P = .001) 改善相关。
结论：研究表明，MPS评分越高，基线肺功能越差；且MPS高水平可预测重度哮喘患者对生物制剂治疗的临床和肺功能应答。
关键词： 哮喘；黏液堵塞；黏液栓评分；生物制剂治疗；抗体；FEV1；肺功能；弥散能力；FeNO；治疗应答
文献来源：(Götschke J, Walter J, Leuschner G, et al. Mucus plug score predicts clinical and pulmonary function response to biologic therapy in patients with severe asthma[J]. The Journal of Allergy and Clinical Immunology: in Practice, 2025: S2213219825000534. DOI: 10.1016/j.jaip.2025.01.010.)
Abstract
Background:Mucus plugging has been identified as an important feature of severe asthma contributing to airway obstruction and disease severity. Recently, improvement in mucus plugging has been found on treatment with several biologic therapies.
Objective:To analyze associations of baseline characteristic with the mucus plugging score (MPS) and to determine whether the MPS at baseline predicts the clinical and functional response to biologic treatment in patients with severe asthma.
Methods:We retrospectively analyzed biologic-naive patients with a suitable computed tomography scan available at baseline. We calculated the MPS and analyzed correlations with baseline parameters and improvements in biomarkers, pulmonary function, and clinical parameters after 4 months of biologic therapy.
Results：We included 113 patients in the baseline cohort, 101 patients of whom had sufficient data after 4 months of biologic therapy for the follow-up analysis. Computed tomography showed mucus plugging in 77% of patients (median MPS, 4). Multivariate regression analysis showed a correlation of MPS with lower FEV1 (ρ = –0.24; P = .009) and diffusing capacity for carbon monoxide (ρ = –0.26; P = .01), and higher FeNO (ρ = .36; P = .0003) at baseline. Patients received treatment with anti-IgE (8.8%), anti-IL-5 (27.4%), anti-IL-5R (37.2%), anti-IL-4R (25.7%), and anti-thymic stromal lymphopoietin (0.9%) in clinical routine. Baseline MPS correlated with improvements in FEV1 (β = 0.72; P = .01) and Asthma Control Test (β = 0.24; P = .001) in multivariate regression analysis.
Conclusion：Our study suggests that a higher MPS correlates with worse pulmonary function at baseline but also predicts a larger clinical and pulmonary function response to biologic therapies in severe asthma.
Key words：Asthma; Mucus plugging; Mucus plug score; Biologic therapy; Antibody ;FEV1 ;Pulmonary function ;Diffusion capacity ; FeNO; Response
背景：黏液栓形成已被确定为重度哮喘的重要特征，可导致气道阻塞和加重病情。最近研究发现，多种生物疗法可改善黏液堵塞。
目的：分析重度哮喘患者的基线特征与黏液堵塞评分（MPS）的相关性，并确定基线MPS是否可预测这类患者对生物制剂治疗的临床和肺功能应答。
方法：作者回顾性分析了基线时有CT检查且未接受过生物制剂治疗的患者。计算MPS并分析其与基线资料、生物标志物、肺功能和4个月生物制剂治疗后临床参数改善的相关性。
结果：共纳入了113例患者，其中101例患者在4个月生物治疗后有足够的数据用于随访分析。CT显示77%的患者存在黏液栓形成（中位MPS为4）。多元回归分析显示，MPS与基线FEV1降低（ρ = -0.24；P = .009）和一氧化碳弥散能力下降（ρ = -0.26；P = .01)、FeNO水平升高 (ρ = .36；P = .0003）相关。患者常规接受抗IgE（8.8%）、抗IL -5（27.4%）、抗IL – 5R（37.2%）、抗IL – 4R（25.7%）和抗-TSLP（0.9%）治疗。基线MPS与FEV1 改善（β = 0.72；P = .01）和哮喘控制测试（ACT）评分（β = 0.24；P = .001) 改善相关。
结论：研究表明，MPS评分越高，基线肺功能越差；且MPS高水平可预测重度哮喘患者对生物制剂治疗的临床和肺功能应答。
关键词： 哮喘；黏液堵塞；黏液栓评分；生物制剂治疗；抗体；FEV1；肺功能；弥散能力；FeNO；治疗应答
文献来源：(Götschke J, Walter J, Leuschner G, et al. Mucus plug score predicts clinical and pulmonary function response to biologic therapy in patients with severe asthma[J]. The Journal of Allergy and Clinical Immunology: in Practice, 2025: S2213219825000534. DOI: 10.1016/j.jaip.2025.01.010.)
（南方医科大学南方医院 黄海伦 龚钊乾 赵文驱 赵海金）
Abstract
Background:Mucus plugging has been identified as an important feature of severe asthma contributing to airway obstruction and disease severity. Recently, improvement in mucus plugging has been found on treatment with several biologic therapies.
Objective:To analyze associations of baseline characteristic with the mucus plugging score (MPS) and to determine whether the MPS at baseline predicts the clinical and functional response to biologic treatment in patients with severe asthma.
Methods:We retrospectively analyzed biologic-naive patients with a suitable computed tomography scan available at baseline. We calculated the MPS and analyzed correlations with baseline parameters and improvements in biomarkers, pulmonary function, and clinical parameters after 4 months of biologic therapy.
Results：We included 113 patients in the baseline cohort, 101 patients of whom had sufficient data after 4 months of biologic therapy for the follow-up analysis. Computed tomography showed mucus plugging in 77% of patients (median MPS, 4). Multivariate regression analysis showed a correlation of MPS with lower FEV1 (ρ = –0.24; P = .009) and diffusing capacity for carbon monoxide (ρ = –0.26; P = .01), and higher FeNO (ρ = .36; P = .0003) at baseline. Patients received treatment with anti-IgE (8.8%), anti-IL-5 (27.4%), anti-IL-5R (37.2%), anti-IL-4R (25.7%), and anti-thymic stromal lymphopoietin (0.9%) in clinical routine. Baseline MPS correlated with improvements in FEV1 (β = 0.72; P = .01) and Asthma Control Test (β = 0.24; P = .001) in multivariate regression analysis.
Conclusion：Our study suggests that a higher MPS correlates with worse pulmonary function at baseline but also predicts a larger clinical and pulmonary function response to biologic therapies in severe asthma.
Key words：Asthma; Mucus plugging; Mucus plug score; Biologic therapy; Antibody ;FEV1 ;Pulmonary function ;Diffusion capacity ; FeNO; Response
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支气管舒张反应性和未来慢性气流阻塞关系：一项多国纵向研究
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