哮喘异质性与血液中炎性模式的研究
2009/07/30
目前对与炎症模式相关的哮喘异质性的研究逐渐变热。为了评估疾病的表型特点，尤其是临床表现。R Nadif等研究者从法国“遗传和环境相关哮喘”（EGEA）流行病研究中选取了381名有哮喘典型症状的患者，得到其血液中炎症模式。四种血液炎性模式的定义是根据嗜酸细胞(EOS)和中性粒细胞(NEU)计数截点来决定的。血样中250 EOS/mm3定义为EOShi，5000 NEU/mm3定义为NEUhi。临床症状表现为典型哮喘和慢性阻塞性肺疾病（COPD）样症状，并将病情量化评分。
结果发现，56.2%哮喘患者的血样表现为EOSlo 型（即<250 EOS/mm3）。血样表现为EOShi型的哮喘患者其IgE较高、FEV1较低，且比血样EOSlo型的患者哮喘更易发病。EOSlo型的患者其中性粒细胞炎症程度NEUhi与皮肤点刺实验阳性反应相关性不大(OR 0.44, 95% CI 0.20 to 0.96)。血样EOShi型的哮喘患者，在不考虑年龄、性别、吸烟史和吸及糖皮质激素治疗史的情况下，中性粒细胞的炎性反应不能解释哮喘的发病和严重程度及分级，但却与夜间哮喘症状的发作明显相关(OR 5.21, 95% CI 1.44 to 18.8)。非吸烟的哮喘人群中，有慢性阻塞性肺疾病（COPD）样症状，尤其是有顽固性咳痰的患者，其血样中中性粒细胞炎性表现更明显，而与嗜酸粒细胞升高关系不明显(OR 2.35, 95% CI 1.08 to 5.10)。
由此研究得出：哮喘的症状与血液嗜酸细胞和中性粒细胞升高有关。同时考虑嗜酸细胞和中性粒细胞两种炎性反应，可能有助于对哮喘的深入研究。
结果发现，56.2%哮喘患者的血样表现为EOSlo 型（即<250 EOS/mm3）。血样表现为EOShi型的哮喘患者其IgE较高、FEV1较低，且比血样EOSlo型的患者哮喘更易发病。EOSlo型的患者其中性粒细胞炎症程度NEUhi与皮肤点刺实验阳性反应相关性不大(OR 0.44, 95% CI 0.20 to 0.96)。血样EOShi型的哮喘患者，在不考虑年龄、性别、吸烟史和吸及糖皮质激素治疗史的情况下，中性粒细胞的炎性反应不能解释哮喘的发病和严重程度及分级，但却与夜间哮喘症状的发作明显相关(OR 5.21, 95% CI 1.44 to 18.8)。非吸烟的哮喘人群中，有慢性阻塞性肺疾病（COPD）样症状，尤其是有顽固性咳痰的患者，其血样中中性粒细胞炎性表现更明显，而与嗜酸粒细胞升高关系不明显(OR 2.35, 95% CI 1.08 to 5.10)。
由此研究得出：哮喘的症状与血液嗜酸细胞和中性粒细胞升高有关。同时考虑嗜酸细胞和中性粒细胞两种炎性反应，可能有助于对哮喘的深入研究。
（于娜 沈阳中国医科大学附属第一医院呼吸内科 110001 摘译）
（Thorax 2009;64:374-380）
Heterogeneity of asthma according to blood inflammatory patterns
R Nadif1, V Siroux2, M-P Oryszczyn1, C Ravault1, C Pison1, I Pin3, F Kauffmann1 on behalf of the Epidemiological study on the Genetics and Environment of Asthma (EGEA)
Rationale: There is increasing interest regarding asthma heterogeneity in relation to inflammatory patterns.
Objectives: To assess phenotypic characteristics, in particular clinical presentation of the disease, in 381 well-characterised adults with asthma from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) according to their blood inflammatory pattern.
Methods: Four blood inflammatory patterns were defined according to eosinophil (EOS) and neutrophil (NEU) count cut-off points. Samples with 250 EOS/mm3 were classified as EOShi and those with 5000 NEU/mm3 as NEUhi. Clinical characteristics include typical asthma and chronic obstructive pulmonary disease (COPD)-like symptoms, as well as composite quantitative scores addressing the activity of the disease.
Results: A substantial number of those with asthma (56.2%) had the EOSlo pattern (<250 EOS/mm3). Patients with asthma who had the EOShi pattern had higher immunoglobulin E (IgE), a lower forced expiratory volume in 1 s (FEV1) and presented a more active asthma than those with the EOSlo pattern. Among those with the EOSlo pattern, neutrophil inflammation (NEUhi) was related to a less frequent positive skin prick test response (OR 0.44, 95% CI 0.20 to 0.96). Among those with the EOShi pattern, neutrophil inflammation did not explain current asthma or asthma activity, and was significantly related to nocturnal symptoms (OR 5.21, 95% CI 1.44 to 18.8) independently of age, sex, smoking and inhaled corticosteroid treatment. In non-smokers with asthma, COPD-like symptoms, in particular chronic phlegm, were more frequent in those with neutrophil inflammation, independent of eosinophil inflammation.
Conclusions: Besides eosinophilia, neutrophil inflammation assessed in the blood is related to specific characteristics of asthma. Considering simultaneously neutrophilic and eosinophilic inflammation may contribute to help to disentangle this complex disease.
Objectives: To assess phenotypic characteristics, in particular clinical presentation of the disease, in 381 well-characterised adults with asthma from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) according to their blood inflammatory pattern.
Methods: Four blood inflammatory patterns were defined according to eosinophil (EOS) and neutrophil (NEU) count cut-off points. Samples with 250 EOS/mm3 were classified as EOShi and those with 5000 NEU/mm3 as NEUhi. Clinical characteristics include typical asthma and chronic obstructive pulmonary disease (COPD)-like symptoms, as well as composite quantitative scores addressing the activity of the disease.
Results: A substantial number of those with asthma (56.2%) had the EOSlo pattern (<250 EOS/mm3). Patients with asthma who had the EOShi pattern had higher immunoglobulin E (IgE), a lower forced expiratory volume in 1 s (FEV1) and presented a more active asthma than those with the EOSlo pattern. Among those with the EOSlo pattern, neutrophil inflammation (NEUhi) was related to a less frequent positive skin prick test response (OR 0.44, 95% CI 0.20 to 0.96). Among those with the EOShi pattern, neutrophil inflammation did not explain current asthma or asthma activity, and was significantly related to nocturnal symptoms (OR 5.21, 95% CI 1.44 to 18.8) independently of age, sex, smoking and inhaled corticosteroid treatment. In non-smokers with asthma, COPD-like symptoms, in particular chronic phlegm, were more frequent in those with neutrophil inflammation, independent of eosinophil inflammation.
Conclusions: Besides eosinophilia, neutrophil inflammation assessed in the blood is related to specific characteristics of asthma. Considering simultaneously neutrophilic and eosinophilic inflammation may contribute to help to disentangle this complex disease.
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鼻病毒与哮喘发生
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哮喘患者的情感神经元回路及精神-躯体的影响
