哮喘联盟

    背景：对于哮喘患者与其肺功能下降有关的因素目前了解较少。
    目的：在基线状态下有或无气流阻塞的成人哮喘患者中，筛查导致FEV1下降的决定因素。
    方法：在欧洲社区呼吸健康调查（1991～1993）研究中，对638名哮喘患者（20～44岁）进行队列研究，随访期从1998～2002年。研究期和随访期都进行肺功能检测。基线状态下和随访期内，采用随机截距线性回归模型对与FEV1下降相关的潜在决定因素进行评价。通过患者在基线状态下是否出现气流阻塞（FEV1/最大肺活量<0.70）进行分层。
    结果：无气流阻塞组（n = 544），中等体重指数（BMI）个体FEV1值的下降大于较瘦和肥胖个体。FEV1的下降与体重增加相关，且独立于基线BMI。在男性中，该项因素的相关性（20; 95% CI, 10-30, mL/y/kg体重增加）高于女性（6; 95% CI, 1-11, mL/y）。在有气流阻塞组（n = 94），对过敏原不敏感和基线时BMI较低与FEV1下降较快有关，而体重增加与此无关。
    结论：体重增加对FEV1的不利作用在无气流阻塞的哮喘患者中尤为显著。本研究结果支持控制体重对于哮喘治疗具有重要作用，建议超重或肥胖的哮喘患者适当减肥。

（苏楠 审校）
Marcon A, et al. J Allergy Clin Immunol. 2009 Mar 23. [Epub ahead of print]

Body mass index, weight gain, and other determinants of lung function decline in adult asthma.

BACKGROUND: Little is known about factors associated with lung function decline in asthma.
OBJECTIVE: To identify the determinants of FEV(1) decline in adults with asthma with and without airflow obstruction at baseline.
METHODS: An international cohort of 638 subjects with asthma (20-44 years old) was identified in the European Community Respiratory Health Survey (1991-1993) and followed up from 1998 to 2002. Spirometry was performed on both occasions. FEV(1) decline was related to potential determinants evaluated at baseline and during the follow-up by random intercept linear regression models. The analyses were stratified by the presence of airflow obstruction (FEV(1)/forced vital capacity < 0.70) at baseline.
RESULTS: In the group of individuals without airflow obstruction (n = 544), a faster FEV(1) decline was observed for subjects with intermediate body mass index (BMI) than for lean and obese subjects. FEV(1) decline was associated with weight gain independently of baseline BMI, and this association was stronger in men (20; 95% CI, 10-30, mL/y/kg gained) than in women (6; 95% CI, 1-11, mL/y). In the group of individuals with airflow obstruction (n = 94), the absence of allergen sensitization and a low BMI at baseline were associated with a faster FEV(1) decline, whereas weight gain was not associated with decline.
CONCLUSIONS: The detrimental effect of weight gain on FEV(1) decline is particularly relevant in subjects with asthma who still do not have an established airflow obstruction. Our findings support the importance of weight management in asthma and recommend weight loss in overweight or obese individuals with asthma.