哮喘联盟

   摘要 
   目的：哮喘患者存在一些有可能影响心血管疾病发病率的独特特征。我们测试了下呼吸道口径、阻塞性睡眠呼吸暂停（OSA）及其他与哮喘有关的因素与系统性高血压（HTN）的关联。
   方法：专科诊所的哮喘患者完成睡眠障碍问卷（SA-SDQ）的睡眠呼吸暂停部分内容。为诊断HTN、OSA和合并症以及了解患者的肺功能和目前的药物，研究对患者的病历进行了审查。FEV1％预计值被划分为≥80、70-79、60-69和<60四个水平（参考文献）。男性SA-SDQ≥36和女性SA-SDQ≥32为OSA的高危险人群。
   结果：研究纳入812例哮喘患者（平均年龄±标准差：46±14岁），191例（24％）诊断为HTN，65例（8％）诊断为OSA，239例（29％）诊断为OSA或OSA高危人群（合并OSA变量）。HTN在FEV1％低水平人群（P<0.0001）、OSA患者和那些合并OSA变量的患者（分别为55 vs.21％和46 vs. 14％，P<0.0001）中更加普遍。随着变量的调整，不同FEV1％水平患者与高血压仍然有显著的联系（70-79％，比值比为1.60[95％CI0.90-2.87]；60-69％为2.73[1.28-5.79]；<60％为0.96[0.43-2.14]），对于OSA（比值比为2.20[1.16-4.19]）。与单一OSA比较，合并OSA变量在这个模型中表现出与高血压更强的相关性（3.17[1.99-5.04]）。吸入最低剂量的糖皮质激素（ICS），相较于没有使用ICS，与HTN存在一个独立的“保护性”的关联（0.44[0.22-0.90]）。
   结论：在这个年轻的群体中，更严重的下呼吸道阻塞和OSA均与高血压有关联。相反，减少ICS的使用剂量降低发生HTN的可能性。通过适当的ICS剂量和筛查OSA充分地控制气道炎症可以减少哮喘患者的高血压负担。
 

（苏楠 审校）
Lung.2014 Jun 12. [Epub ahead of print]

 

Factors Associated with Systemic Hypertension in Asthma.
 

Ferguson S1, Teodorescu MC, Gangnon RE, Peterson AG, Consens FB, Chervin RD, Teodorescu M.
 

ABSTRACT
PURPOSE: Asthmatics have unique characteristics that may influence cardiovascular morbidity. We tested the association of lower airway caliber, obstructive sleep apnea (OSA), and other asthma-related factors, with systemic hypertension (HTN).
METHODS: Asthma individuals at specialty clinics completed the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ). Medical records were reviewed for diagnosed HTN, OSA and comorbidities, spirometry, and current medications. FEV1% predicted was categorized as ≥80 (reference), 70-79, 60-69, and <60. SA-SDQ ≥36 for men and ≥32 for women defined high OSA risk.
RESULTS:Among 812 asthmatics (mean age ± standard deviation: 46 ± 14 years), HTN was diagnosed in 191 (24 %), OSA in 65 (8 %), and OSA or high OSA risk (combined OSA variable) in 239 (29 %). HTN was more prevalent in lower FEV1% categories (p < 0.0001), in subjects with OSA, and those with combined OSA variable (55 vs. 21 % and 46 vs. 14 %, respectively, both p < 0.0001). With adjustment for covariates, associations with HTN remained significant for some FEV1% categories (70-79 % odds ratio = 1.60 [95 % CI 0.90-2.87]; 60-69 % 2.73 [1.28-5.79]; <60 % 0.96 [0.43-2.14]), and for OSA (2.20 [1.16-4.19]). The combined OSA variable in comparison with OSA alone demonstrated a stronger association with HTN (3.17 [1.99-5.04]) in a reiteration of this model. Inhaled corticosteroids (ICS) at lowest doses, in comparison to no ICS use had an independent "protective" association with HTN (0.44 [0.22-0.90]).
CONCLUSIONS: In this young population, worse lower airways obstruction and OSA were associated with HTN. In contrast, lower ICS doses attenuated likelihood for HTN. Adequate control of airway inflammation at appropriate ICS doses, and screening for OSA may reduce the burden of HTN in asthma.
 

Lung.2014 Jun 12. [Epub ahead of print]