哮喘控制和支气管高反应性及气道炎症的关系：日常实践的横断面研究
2009/12/15
背景：哮喘治疗的主要终点是获得最佳的控制。本试验旨在评价气道炎症标记物（痰嗜酸性粒细胞和呼出气一氧化氮）、支气管高反应性（BHR）与哮喘控制之间的关系。
方法：2004年1月至2005年9月在我院哮喘门诊就诊的134名患者（平均年龄为42岁；平均第一秒用力呼气量（FVE1）：86％预测值）入选本研究。其中86名患者采用吸入性糖皮质激素治疗；99名为特应性患者，23名为吸烟患者。所有患者经过详细检查，包括呼出气一氧化氮分数（FE(NO)）检查，完成有效的哮喘控制问卷调查（ACQ6 Juniper），当FVE1大于70%预测值时，进行痰液诱导和乙酰甲胆碱激发试验。
结果：根据ACQ 诊断的哮喘控制水平，将患者分成三组（哮喘控制较好[ACQ≤0.75]，哮喘控制一般(临界)[ACQ＞0.75]，哮喘控制不佳[ACQ≥1.5]）。结果显示，与对照组相比，哮喘控制不佳的哮喘患者对乙酰甲胆碱的BHR和痰液嗜酸性粒细胞水平较高（分别为P<0.05，P<0.001）。相反，FE(NO)水平三组之间未见明显差异。此外，我们采用受试者工作特征曲线来区分哮喘控制较差患者（ACQ≥1.5）和哮喘控制一般或较好患者（ACQ<1.5），结果显示，痰液嗜酸性粒细胞和乙酰甲胆碱反应性在区分这些患者上较FE(NO)更准确（曲线下面积分别为0.72、0.72和0.59）。
结论：在临床上众多的哮喘患者中，与哮喘控制较差有相关性的是痰液嗜酸性粒细胞和乙酰甲胆碱支气管高反应性，而不是FE(NO)。
（苏楠 审校）
Clin Exp Allergy. 2009 Oct 8.
Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practice.
Quaedvlieg V, Sele J, Henket M, Louis R.
Summary Background The primary end-point in the management of asthma is to obtain optimal control. The aim of this study was to assess the relationships between the markers of airway inflammation (sputum eosinophilia and exhaled nitric oxide), bronchial hyperresponsiveness (BHR) and asthma control. Methods One hundred and thirty-four patients were recruited from our asthma clinic between January 2004 and September 2005 [mean age: 42 years, mean forced expiratory volume in 1 s (FEV(1)): 86% predicted]. Eighty-six of them were treated by inhaled corticosteroids, 99 were atopic and 23 were current smokers. They all underwent detailed investigations including fractional-exhaled nitric oxide (FE(NO)) measurement, sputum induction and methacholine challenge when FEV(1) was >70% predicted, and filled in a validated asthma control questionnaire (ACQ6 Juniper). Results When dividing patients into the three groups according to their level of asthma control determined by ACQ [well-controlled asthma (ACQ score /=1.5)], it appeared that uncontrolled asthmatics had a greater BHR to methacholine and sputum eosinophilia than controlled asthma (P<0.05, P<0.001, respectively). By contrast, we failed to show significant differences in the FE(NO) levels between the groups. With receiver-operating characteristic curves for differentiating uncontrolled (ACQ>/=1.5) from controlled and borderline (ACQ<1.5) asthma, sputum eosinophilia and methacholine responsiveness were found to be more accurate than FE(NO) (area under the curve: 0.72, 0.72 and 0.59, respectively). Conclusion In a broad spectrum of asthmatics encountered in clinical practice, sputum eosinophilia and methacholine bronchial hyperresponsiveness, but not FE(NO), are associated with uncontrolled asthma
Clin Exp Allergy. 2009 Oct 8.
方法：2004年1月至2005年9月在我院哮喘门诊就诊的134名患者（平均年龄为42岁；平均第一秒用力呼气量（FVE1）：86％预测值）入选本研究。其中86名患者采用吸入性糖皮质激素治疗；99名为特应性患者，23名为吸烟患者。所有患者经过详细检查，包括呼出气一氧化氮分数（FE(NO)）检查，完成有效的哮喘控制问卷调查（ACQ6 Juniper），当FVE1大于70%预测值时，进行痰液诱导和乙酰甲胆碱激发试验。
结果：根据ACQ 诊断的哮喘控制水平，将患者分成三组（哮喘控制较好[ACQ≤0.75]，哮喘控制一般(临界)[ACQ＞0.75]，哮喘控制不佳[ACQ≥1.5]）。结果显示，与对照组相比，哮喘控制不佳的哮喘患者对乙酰甲胆碱的BHR和痰液嗜酸性粒细胞水平较高（分别为P<0.05，P<0.001）。相反，FE(NO)水平三组之间未见明显差异。此外，我们采用受试者工作特征曲线来区分哮喘控制较差患者（ACQ≥1.5）和哮喘控制一般或较好患者（ACQ<1.5），结果显示，痰液嗜酸性粒细胞和乙酰甲胆碱反应性在区分这些患者上较FE(NO)更准确（曲线下面积分别为0.72、0.72和0.59）。
结论：在临床上众多的哮喘患者中，与哮喘控制较差有相关性的是痰液嗜酸性粒细胞和乙酰甲胆碱支气管高反应性，而不是FE(NO)。
（苏楠 审校）
Clin Exp Allergy. 2009 Oct 8.
Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practice.
Quaedvlieg V, Sele J, Henket M, Louis R.
Summary Background The primary end-point in the management of asthma is to obtain optimal control. The aim of this study was to assess the relationships between the markers of airway inflammation (sputum eosinophilia and exhaled nitric oxide), bronchial hyperresponsiveness (BHR) and asthma control. Methods One hundred and thirty-four patients were recruited from our asthma clinic between January 2004 and September 2005 [mean age: 42 years, mean forced expiratory volume in 1 s (FEV(1)): 86% predicted]. Eighty-six of them were treated by inhaled corticosteroids, 99 were atopic and 23 were current smokers. They all underwent detailed investigations including fractional-exhaled nitric oxide (FE(NO)) measurement, sputum induction and methacholine challenge when FEV(1) was >70% predicted, and filled in a validated asthma control questionnaire (ACQ6 Juniper). Results When dividing patients into the three groups according to their level of asthma control determined by ACQ [well-controlled asthma (ACQ score /=1.5)], it appeared that uncontrolled asthmatics had a greater BHR to methacholine and sputum eosinophilia than controlled asthma (P<0.05, P<0.001, respectively). By contrast, we failed to show significant differences in the FE(NO) levels between the groups. With receiver-operating characteristic curves for differentiating uncontrolled (ACQ>/=1.5) from controlled and borderline (ACQ<1.5) asthma, sputum eosinophilia and methacholine responsiveness were found to be more accurate than FE(NO) (area under the curve: 0.72, 0.72 and 0.59, respectively). Conclusion In a broad spectrum of asthmatics encountered in clinical practice, sputum eosinophilia and methacholine bronchial hyperresponsiveness, but not FE(NO), are associated with uncontrolled asthma
Clin Exp Allergy. 2009 Oct 8.
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呼出气中的挥发性有机化合物作为儿童哮喘诊断指标
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乙酰甲胆碱激发试验阴性患者对支气管扩张剂的反应能预测将来哮喘诊断
