哮喘联盟

   摘要
   系统及气道嗜酸性粒细胞增多被确认为是哮喘的特点。但患者局部与系统嗜酸性粒细胞增多表现出了不一致性。本研究试图确定伴或不伴系统及气道嗜酸性粒细胞增多患者的流行情况和特点。本回顾性研究纳入了508例成功痰液诱导的哮喘患者。根据血液(≥400个细胞/mm3)和痰液(≥3%)嗜酸性粒细胞计数将人群分为4组，评估血液和痰液嗜酸性粒细胞之间的关系。然后，在250例匹配的新哮喘患者队列中，前瞻性评估嗜酸性粒细胞与哮喘控制(哮喘控制问卷 (ACQ))和急性发作率之间的相关性。在本回顾性队列研究中，所占比例最大的一组为不伴嗜酸性粒细胞炎症的哮喘患者(49%)。与非嗜酸性粒细胞哮喘相比，痰液嗜酸性粒细胞增多组(25%)与更低的第一秒用力呼气量(FEV1)和FEV1/最大肺活量、更高的气道高反应性和呼出一氧化氮分数(FeNO)相关。系统嗜酸性粒细胞增多的哮喘患者(7%)与非嗜酸性粒细胞哮喘患者特点相似。伴系统和气道嗜酸性细胞增多组(19%)表现出显著的男性趋势，具有最低的气道管径、ACQ评分以及生活质量，最高的气道高反应性、FeNO以及急性发作率。本前瞻性队列研究证实了不同的亚组比例，与非嗜酸细胞性哮喘患者比较，弥漫性嗜酸性粒细胞增多患者具有更高的ACQ评分以及急性发作率。伴随全身以及气道嗜酸细胞性炎症可导致哮喘控制不佳。
 

（林江涛 审校）
Eur Respir J. 2014 Feb 13. [Epub ahead of print]

 

Importance of concomitant local and systemic eosinophilia in uncontrolled asthma.
 

Schleich FN, Chevremont A, Paulus V, Henket M, Manise M, Seidel L, Louis R.
 

Abstract
Systemic and airway eosinophilia are recognised features of asthma. There are, however, patients who exhibit discordance between local and systemic eosinophilia. In this study, we sought to determine the prevalence and characteristics of patients with concordant and discordant systemic and bronchial eosinophilia. We conducted a retrospective study on 508 asthmatics with successful sputum induction. We assessed the relationship between blood and sputum eosinophils by breaking down the population into four groups according to blood (≥400 cells per mm3) and sputum (≥3%) eosinophils. Then, we prospectively reassessed the link between eosinophils and asthma control (Asthma Control Questionnaire (ACQ)) and exacerbation rate in a new cohort of 250 matched asthmatics. In our retrospective cohort, asthmatics without eosinophilic inflammation were the largest group (49%). The group with isolated sputum eosinophilia (25%) was, compared with noneosinophilic asthma, associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity ratio and higher bronchial hyperresponsiveness and exhaled nitric oxide fraction (FeNO). Asthmatics exhibiting isolated systemic eosinophilia (7%) had similar characteristics as noneosinophilic asthmatics. The group with concordant systemic and airway eosinophilia (19%) showed remarkable male predominance, and had the lowest airway calibre, ACQ score and quality of life, and the highest bronchial hyperresponsiveness, FeNO and exacerbation rate. The prospective cohort confirmed the different subgroup proportions and the higher ACQ and exacerbation rates in cases of diffuse eosinophilia compared with noneosinophilic asthmatics.Concomitant systemic and bronchial eosinophilic inflammation contribute to poor asthma control.
 

Eur Respir J. 2014 Feb 13. [Epub ahead of print]