哮喘或慢性阻塞性肺疾病导致固定性气流阻塞：5年的随访研究
2010/07/05
背景：吸烟者和哮喘患者常出现固定性气流阻塞，这与多种形式的气道疾病有关。固定性气流阻塞对这些患者预后的影响目前尚不清楚。
目的：本试验在由哮喘或慢性阻塞性肺疾病（COPD）导致的固定性气流阻塞患者中进行为期5年的前瞻性研究，调查这些患者肺功能下降和哮喘恶化的情况。此外，对功能性、病理性及临床特征性进行评价。
方法：入选患者包括由哮喘（=16）或COPD（n=21）导致固定性气流阻塞的患者和具有可逆性气流阻塞的对照组哮喘患者（n=15），对这些患者进行5年的随访。
结果：对于由哮喘或COPD导致的固定气流阻塞的患者，其FEV1下降程度类似（分别为-49.7 +/- 10.6 mL/y和-51.4 +/- 9.8 mL/y），但这些患者的FEV1下降高于可逆性气流阻塞哮喘患者（-18.1 +/- 10.1 mL/y, P <0.01）。此外，与可逆性气流阻塞的哮喘患者相比（每名患者每年0.53 +/- 0.11, P <0 .01），由哮喘（每名患者每年1.41 +/- 0.26）或COPD（每名患者每年1.98 +/- 0.3）导致固定性气流阻塞的患者，其恶化次数也显著增加。对于有固定性气流阻塞的哮喘患者，在基线状态下，呼出气一氧化氮水平和痰液嗜酸性粒细胞计数与FEV1下降相关。相反，在基线状态下痰液中性粒细胞计数、肺气肿评分、共患病及恶化频率直接与COPD患者FEV1下降相关，而肺弥散能力与COPD患者FEV1下降负向相关。
结论：对于哮喘和COPD患者，固定性气流阻塞与肺功能下降增加、疾病恶化频率增加相关。而肺功能下降可能与疾病特异性的病理和临床特征相关。
Contoli M, et al. J Allergy Clin Immunol. 2010 Mar 12. [Epub ahead of print]
Fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease: 5-year follow-up.
Contoli M, Baraldo S, Marku B, Casolari P, Marwick JA, Turato G, Romagnoli M, Caramori G, Saetta M, Fabbri LM, Papi A.
Research Centre on Asthma and COPD, Department of Clinical and Experimental Medicine,
BACKGROUND: Both smokers and patients with asthma can experience fixed airflow obstruction, which is associated with distinctive patterns of airway pathology. The influence of fixed airflow obstruction on the prognosis of these patients is unknown.
OBJECTIVE: We sought to investigate lung function decline and exacerbations in a 5-year prospective study of subjects with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease (COPD). We also sought to explore correlations between functional, pathological, and clinical features.
METHODS: Patients with fixed airflow obstruction due to asthma (n = 16) or COPD (n = 21) and a control group of asthmatic patients with fully reversible airflow obstruction (n = 15) were followed for 5 years.
RESULTS: The rates of decline in FEV(1) were similar in patients with fixed airflow obstruction caused by asthma (-49.7 +/- 10.6 mL/y) or COPD (-51.4 +/- 9.8 mL/y) and were higher than in asthmatic patients with reversible airflow obstruction (-18.1 +/- 10.1 mL/y, P < .01). Exacerbation rates were also higher in patients with fixed airflow obstruction caused by asthma (1.41 +/- 0.26 per patient-year) or COPD (1.98 +/- 0.3 per patient-year) compared with those seen in asthmatic patients with reversible airflow obstruction (0.53 +/- 0.11 per patient-year, P < .01). Baseline exhaled nitric oxide levels and sputum eosinophil counts correlated with the FEV(1) decline in asthmatic patients with fixed airflow obstruction. By contrast, baseline sputum neutrophil counts, emphysema scores, comorbidities, and exacerbation frequency correlated directly and pulmonary diffusion capacity correlated inversely with the FEV(1) decline in patients with COPD.
CONCLUSION: In both patients with asthma and those with COPD, fixed airflow obstruction is associated with increased lung function decline and frequency of exacerbations. Nevertheless, the decline in lung function entails the specific pathological and clinical features of the underlying diseases.
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哮喘发病过程中天然免疫和获得性免疫的相互影响：来自哮喘急性加重研究的新视角
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