严重的成人发作哮喘：一个特殊的表型
2013/12/16
背景：一些患者有严重的成人发作哮喘，然而其他患者则有轻度一过性的哮喘发作。到目前为止还不知道有着严重的成人发作哮喘的患者是否是一个特殊的临床表型。
目的：我们寻找研究是否严重成人发作哮喘与具体的表型特征有联系。
方法：从1个大学医院和3个非大学医院的门诊诊所征募来成人发作哮喘的患者176个。严重的难治性哮喘根据国际创新药物计划的规定， 轻度至中度持续发作哮喘根据全球标准哮喘倡议定义。患者从临床上，肺功能上和炎症等参数的方面上来区别。非配对t检验和卡方检验用来进行组间比较；单变量和多变量的logistic 回归用来测定疾病的严重程度相关的因素。
结果：除了预期的症状分数高，生活质量差，需要高强度治疗，肺功能低和发作率高，有严重成人发作哮喘的患者更多是非特异性的(52%比34%, P =0.02) ，更多的鼻部症状和鼻息肉(54%比27%, P ≤ 0.001)，更高的呼出气一氧化氮水平(38比27 ppb, P =0.02)和血液中中性粒细胞计数(5.3比4.0 10(9)/L, P ≤ .001)和痰嗜酸性粒细胞(11.8%比0.8%, P ≤0.001)。多因素logistic回归分析显示血液中中性粒细胞的增多(比值比, 10.9; P = .002)和痰嗜酸性粒细胞(比值比, 1.5; P = .005)的计数与严重成人发作疾病独立相关。
结论：大多数有严重成人发作哮喘的患者是非特异性的，有着持续的嗜酸性粒细胞气道炎症。这提示我们严重成人发作哮喘与中度哮喘相比有特殊的潜在的发病机制。
（苏新明 中国医科大学附属一院呼吸科 110001 摘译）
（Amelink M, de Groot JC, de Nijs SB, et al. J Allergy Clin Immunol.2013 Aug;132(2):336-41.）
Severe adult-onset asthma: A distinct phenotype.
KEYWORDS:Asthma, BMI, Body mass index, Feno, Fraction of exhaled nitric oxide, OR, Odds ratio, adult onset, eosinophilia, sinus disease
Abstract
BACKGROUND:Some patients with adult-onset asthma have severe disease, whereas others have mild transient disease. It is currently unknown whether patients with severe adult-onset asthma represent a distinct clinical phenotype.
OBJECTIVE:We sought to investigate whether disease severity in patients with adult-onset asthma is associated with specific phenotypic characteristics.
METHODS:One hundred seventy-six patients with adult-onset asthma were recruited from 1 academic and 3 nonacademic outpatient clinics. Severe refractory asthma was defined according to international Innovative Medicines Initiative criteria, and mild-to-moderate persistent asthma was defined according to Global Initiative for Asthma criteria. Patients were characterized with respect to clinical, functional, and inflammatory parameters. Unpaired t tests and χ(2) tests were used for group comparisons; both univariate and multivariate logistic regression were used to determine factors associated with disease severity.
RESULTS:Apart from the expected high symptom scores, poor quality of life, need for high-intensity treatment, low lung function, and high exacerbation rate, patients with severe adult-onset asthma were more often nonatopic (52% vs 34%, P = .02) and had more nasal symptoms and nasal polyposis (54% vs 27%, P ≤ .001), higher exhaled nitric oxide levels (38 vs 27 ppb, P = .02) and blood neutrophil counts (5.3 vs 4.0 10(9)/L, P ≤ .001) and sputum eosinophilia (11.8% vs 0.8%, P ≤ .001). Multiple logistic regression analysis showed that increased blood neutrophil (odds ratio, 10.9; P = .002) and sputum eosinophil (odds ratio, 1.5; P = .005) counts were independently associated with severe adult-onset disease.
CONCLUSION:The majority of patients with severe adult-onset asthma are nonatopic and have persistent eosinophilic airway inflammation. This suggests that severe adult-onset asthma has a distinct underlying mechanism compared with milder disease.
Amelink M, de Groot JC, de Nijs SB, et al. J Allergy Clin Immunol.2013 Aug;132(2):336-41.
