哮喘联盟

   摘要 
   哮喘未控制将带来沉重负担，可能使妊娠复杂化，影响妊娠结果。炎症标志物suPAR升高在许多条件下（如感染、自身免疫或妊娠期相关性疾病）与疾病预后有关。然而，在哮喘和妊娠期哮喘中，suPAR的价值未知。
   本研究旨在比较哮喘（非妊娠期哮喘 ANP;N=38岁;女性N=27)和妊娠期哮喘(AP; N = 15)患者与健康非妊娠期女性（HNP; N = 29; 女性N = 19）和健康妊娠期女性(HP; N = 58)的suPAR、C反应蛋白和IL-6水平的差异。同时评估suPAR水平和哮喘控制之间的关系。采用ROC法分析suPAR水平在哮喘控制中的诊断作用。各研究组的IL-6和C反应蛋白水平相当。与HNP和ANP组受试者相比，HP 和AP组患者的suPAR水平更低(2.01 [1.81-2.38]和 2.39 [2.07-2.69] vs. 2.60 [1.82-3.49] 和 2.84 [2.33-3.72] ng/mL, P = 0.0001)。ANP组患者suPAR水平和呼吸道阻力相关(r = 0.47, P = 0.004)。在ANP组患者中，suPAR判断PEF高于和低于80%的 ROC 曲线下面积（AUC）为0.75 (95% CI: 0.57-0.92, P= 0.023) ，判断ACT总评分高于或低于20的AUC为0.8% (95% CI: 0.64-0.95, P  = 0.006).在AP和ANP患者中，suPAR 区别控制与非控制组的cut-off值为4.04ng/ml。总之，suPAR水平可能有助于客观评估哮喘控制情况，因为它与气道阻力和哮喘控制受损的敏感性有关。在健康和妊娠期女性中均检测到可溶性尿激酶受体水平的降低，这可能预示着妊娠期可诱导免疫耐受。

 

(刘国梁 审校)
PLoS One. 2013;8(4):e60697. doi: 10.1371/journal.pone.0060697. Epub 2013 Apr 2.

 

Relationship of Circulating Soluble Urokinase Plasminogen Activator Receptor (suPAR) Levels to Disease Control in Asthma and Asthmatic Pregnancy.
 

Ivancsó I, Toldi G, Bohács A, Eszes N, Müller V, Rigó J Jr, Vásárhelyi B, Losonczy G, Tamási L.

Abstract
Asthma has a high burden of morbidity if not controlled and may frequently complicate pregnancy, posing a risk for pregnancy outcomes. Elevated plasma level of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is related to a worse prognosis in many conditions such as infectious, autoimmune, or pregnancy-related diseases; however the value of suPAR in asthma and asthmatic pregnancy is unknown. The present study aimed to investigate the suPAR, CRP and IL-6 levels in asthma (asthmatic non-pregnant, ANP; N = 38; female N = 27) and asthmatic pregnancy (AP; N = 15), compared to healthy non-pregnant controls (HNP; N = 29; female N = 19) and to healthy pregnant women (HP; N = 58). The relationship between suPAR levels and asthma control was also evaluated. The diagnostic efficacy of suPAR in asthma control was analyzed using ROC analysis. IL-6 and CRP levels were comparable in all study groups.
Circulating suPAR levels were lower in HP and AP than in HNP and ANP subjects, respectively (2.01 [1.81-2.38] and 2.39 [2.07-2.69] vs. 2.60 [1.82-3.49] and 2.84 [2.33-3.72] ng/mL, respectively, p = 0.0001). suPAR and airway resistance correlated in ANP (r = 0.47, p = 0.004). ROC analysis of suPAR values in ANP patients with PEF above and below 80% yielded an AUC of 0.75 (95% CI: 0.57-0.92, p = 0.023) and with ACT total score above and below 20 an AUC of 0.80 (95% CI: 0.64-0.95, p = 0.006). The cut-off value of suPAR to discriminate between controlled and not controlled AP and ANP was 4.04 ng/mL. In conclusion, suPAR may help the objective assessment of asthma control, since it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease in circulating suPAR levels detected both in healthy and asthmatic pregnant women presumably represents pregnancy induced immune tolerance.

PLoS One. 2013;8(4):e60697. doi: 10.1371/journal.pone.0060697. Epub 2013 Apr 2.