黏液栓评分可预测重度哮喘患者对生物制剂的临床及肺功能反应
2025/07/15
摘要
背景：黏液栓塞已被确定为导致重度哮喘患者气道阻塞和疾病严重程度加重的重要特征。近期研究发现，多种生物制剂治疗可改善黏液栓塞。
目的：分析基线特征与黏液栓评分（mucus plugging score, MPS）的关联性，并探讨基线MPS能否预测重度哮喘患者对生物制剂治疗后的临床反应和肺功能变化。
方法：研究回顾性分析了基线期具有合格CT扫描且未接受过生物制剂治疗的重度哮喘患者。计算MPS评分，并分析其与基线参数及生物制剂治疗4个月后生物标志物、肺功能和临床参数改善的相关性。
结果：基线队列纳入113例患者，其中101例具有完整的4个月的随访数据。CT显示77%的患者存在黏液栓（中位MPS为 4分）。多变量回归分析显示，基线MPS与较低的FEV1（r=-0.24；P=0.009）、一氧化碳弥散功能（r=-0.26；P=0.01）以及较高的FeNO水平（r=0.36；P=0.0003）相关。患者接受的生物制剂包括：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。多变量回归分析显示，基线MPS与FEV1改善（β=0.72；P=0.01），ACT评分改善（β=0.24；P=0.001）呈正相关。
结论：本研究表明，较高的MPS不仅与基线期更差的肺功能相关，还能预测重度哮喘患者对生物制剂治疗更好的临床和肺功能反应。
Mucus Plug Score Predicts Clinical and Pulmonary Function Response to Biologic Therapy in Patients With Severe Asthma
Jeremias Götschke, Julia Walter, Gabriele Leuschner1, Michael Gerckens, Melanie Götschke, Pontus Mertsch, Carlo Mümmler, Alexandra Lenoir1, Michaela Barnikel1, Julien Dinkel, Jürgen Behr1, Nikolaus Kneidinger, Judith Eva Spiro, Katrin Milger
J Allergy Clin Immunol Pract. 2025 Jan 16:S2213-2198(25)00053-4. doi: 10.1016/j.jaip.2025.01.010. PMID: 39826645
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.
Conclusions: 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.
背景：黏液栓塞已被确定为导致重度哮喘患者气道阻塞和疾病严重程度加重的重要特征。近期研究发现，多种生物制剂治疗可改善黏液栓塞。
目的：分析基线特征与黏液栓评分（mucus plugging score, MPS）的关联性，并探讨基线MPS能否预测重度哮喘患者对生物制剂治疗后的临床反应和肺功能变化。
方法：研究回顾性分析了基线期具有合格CT扫描且未接受过生物制剂治疗的重度哮喘患者。计算MPS评分，并分析其与基线参数及生物制剂治疗4个月后生物标志物、肺功能和临床参数改善的相关性。
结果：基线队列纳入113例患者，其中101例具有完整的4个月的随访数据。CT显示77%的患者存在黏液栓（中位MPS为 4分）。多变量回归分析显示，基线MPS与较低的FEV1（r=-0.24；P=0.009）、一氧化碳弥散功能（r=-0.26；P=0.01）以及较高的FeNO水平（r=0.36；P=0.0003）相关。患者接受的生物制剂包括：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。多变量回归分析显示，基线MPS与FEV1改善（β=0.72；P=0.01），ACT评分改善（β=0.24；P=0.001）呈正相关。
结论：本研究表明，较高的MPS不仅与基线期更差的肺功能相关，还能预测重度哮喘患者对生物制剂治疗更好的临床和肺功能反应。
（四川大学华西医院呼吸与危重症医学科 谯猗丹1 王霁1 王刚1 译）
（J Allergy Clin Immunol Pract. 2025 Jan 16:S2213-2198(25)00053-4. doi: 10.1016/j.jaip.2025.01.010. PMID: 39826645）
Mucus Plug Score Predicts Clinical and Pulmonary Function Response to Biologic Therapy in Patients With Severe Asthma
Jeremias Götschke, Julia Walter, Gabriele Leuschner1, Michael Gerckens, Melanie Götschke, Pontus Mertsch, Carlo Mümmler, Alexandra Lenoir1, Michaela Barnikel1, Julien Dinkel, Jürgen Behr1, Nikolaus Kneidinger, Judith Eva Spiro, Katrin Milger
J Allergy Clin Immunol Pract. 2025 Jan 16:S2213-2198(25)00053-4. doi: 10.1016/j.jaip.2025.01.010. PMID: 39826645
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.
Conclusions: 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.
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