肥胖对哮喘表型的影响依赖于哮喘严重程度
2011/03/24
摘要
背景：近期研究显示，肥胖与非肥胖的哮喘患者，具有相似的气流受限且针对支气管扩张剂具有相似的反应，但肥胖患者表现出更多的症状。有关肥胖对不同严重程度哮喘（通过客观生理指标检测）的影响，研究结果较少。研究肥胖对不同严重程度哮喘的影响有助于了解肥胖患者哮喘的发病机制及为肥胖患者哮喘治疗提供证据。
方法：哮喘患者来自于美国肺科协会-哮喘临床研究中心(ALA-ACRC)的两个研究，根据气流受限的三分位数[第一秒用力肺活量（FEV1）%预测值、FEV1与用力肺活量（FVC）比值、乙酰甲胆碱（PC20FEV1）]将患者分组。各组内，研究体重指数(BMI)、体重与正常体重比值、超重及肥胖对肺功能、气道反应性和症状的影响。
结果：总体来说，随着BMI的增加，FEV1和FVC下降，症状恶化，而气道反应性未显著变化。若根据气流受限程度分层，较高的BMI并不与更高的气道反应性（乙酰甲胆碱）相关。仅在FEV1/FVC最小三分位数组，较高的BMI与更多的症状相关。若根据气道反应性分层，在所有PC20 FEV1各组，BMI与FVC成负相关。仅在最低气道反应性的患者中，BMI直接与哮喘症状相关。
结论：肥胖并不影响哮喘患者的气道反应性，但在并不严重的哮喘患者中，肥胖与更多的症状相关。
（苏楠 审校）
J Asthma. 2010 Nov 22. [Epub ahead of print]
Effect of Obesity on Asthma Phenotype is Dependent upon Asthma Severity.
Raviv S, Dixon AE, Kalhan R, Shade D, Smith LJ.
Department of Pulmonary and Critical Care Medicine, Northshore University Health System, Evanston, IL, USA.
Abstract
Background. We recently reported that obese and non-obese patients with asthma have similar airflow limitation and bronchodilator responsiveness, but obese patients have more symptoms overall. There is limited information on the effect of obesity on asthmatics of varying severity measured by objective physiological parameters. Understanding how obesity affects asthmatics of differing severity can provide insights into the pathogenesis of asthma in the obese and a rationale for the therapeutic approach to such patients.
Methods. Participants with asthma from two American Lung Association-Asthma Clinical Research Center (ALA-ACRC) studies were grouped by tertiles of airflow obstruction (forced expiratory volume in one second (FEV(1)%) predicted, FEV(1)/forced vital capacity (FVC)) and methacholine reactivity (PC(20)FEV(1)). Within each tertile, we examined the independent effect of body mass index (BMI), divided into normal weight, overweight, and obese categories, on lung function, airway reactivity, and symptoms.
Results. Overall, both FEV(1) and FVC decreased and symptoms worsened with increasing BMI; airway reactivity was unchanged. When stratified by the degree of airflow obstruction, higher BMI was not associated with greater airway reactivity to methacholine. Higher BMI was associated with more asthma symptoms only in the least obstructed FEV(1)/FVC tertile. When stratified by degree of airway reactivity, BMI was inversely associated with FVC in all PC(20)FEV(1) tertiles. BMI was directly associated with asthma symptoms only in those with the least airway reactivity.
Conclusions. Obesity does not influence airway reactivity in patients with asthma and it is associated with more symptoms only in those with less severe disease.
J Asthma. 2010 Nov 22. [Epub ahead of print]
背景：近期研究显示，肥胖与非肥胖的哮喘患者，具有相似的气流受限且针对支气管扩张剂具有相似的反应，但肥胖患者表现出更多的症状。有关肥胖对不同严重程度哮喘（通过客观生理指标检测）的影响，研究结果较少。研究肥胖对不同严重程度哮喘的影响有助于了解肥胖患者哮喘的发病机制及为肥胖患者哮喘治疗提供证据。
方法：哮喘患者来自于美国肺科协会-哮喘临床研究中心(ALA-ACRC)的两个研究，根据气流受限的三分位数[第一秒用力肺活量（FEV1）%预测值、FEV1与用力肺活量（FVC）比值、乙酰甲胆碱（PC20FEV1）]将患者分组。各组内，研究体重指数(BMI)、体重与正常体重比值、超重及肥胖对肺功能、气道反应性和症状的影响。
结果：总体来说，随着BMI的增加，FEV1和FVC下降，症状恶化，而气道反应性未显著变化。若根据气流受限程度分层，较高的BMI并不与更高的气道反应性（乙酰甲胆碱）相关。仅在FEV1/FVC最小三分位数组，较高的BMI与更多的症状相关。若根据气道反应性分层，在所有PC20 FEV1各组，BMI与FVC成负相关。仅在最低气道反应性的患者中，BMI直接与哮喘症状相关。
结论：肥胖并不影响哮喘患者的气道反应性，但在并不严重的哮喘患者中，肥胖与更多的症状相关。
（苏楠 审校）
J Asthma. 2010 Nov 22. [Epub ahead of print]
Effect of Obesity on Asthma Phenotype is Dependent upon Asthma Severity.
Raviv S, Dixon AE, Kalhan R, Shade D, Smith LJ.
Department of Pulmonary and Critical Care Medicine, Northshore University Health System, Evanston, IL, USA.
Abstract
Background. We recently reported that obese and non-obese patients with asthma have similar airflow limitation and bronchodilator responsiveness, but obese patients have more symptoms overall. There is limited information on the effect of obesity on asthmatics of varying severity measured by objective physiological parameters. Understanding how obesity affects asthmatics of differing severity can provide insights into the pathogenesis of asthma in the obese and a rationale for the therapeutic approach to such patients.
Methods. Participants with asthma from two American Lung Association-Asthma Clinical Research Center (ALA-ACRC) studies were grouped by tertiles of airflow obstruction (forced expiratory volume in one second (FEV(1)%) predicted, FEV(1)/forced vital capacity (FVC)) and methacholine reactivity (PC(20)FEV(1)). Within each tertile, we examined the independent effect of body mass index (BMI), divided into normal weight, overweight, and obese categories, on lung function, airway reactivity, and symptoms.
Results. Overall, both FEV(1) and FVC decreased and symptoms worsened with increasing BMI; airway reactivity was unchanged. When stratified by the degree of airflow obstruction, higher BMI was not associated with greater airway reactivity to methacholine. Higher BMI was associated with more asthma symptoms only in the least obstructed FEV(1)/FVC tertile. When stratified by degree of airway reactivity, BMI was inversely associated with FVC in all PC(20)FEV(1) tertiles. BMI was directly associated with asthma symptoms only in those with the least airway reactivity.
Conclusions. Obesity does not influence airway reactivity in patients with asthma and it is associated with more symptoms only in those with less severe disease.
J Asthma. 2010 Nov 22. [Epub ahead of print]
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病毒诱导的急性哮喘患者中自然免疫信号受体特征
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儿童肥胖与过敏性和非过敏性哮喘间的关系：来自国家健康与营养调查的结果（1999～2006）
