难治性哮喘儿童的激素反应和临床特征
2010/08/20
关键词：激素反应；难治性哮喘；嗜酸性粒细胞；一氧化氮；儿童哮喘
为了明确儿童难治性哮喘的临床特征和激素反应，Bossley等进行了以下两个连续研究：对102例难治性哮喘儿童（平均年龄11.6±2.8岁）进行了交叉、分层研究；并对其中89例患儿进行激素反应研究。激素反应性研究假设难治性哮喘儿童不具备完整的激素反应，即症状改善、肺功能正常、呼出气一氧化氮(FeNO)正常，无气道高反应性(BDR <12%)，在患儿全身激素治疗前后进行肺功能、呼出气一氧化氮(FeNO)和气道高反应性(BDR)测定，并在治疗后进行支气管镜检查。
交叉分层研究发现，102例难治性哮喘患儿中，60例(59%) 男性，88例(86%)患者为过敏性哮喘，52例(51%)存在其他诊断。在81例完成激素反应性研究的患者中，仅9例（11%）具备完全的激素反应性。在75例有症状资料的患者中，37例(49%)有症状反应，但与室内有吸烟者的反应不同(OR 0.31, 95% CI 0.02–0.82)。在75例有肺功能数据的患者中，35例(46%)的肺功能正常，且与BAL嗜酸性粒细胞数(OR 5.43, 95% CI 1.13–26.07) 和高FEV1基线(OR 1.08, 95% CI 1.02–1.12)相关。在这75例患者中，64例有BDR资料，其中36例(56%)的BDR<12% 。而在具备FeNO数据的70例患者中，53例(75%)的FeNO正常。75例有气流受限资料的患者中，17例(26%)存在持续性气流受限，且与较低的FEV1基线有关(OR 0.93, 95% CI 0.90–0.97)。
作者认为，难治性哮喘儿童对激素的反应较差，仅11%具备完整的激素反应，因此这些患儿需要选择其他的治疗方法。
（韩伟 青岛大学附属青岛市立医院东院 266071 摘译）
（Eur Respir J 2009; 34:1052-1059）
Difficult asthma child’s hormone response and clinical characteristic
C. J. Bossley, S. Saglani, C. Kavanagh, D. N. R. Payne, N. Wilson, L. Tsartsali, M. Rosenthal, I. M. Balfour-Lynn, A. G. Nicholson and A. Bush
Keywords: Corticosteroid responsiveness, difficult asthma, eosinophil, nitric oxide, paediatric asthma
This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (FeNO) and no bronchodilator responsiveness (BDR <12%)) is uncommon in paediatric DA.
We report on 102 children, mean±SD age 11.6±2.8 yrs, with DA in a cross-sectional study. 89 children underwent spirometry, BDR and FeNO before and after 2 weeks of systemic corticosteroids (corticosteroid response study). Bronchoscopy was performed after the corticosteroid trial.
Of the 102 patients in the cross-sectional study, 88 (86%) were atopic, 60 (59%) were male and 52 (51%) had additional or alternative diagnoses. Out of the 81 patients in the corticosteroid response study, nine (11%) were complete responders. Of the 75 patients with symptom data available, 37 (49%) responded symptomatically, which was less likely if there were smokers in the home (OR 0.31, 95% CI 0.02–0.82). Of the 75 patients with available spirometry data, 35 (46%) had normal spirometry, with associations being BAL eosinophilia (OR 5.43, 95% CI 1.13–26.07) and high baseline forced expiratory volume in 1 s (FEV1) (OR 1.08, 95% CI 1.02–1.12). Of these 75 patients, BDR data were available in 64, of whom 36 (56%) had <12% BDR. FeNO data was available in 70 patients, of whom 53 (75%) had normal FeNO. Airflow limitation data was available in 75 patients, of whom 17 (26%) had persistent airflow limitation, which was associated with low baseline FEV1 (OR 0.93, 95% CI 0.90–0.97).
Only 11% of DA children exhibited complete corticosteroid responsiveness. The rarity of complete corticosteroid responsiveness suggests alternative therapies are needed for children with DA.
