中重度顽固性哮喘患者中非嗜酸粒细胞升高型哮喘患者比例调查
2012/10/29
研究背景：气道的嗜酸粒细胞炎症是哮喘的典型特征,诸多控制治疗即针对该特征。但哮喘患者的临床表现不同，部分哮喘患者并不具备嗜酸粒细胞性气道炎症。由于以往的研究并未进行重复性痰细胞学检查来了解哮喘患者痰中何时出现间歇性或持续性的嗜酸粒细胞增多，以及何时出现持续性非嗜酸粒细胞增多，因此这部分亚组患者人数目前仍不清楚。
目的：探讨非嗜酸粒细胞增多表型哮喘患者的发病率和临床特征。
方法：本文通过入选哮喘临床研究网络临床试验的995例哮喘患者分析其痰细胞学数据。这些临床试验中对入选患者进行了诱导痰及其细胞学检查，多为重复多次的检测，并对标准化哮喘治疗方案的疗效加以评估。
目的：探讨非嗜酸粒细胞增多表型哮喘患者的发病率和临床特征。
方法：本文通过入选哮喘临床研究网络临床试验的995例哮喘患者分析其痰细胞学数据。这些临床试验中对入选患者进行了诱导痰及其细胞学检查，多为重复多次的检测，并对标准化哮喘治疗方案的疗效加以评估。
结果：横断面分析显示，未接受糖皮质激素吸入（ICS）治疗的哮喘患者中仅36%的患者具有痰嗜酸粒细胞增多（≥2%），而接受ICS治疗的哮喘患者则仅17%具有痰嗜酸粒细胞增多。即使在哮喘得到部分控制的患者，痰中未检见嗜酸粒细胞增多的患者比例并非少数。在对未接受ICS治疗的哮喘患者重复进行的痰细胞学检查结果分析中，每次痰检均显示嗜酸粒细胞增多的患者比例达22%（持续性嗜酸粒细胞增多），至少一次痰检阳性的患者比例为31%（间歇性嗜酸粒细胞增多），47%的患者从未出现过痰检结果阳性（持续性非嗜酸粒细胞增多）。在接受为期两周的联合抗炎治疗后，痰嗜酸粒细胞检查阳性的患者气流受限得到明显改善，但在痰嗜酸粒细胞检查结果阴性的患者则并无改善。相反，对支气管扩张剂沙丁胺醇的反应两组患者无明显差异。
结论：将近半数的中重度哮喘患者痰嗜酸粒细胞检查阴性，这类哮喘患者对于目前的抗炎治疗疗效欠佳。
结论：将近半数的中重度哮喘患者痰嗜酸粒细胞检查阴性，这类哮喘患者对于目前的抗炎治疗疗效欠佳。
(方萍 西安交通大学医学院第二附属医院 710004 摘译)
Am J Respir Crit Care Med. 2012 Mar 15;185(6):612-9. Epub 2012 Jan 20.
A large subgroup of mild-to-moderate asthma is persistently noneosinophilic.
McGrath KW, Icitovic N, Boushey HA, Lazarus SC, Sutherland ER, Chinchilli VM, Fahy JV; Asthma Clinical Research Network of the National Heart, Lung, and Blood Institute.
Collaborators: Deykin A, Drazen JM, Israel E, Wechsler ME, Kraft M, Martin RJ, Szefler SJ, Lemanske RF, Sorkness CA, Jarjour NN, Fish JE, Leone FT, Peters SP, Ford JG, DiMango E, Pesola GR, Calhoun WJ, Ameredes BT, Castro M, Walter MJ, Ramsdell J, Wasserman S, Bleecker E, Meyers D, Peters SP, Craig TJ, King TS, Mauger EA.
Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94143, USA.
RATIONALE: Airway eosinophilia is typical of asthma, and many controller treatments target eosinophilic disease. Asthma is clinically heterogeneous, however, and a subgroup of people with asthma do not have airway eosinophilia. The size of this subgroup is uncertain because prior studies have not examined repeated measures of sputum cytology to determine when people with asthma have intermittent versus persistent sputum eosinophila and when they are persistently noneosinophilic.
OBJECTIVES: To determine the prevalence and clinical characteristics of the noneosinophilic asthma phenotype.
METHODS: We analyzed sputum cytology data from 995 subjects with asthma enrolled in clinical trials in the Asthma Clinical Research Network where they had undergone sputum induction and measures of sputum cytology, often repeatedly, and assessment of responses to standardized asthma treatments.
MEASUREMENTS AND MAIN RESULTS: In cross-sectional analyses, sputum eosinophilia (≥2% eosinophils) was found in only 36% of subjects with asthma not taking an inhaled corticosteroid (ICS) and 17% of ICS-treated subjects with asthma; an absence of eosinophilia was noted frequently, even in subjects with asthma whose disease was suboptimally controlled. In repeated measures analyses of people with asthma not taking an ICS, 22% of subjects had sputum eosinophilia on every occasion (persistent eosinophilia); 31% had eosinophilia on at least one occasion (intermittent eosinophilia); and 47% had no eosinophilia on every occasion (persistently noneosinophilic). Two weeks of combined antiinflammatory therapy caused significant improvements in airflow obstruction in eosinophilic asthma, but not in persistently noneosinophilic asthma. In contrast, bronchodilator responses to albuterol were similar in eosinophilic and noneosinophilic asthma.
CONCLUSIONS: Approximately half of patients with mild-to-moderate asthma have persistently noneosinophilic disease, a disease phenotype that responds poorly to currently available antiinflammatory therapy.
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在非运动员中进行气道高反应性检测时，等二氧化碳自主过度通气优于乙酰甲胆碱激发测试
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