肺功能预测β激动剂的长期反应
2009/05/18
关键词：哮喘；β2受体表型；支气管舒张剂；分形；峰流速
哮喘患者对β2激动剂的反应因人而异，可能的影响因素包括16位点的β2肾上腺素受体基因型、肺功能和气道高反应性。波动分析（参数α）能够简便的反映出每日呼气峰流速的复杂关联特征。
为了调查肺功能波动分析对β2激动剂临床疗效的预测能力，Thamrin等进行了研究分析66例哮喘患者进行了为期18个月的研究。研究中所有患者分别接受安慰剂、沙丁胺醇或沙美特罗治疗，每种方法6个月，顺序随机。每天测定2次呼气峰流速。患者随机接受为期6个月的。采用多元线性回归分析确定安慰剂治疗期α值与治疗反应（有症状日）的关系，并分析其他预测因素，如β2肾上腺素受体基因型、肺功能及其变化和气道高反应性。
研究发现，安慰剂期的α值与治疗反应密切相关。在多因素模型中肺功能与沙美特罗治疗后有症状日的相关性更加明显，α值中水平和高水平的哮喘患者中有症状日分别减少17.9天和16.1天。因此测定安慰剂期α值明显改善对沙丁胺醇治疗反应的预测。
综合研究结果，作者认为，患者对β2激动剂的反应与肺功能的时间关联特征有关，肺功能的波形分析有助于预测和识别患者的治疗反应。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur. Respir. J., Mar 2009; 33: 486 - 493）
Eur Respir J. 2009 Mar;33(3):486-93.
Fluctuation analysis of lung function as a predictor of long-term response to beta2-agonists.
Keywords: Asthma, β2-adrenoceptor genotype, bronchodilators, fractals, peak expiratory flow
Thamrin C, Stern G, Strippoli MP, Kuehni CE, Suki B, Taylor DR, Frey U.
The response to beta(2)-agonists differs between asthmatics and has been linked to subsequent adverse events, even death. Possible determinants include beta(2)-adrenoceptor genotype at position 16, lung function and airway hyperresponsiveness. Fluctuation analysis provides a simple parameter alpha measuring the complex correlation properties of day-to-day peak expiratory flow. The present study investigated whether alpha predicts clinical response to beta(2)-agonist treatment, taking into account other conventional predictors. Analysis was performed on previously published twice-daily peak expiratory flow measurements in 66 asthmatic adults over three 6-month randomised order treatment periods: placebo, salbutamol and salmeterol. Multiple linear regression was used to determine the association between alpha during the placebo period and response to treatment (change in the number of days with symptoms), taking into account other predictors namely beta(2)-adrenoceptor genotype, lung function and its variability, and airway hyperresponsiveness. The current authors found that alpha measured during the placebo period considerably improved the prediction of response to salmeterol treatment, taking into account genotype, lung function or its variability, or airway hyperresponsiveness. The present study provides further evidence that response to beta(2)-agonists is related to the time correlation properties of lung function in asthma. The current authors conclude that fluctuation analysis of lung function offers a novel predictor to identify patients who may respond well or poorly to treatment.
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职业性哮喘的一项新的诊断评分标准——日间工作状态与非工作时最大呼气流量的曲线间面积（ABC评分）
