气道高反应性的自然史及其与哮喘特征的关系
2025/08/31
摘要
背景：目前关于儿童至成人期气道高反应性（AHR）的自然病程及其与哮喘状态的关系尚不明确。本研究旨在阐明AHR与哮喘特征（如症状、特应性及肺功能）相关的自然史，以增进对青少年时期AHR随哮喘病理生理学变化的认知。
方法：我们在怀特岛全人口出生队列中分别于10岁（n=783）、18岁（n=585）和26岁（n=86）时进行了乙酰甲胆碱支气管激发试验（BCT）。每个时间点均收集喘息症状、肺功能和特应性数据。明确AHR定义为乙酰甲胆碱浓度使1秒用力呼气量（FEV1）下降20%的阈值浓度（PC20）<4 mg/mL。
结果： AHR患病率在10岁时为21.6%（169/783），18岁时降至5%（29/585）（p<0.01）。在10岁和18岁均完成乙酰甲胆碱BCT检测的406名参与者中，80.9%的10岁AHR阳性者至18岁时转为阴性。在群体水平上，AHR的变化轨迹与哮喘（10岁14.7%升至18岁17.6%；p=0.004）、特应性（10岁26.9%升至18岁41.5%；p<0.001）及气道阻塞（FEV1/FVC比值从10岁0.88降至18岁0.87；p<0.001）呈相反趋势。18至26岁期间AHR患病率保持稳定。
结论：AHR的自然史以青少年期患病率显著下降为特征，这与哮喘及其他哮喘特征的变化模式相反。在将AHR作为哮喘定义特征进行解读时，应考虑年龄因素的影响。
Natural History of Airway Hyperresponsiveness and Its Association With Asthma Traits.
Sophie, Carra; Hongmei, Zhang; Ramesh J,
AbstrastBACKGROUND: The natural history of airway hyperresponsiveness (AHR) from childhood to adulthood and its association with asthma status are poorly understood. We aim to define the natural history of AHR in relation to asthma characteristics such as symptoms, atopy and lung function to improve our understanding of the changes in AHR with asthma pathophysiology during adolescence.
METHODS: Methacholine bronchial challenge test (BCT) was undertaken in the Isle of Wight whole population birth cohort at 10 years (n = 783), 18 years (n = 585) and 26 years (n = 86). Data on wheeze, lung function, and atopy were collected at each time point. Definite AHR was defined as methacholine concentration provoking a 20% decrease in Forced Expiratory Volume in 1 s (PC(20)) at < 4 mg/mL.
RESULTS: AHR prevalence was 21.6% (169/783) at 10 years and 5% (29/585) at 18 years of age (p < 0.01). In 406 participants, where methacholine BCT was performed at both 10 and 18 years, 80.9% of those with AHR at age 10 became negative at 18 years. At a population level, AHR trajectory was in the opposite direction to that of asthma (14.7% at age 10 to 17.6% at age 18; p = 0.004), atopy (26.9% at age 10 to 41.5% at age 18; p < 0.001) and airway obstruction (FEV(1)/FVC ratio of 0.88 at age 10 to 0.87 at age 18; p < 0.001). AHR prevalence remained stable between the ages of 18 and 26 years.
CONCLUSION: The natural history of AHR is characterised by a marked decrease in prevalence during adolescence, in contrast to asthma and other asthma characteristics. Age should be considered when interpreting AHR as an asthma defining trait.
背景：目前关于儿童至成人期气道高反应性（AHR）的自然病程及其与哮喘状态的关系尚不明确。本研究旨在阐明AHR与哮喘特征（如症状、特应性及肺功能）相关的自然史，以增进对青少年时期AHR随哮喘病理生理学变化的认知。
方法：我们在怀特岛全人口出生队列中分别于10岁（n=783）、18岁（n=585）和26岁（n=86）时进行了乙酰甲胆碱支气管激发试验（BCT）。每个时间点均收集喘息症状、肺功能和特应性数据。明确AHR定义为乙酰甲胆碱浓度使1秒用力呼气量（FEV1）下降20%的阈值浓度（PC20）<4 mg/mL。
结果： AHR患病率在10岁时为21.6%（169/783），18岁时降至5%（29/585）（p<0.01）。在10岁和18岁均完成乙酰甲胆碱BCT检测的406名参与者中，80.9%的10岁AHR阳性者至18岁时转为阴性。在群体水平上，AHR的变化轨迹与哮喘（10岁14.7%升至18岁17.6%；p=0.004）、特应性（10岁26.9%升至18岁41.5%；p<0.001）及气道阻塞（FEV1/FVC比值从10岁0.88降至18岁0.87；p<0.001）呈相反趋势。18至26岁期间AHR患病率保持稳定。
结论：AHR的自然史以青少年期患病率显著下降为特征，这与哮喘及其他哮喘特征的变化模式相反。在将AHR作为哮喘定义特征进行解读时，应考虑年龄因素的影响。
（中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校）
（Allergy 2025 Aug 22;(0)DOI:10.1111/all.70006 IF: 8.706）
Natural History of Airway Hyperresponsiveness and Its Association With Asthma Traits.
Sophie, Carra; Hongmei, Zhang; Ramesh J,
AbstrastBACKGROUND: The natural history of airway hyperresponsiveness (AHR) from childhood to adulthood and its association with asthma status are poorly understood. We aim to define the natural history of AHR in relation to asthma characteristics such as symptoms, atopy and lung function to improve our understanding of the changes in AHR with asthma pathophysiology during adolescence.
METHODS: Methacholine bronchial challenge test (BCT) was undertaken in the Isle of Wight whole population birth cohort at 10 years (n = 783), 18 years (n = 585) and 26 years (n = 86). Data on wheeze, lung function, and atopy were collected at each time point. Definite AHR was defined as methacholine concentration provoking a 20% decrease in Forced Expiratory Volume in 1 s (PC(20)) at < 4 mg/mL.
RESULTS: AHR prevalence was 21.6% (169/783) at 10 years and 5% (29/585) at 18 years of age (p < 0.01). In 406 participants, where methacholine BCT was performed at both 10 and 18 years, 80.9% of those with AHR at age 10 became negative at 18 years. At a population level, AHR trajectory was in the opposite direction to that of asthma (14.7% at age 10 to 17.6% at age 18; p = 0.004), atopy (26.9% at age 10 to 41.5% at age 18; p < 0.001) and airway obstruction (FEV(1)/FVC ratio of 0.88 at age 10 to 0.87 at age 18; p < 0.001). AHR prevalence remained stable between the ages of 18 and 26 years.
CONCLUSION: The natural history of AHR is characterised by a marked decrease in prevalence during adolescence, in contrast to asthma and other asthma characteristics. Age should be considered when interpreting AHR as an asthma defining trait.
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