为了明确儿童难治性哮喘的临床特征和激素反应，Bossley等进行了以下两个连续研究：对102例难治性哮喘儿童（平均年龄11.6±2.8岁）进行了交叉、分层研究；并对其中89例患儿进行激素反应研究。激素反应性研究假设难治性哮喘儿童不具备完整的激素反应，即症状改善、肺功能正常、呼出气一氧化氮(FeNO)正常，无气道高反应性(BDR <12%)，在患儿全身激素治疗前后进行肺功能、呼出气一氧化氮(FeNO)和气道高反应性(BDR)测定，并在治疗后进行支气管镜检查。
交叉分层研究发现，102例难治性哮喘患儿中，60例(59%) 男性，88例(86%)患者为过敏性哮喘，52例(51%)存在其他诊断。在81例完成激素反应性研究的患者中，仅9例（11%）具备完全的激素反应性。在75例有症状资料的患者中，37例(49%)有症状反应，但与室内有吸烟者的反应不同(OR 0.31, 95% CI 0.02–0.82)。在75例有肺功能数据的患者中，35例(46%)的肺功能正常，且与BAL嗜酸性粒细胞数(OR 5.43, 95% CI 1.13–26.07) 和高FEV1基线(OR 1.08, 95% CI 1.02–1.12)相关。在这75例患者中，64例有BDR资料，其中36例(56%)的BDR<12% 。而在具备FeNO数据的70例患者中，53例(75%)的FeNO正常。75例有气流受限资料的患者中，17例(26%)存在持续性气流受限，且与较低的FEV1基线有关(OR 0.93, 95% CI 0.90–0.97)。
作者认为，难治性哮喘儿童对激素的反应较差，仅11%具备完整的激素反应，因此这些患儿需要选择其他的治疗方法。
（韩伟 青岛大学附属青岛市立医院东院 266071 摘译）
（Eur Respir J 2009; 34:1052-1059）
Difficult asthma child’s hormone response and clinical characteristic
C. J. Bossley, S. Saglani, C. Kavanagh, D. N. R. Payne, N. Wilson, L. Tsartsali, M. Rosenthal, I. M. Balfour-Lynn, A. G. Nicholson and A. Bush
Keywords: Corticosteroid responsiveness, difficult asthma, eosinophil, nitric oxide, paediatric asthma
This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (FeNO) and no bronchodilator responsiveness (BDR <12%)) is uncommon in paediatric DA.
We report on 102 children, mean±SD age 11.6±2.8 yrs, with DA in a cross-sectional study. 89 children underwent spirometry, BDR and FeNO before and after 2 weeks of systemic corticosteroids (corticosteroid response study). Bronchoscopy was performed after the corticosteroid trial.
Of the 102 patients in the cross-sectional study, 88 (86%) were atopic, 60 (59%) were male and 52 (51%) had additional or alternative diagnoses. Out of the 81 patients in the corticosteroid response study, nine (11%) were complete responders. Of the 75 patients with symptom data available, 37 (49%) responded symptomatically, which was less likely if there were smokers in the home (OR 0.31, 95% CI 0.02–0.82). Of the 75 patients with available spirometry data, 35 (46%) had normal spirometry, with associations being BAL eosinophilia (OR 5.43, 95% CI 1.13–26.07) and high baseline forced expiratory volume in 1 s (FEV1) (OR 1.08, 95% CI 1.02–1.12). Of these 75 patients, BDR data were available in 64, of whom 36 (56%) had <12% BDR. FeNO data was available in 70 patients, of whom 53 (75%) had normal FeNO. Airflow limitation data was available in 75 patients, of whom 17 (26%) had persistent airflow limitation, which was associated with low baseline FEV1 (OR 0.93, 95% CI 0.90–0.97).
Only 11% of DA children exhibited complete corticosteroid responsiveness. The rarity of complete corticosteroid responsiveness suggests alternative therapies are needed for children with DA.
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中年哮喘患者对哮喘治疗指南的依从性分析
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孟鲁司特治疗能改变儿童哮喘患者免疫治疗的早期疗效
