重度哮喘患者血清IgE浓度存在临床显著性变异
2012/02/29
目的：在考虑采用奥玛珠单抗治疗的重度哮喘患者队列中，研究血清免疫球蛋白E（IgE）的变异程度。
方法：2003～2011年克利夫兰呼吸研究所门诊就医的124名采用奥玛珠单抗治疗的哮喘患者中，选取IgE检测两次或以上的65名患者，对其病历进行回顾性研究。存在影响血清IgE浓度因素的患者排除在外。记录人口统计学数据、肺功能、用药、吸烟状态和特应性。计算IgE变异范围和与基础水平IgE相比的变异百分数。
结果：IgE最大值与最小值差异的中位数为94.9 IU/ml (IQR 26.3-324.1 IU/ml)。最小值变异百分数中位数为75.5% (IQR 23.3-152.6%)。年龄、体重指数、肺功能与IgE变异无显著相关性。女性具有较大的变异(p =0.06)。外周嗜酸性粒细胞、全身使用皮质激素和使用白三烯调节剂与IgE变异无关。42名患者中，有20名患者的奥玛珠单抗治疗受到IgE变异的影响。在不同时间点认为适合奥玛珠单抗治疗的6名患者，由于IgE浓度<30 IU/ml或>700 IU/ml而不认为是奥玛珠单抗治疗的候选者。
结论：血清IgE浓度随着时间存在显著性变异，影响患者奥玛珠单抗治疗及其治疗剂量选择。我们结果显示，对于血清IgE浓度<30 IU/ml或>700 IU/ml的哮喘患者，反复检测IgE浓度有助于决定患者是否适合奥玛珠单抗治疗。有必要进行前瞻性研究，以期找到影响IgE变异的因素。
方法：2003～2011年克利夫兰呼吸研究所门诊就医的124名采用奥玛珠单抗治疗的哮喘患者中，选取IgE检测两次或以上的65名患者，对其病历进行回顾性研究。存在影响血清IgE浓度因素的患者排除在外。记录人口统计学数据、肺功能、用药、吸烟状态和特应性。计算IgE变异范围和与基础水平IgE相比的变异百分数。
结果：IgE最大值与最小值差异的中位数为94.9 IU/ml (IQR 26.3-324.1 IU/ml)。最小值变异百分数中位数为75.5% (IQR 23.3-152.6%)。年龄、体重指数、肺功能与IgE变异无显著相关性。女性具有较大的变异(p =0.06)。外周嗜酸性粒细胞、全身使用皮质激素和使用白三烯调节剂与IgE变异无关。42名患者中，有20名患者的奥玛珠单抗治疗受到IgE变异的影响。在不同时间点认为适合奥玛珠单抗治疗的6名患者，由于IgE浓度<30 IU/ml或>700 IU/ml而不认为是奥玛珠单抗治疗的候选者。
结论：血清IgE浓度随着时间存在显著性变异，影响患者奥玛珠单抗治疗及其治疗剂量选择。我们结果显示，对于血清IgE浓度<30 IU/ml或>700 IU/ml的哮喘患者，反复检测IgE浓度有助于决定患者是否适合奥玛珠单抗治疗。有必要进行前瞻性研究，以期找到影响IgE变异的因素。
（林江涛 审校）
J Asthma. 2012 Jan 25. [Epub ahead of print]
J Asthma. 2012 Jan 25. [Epub ahead of print]
Source
Respiratory Institute, Cleveland Clinic , Cleveland, OH , USA.
Respiratory Institute, Cleveland Clinic , Cleveland, OH , USA.
Abstract
OBJECTIVE：To determine the magnitude of immunoglobulin E (IgE) variability in a cohort of patients with severe asthma considered for omalizumab therapy.
METHODS：Retrospective chart review identified 65 patients with two or more IgE determinations out of the 124 patients referred to the Cleveland Clinic Respiratory Institute for treatment with omalizumab from 2003 to 2011. Patients with conditions known to affect IgE concentrations were excluded. Demographic data, pulmonary function testing, medications, smoking status, and atopy were recorded. The range of variability and percent variability in relation to baseline serum IgE were calculated.
OBJECTIVE：To determine the magnitude of immunoglobulin E (IgE) variability in a cohort of patients with severe asthma considered for omalizumab therapy.
METHODS：Retrospective chart review identified 65 patients with two or more IgE determinations out of the 124 patients referred to the Cleveland Clinic Respiratory Institute for treatment with omalizumab from 2003 to 2011. Patients with conditions known to affect IgE concentrations were excluded. Demographic data, pulmonary function testing, medications, smoking status, and atopy were recorded. The range of variability and percent variability in relation to baseline serum IgE were calculated.
RESULTS：The median difference of serum IgE between the minimal and maximal values was 94.9 IU/ml (IQR 26.3-324.1 IU/ml). Percent variability from minimum value had a median of 75.5% (IQR 23.3-152.6%). There was no correlation between age, body mass index, lung function, and IgE variability. Greater variability was associated with female gender (p = .06). There was no association with peripheral eosinophilia, systemic corticosteroid use, and leukotriene modifier use at presentation. The observed variability would have affected omalizumab dosing in 20 out of 42 patients. Six patients who may have qualified at different time points would not have been deemed candidates based on an IgE concentration <30 IU/ml or >700 IU/ml.
CONCLUSION：Serum IgE concentration may have clinically significant variability over time, affecting candidacy and dosing of omalizumab. Our findings imply that repeating serum IgE determinations merits consideration for patients whose initial concentrations are <30 or >700 IU/ml. Prospective studies are warranted to delineate the factors that contribute to IgE variability.
CONCLUSION：Serum IgE concentration may have clinically significant variability over time, affecting candidacy and dosing of omalizumab. Our findings imply that repeating serum IgE determinations merits consideration for patients whose initial concentrations are <30 or >700 IU/ml. Prospective studies are warranted to delineate the factors that contribute to IgE variability.
J Asthma. 2012 Jan 25. [Epub ahead of print]
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