接受吸入性糖皮质激素治疗的患者升高的骨膜蛋白水平与更严重的气流受限相关
2013/12/16
背景：骨膜蛋白，一种细胞基质外的蛋白，有助于哮喘的气道皮下增厚，它的血清水平反映了气道嗜酸性粒细胞炎症。然而，在骨膜蛋白和气流受限的发展，气道模型功能的后果之间的关系仍然不明。
目的：我们旨在确定吸入糖皮质激素治疗的哮喘患者骨膜蛋白血清水平和肺功能下降的关系。
方法：用ICS治疗至少四年的224个哮喘患者（平均年龄，62.3岁）被登记。从吸入ICS开始之后至少一年到登记的时间或者之后（平均，16.2测量，每个人超过8年）评估FEV1每年的变化。在登记中检查了临床参数，包括骨膜蛋白血清的生物标志物和骨膜基因多态性。并分析临床参数或生物标志物与FEV1及其减少的联系。
结果：在登记中高水平的骨膜蛋白血清（≥ 95 ng/mL），最高剂量的治疗步骤，每天稍高的ICS吸入，由于哮喘发作入院的历史，并发症或者鼻息肉的历史，之前的吸烟史，都和每年FEV1 30mL或者更多的减少有联系。多元分析显示高骨膜蛋白，最高剂量的治疗步骤和之前吸烟对于肺功下降是独立的危险因素。骨膜蛋白基因的多态性和更高的骨膜蛋白水平(rs3829365) 和每年FEV1 30mL或者更多的减少(rs9603226)有关。
结论：骨膜蛋白的出现对于吸入ICS的哮喘患者其气流受限的发展是一个有用的生物标志物。
（苏新明 中国医科大学附属一院呼吸科 110001 摘译）
（KanemitsuY,MatsumotoH,IzuharaK,etal.JAllergyClinImmunol.2013Aug;132(2):305-12.e3.）
Increased periostin associates with greater airflow limitation in patients receiving inhaled corticosteroids.
KEYWORDS:ACT, Asthma, Asthma control test, ECP, Eosinophil cationic protein, FAS I, Fasciclin I, High-sensitivity C-reactive protein, ICS, Inhaled corticosteroids, POSTN gene polymorphism, ROC, Receiver operating characteristic, SNP, Single-nucleotide polymorphism, hsCRP, inhaled corticosteroids, lung function decline, periostin, sinusitis, treatment step
Abstract
BACKGROUND:Periostin, an extracellular matrix protein, contributes to subepithelial thickening in asthmatic airways, and its serum levels reflect airway eosinophilic inflammation. However, the relationship between periostin and the development of airflow limitation, a functional consequence of airway remodeling, remains unknown.
OBJECTIVE:We aimed to determine the relationship between serum periostin levels and pulmonary function decline in asthmatic patients on inhaled corticosteroid (ICS) treatment.
METHODS:Two hundred twenty-four asthmatic patients (average age, 62.3 years) treated with ICS for at least 4 years were enrolled. Annual changes in FEV1, from at least 1 year after the initiation of ICS treatment to the time of enrollment or later (average, 16.2 measurements over 8 years per individual), were assessed. At enrollment, clinical indices, biomarkers that included serum periostin, and periostin gene polymorphisms were examined. Associations between clinical indices or biomarkers and a decline in FEV1 of 30 mL or greater per year were analyzed.
RESULTS:High serum periostin levels (≥ 95 ng/mL) at enrollment, the highest treatment step, higher ICS daily doses, a history of admission due to asthma exacerbation, comorbid or a history of sinusitis, and ex-smoking were associated with a decline in FEV1 of 30 mL or greater per year. Multivariate analysis showed that high serum periostin, the highest treatment step, and ex-smoking were independent risk factors for the decline. Polymorphisms of periostin gene were related to higher serum periostin levels (rs3829365) and a decline in FEV1 of 30 mL or greater per year (rs9603226).
CONCLUSIONS:Serum periostin appears to be a useful biomarker for the development of airflow limitation in asthmatic patients on ICS.
Kanemitsu Y, Matsumoto H, Izuhara K, et al. J Allergy Clin Immunol.2013 Aug;132(2):305-12.
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吸入布地奈德福莫特罗对于哮喘患者循环系统淋巴细胞的快速全身抗炎作用
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比较吸入和全身给予糖皮质激素在儿童急性哮喘中的应用：一项系统回顾
