生理和生物指标定义下的哮喘表型的稳定性
2015/02/25
摘要
背景：虽然哮喘以可逆性气道阻塞为特征，但多数哮喘表型的研究都是横断面的。本项泛欧的队列研究评估了一年内反复测量的生理和生物指标定义下的哮喘表型的稳定性。
方法： 收集总病例数169例，其中93例重症哮喘患者（SA）和76例轻中度哮喘患者（MA）。观察时限一年，随访次数达6次以上。哮喘表型簇群以生理指标（肺功能、可逆行和发病年龄）或者生物指标（诱导痰的嗜酸性粒细胞和中性粒细胞）分类。
结果： 随访一年后，23.6%的哮喘患者改变了生理指标定义下的哮喘表型簇别，而42.3%的哮喘病人改变了诱导痰的炎症细胞表型簇别(P = 0.034)。在重症哮喘队列中，分别有30%和48.6%的病人改变了生理指标和生物指标定义下的表型簇别。表型簇别的改变没有因口服或吸入性激素的剂量和哮喘急性发作频数改变而改变。所有生物指标（嗜酸性粒细胞、中性粒细胞和FeNO）呈现出较低的单一和重复测量的稳定性。相反地，生理指标（FEV1）、生活质量和哮喘控制水平呈现较好的稳定性。
结论： 生物指标定义下的哮喘表型比生理指标定义下的哮喘表型呈现出较低的稳定性，在重症哮喘患者中尤为明显。数据提示应考虑肺功能、生物指标和哮喘控制水平的波动，重复测量指标可提高定义哮喘表型的准确性。
Stability of phenotypes defined by physiological variables and biomarkers in adults with asthma
Kupczyk M, Dahle_n B, Sterk PJ, Nizankowska-Mogilnicka E, Papi A, Bel EH, Chanez P, Howarth PH, Holgate ST, Brusselle G, Siafakas NM, Gjomarkaj M, Dahle_n S-E on behalf of the BIOAIR investigators
ABSTRACT
BACKGROUND: Although asthma is characterized by variable airways obstruction, most studies of asthma phenotypes are cross-sectional. The stability of pheno- types defined either by biomarkers or by physiological variables was assessed by repeated measures over 1 year in the Pan-European BIOAIR cohort of adult asthmatics.
METHODS: A total of 169 patients, 93 with severe asthma (SA) and 76 with mild- to-moderate asthma (MA), were examined at six or more visits during 1 year. Asthma phenotype clusters were defined by physiological variables (lung function, reversibility and age of onset of the disease) or by biomarkers (eosinophils and neutrophils in induced sputum).
RESULTS: After 1 year of follow-up, the allocation to clusters was changed in 23.6% of all asthma patients when defined by physiological phenotypes and, remarkably, in 42.3% of the patients when stratified according to sputum cellu- larity (P = 0.034). In the SA cohort, 30% and 48.6% of the patients changed allocation according to physiological and biomarker clustering, respectively. Vari- ability of phenotypes was not influenced by change in oral or inhaled corticoste- roid dose, nor by the number of exacerbations. Lower stability of single and repeated measure was found for all evaluated biomarkers (eosinophils, neutrophils and FeNO) in contrast to good stability of physiological variables (FEV1), quality of life and asthma control.
CONCLUSIONS: Phenotypes determined by biomarkers are less stable than those defined by physiological variables, especially in severe asthmatics. The data also imply that definition of asthma phenotypes is improved by repeated measures to account for fluctuations in lung function, biomarkers and asthma control.
Allergy 2014; 69: 1198–1204
背景：虽然哮喘以可逆性气道阻塞为特征，但多数哮喘表型的研究都是横断面的。本项泛欧的队列研究评估了一年内反复测量的生理和生物指标定义下的哮喘表型的稳定性。
方法： 收集总病例数169例，其中93例重症哮喘患者（SA）和76例轻中度哮喘患者（MA）。观察时限一年，随访次数达6次以上。哮喘表型簇群以生理指标（肺功能、可逆行和发病年龄）或者生物指标（诱导痰的嗜酸性粒细胞和中性粒细胞）分类。
结果： 随访一年后，23.6%的哮喘患者改变了生理指标定义下的哮喘表型簇别，而42.3%的哮喘病人改变了诱导痰的炎症细胞表型簇别(P = 0.034)。在重症哮喘队列中，分别有30%和48.6%的病人改变了生理指标和生物指标定义下的表型簇别。表型簇别的改变没有因口服或吸入性激素的剂量和哮喘急性发作频数改变而改变。所有生物指标（嗜酸性粒细胞、中性粒细胞和FeNO）呈现出较低的单一和重复测量的稳定性。相反地，生理指标（FEV1）、生活质量和哮喘控制水平呈现较好的稳定性。
结论： 生物指标定义下的哮喘表型比生理指标定义下的哮喘表型呈现出较低的稳定性，在重症哮喘患者中尤为明显。数据提示应考虑肺功能、生物指标和哮喘控制水平的波动，重复测量指标可提高定义哮喘表型的准确性。
(郑静1 张红萍1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Allergy 2014; 69: 1198–1204)
（Allergy 2014; 69: 1198–1204)
Stability of phenotypes defined by physiological variables and biomarkers in adults with asthma
Kupczyk M, Dahle_n B, Sterk PJ, Nizankowska-Mogilnicka E, Papi A, Bel EH, Chanez P, Howarth PH, Holgate ST, Brusselle G, Siafakas NM, Gjomarkaj M, Dahle_n S-E on behalf of the BIOAIR investigators
ABSTRACT
BACKGROUND: Although asthma is characterized by variable airways obstruction, most studies of asthma phenotypes are cross-sectional. The stability of pheno- types defined either by biomarkers or by physiological variables was assessed by repeated measures over 1 year in the Pan-European BIOAIR cohort of adult asthmatics.
METHODS: A total of 169 patients, 93 with severe asthma (SA) and 76 with mild- to-moderate asthma (MA), were examined at six or more visits during 1 year. Asthma phenotype clusters were defined by physiological variables (lung function, reversibility and age of onset of the disease) or by biomarkers (eosinophils and neutrophils in induced sputum).
RESULTS: After 1 year of follow-up, the allocation to clusters was changed in 23.6% of all asthma patients when defined by physiological phenotypes and, remarkably, in 42.3% of the patients when stratified according to sputum cellu- larity (P = 0.034). In the SA cohort, 30% and 48.6% of the patients changed allocation according to physiological and biomarker clustering, respectively. Vari- ability of phenotypes was not influenced by change in oral or inhaled corticoste- roid dose, nor by the number of exacerbations. Lower stability of single and repeated measure was found for all evaluated biomarkers (eosinophils, neutrophils and FeNO) in contrast to good stability of physiological variables (FEV1), quality of life and asthma control.
CONCLUSIONS: Phenotypes determined by biomarkers are less stable than those defined by physiological variables, especially in severe asthmatics. The data also imply that definition of asthma phenotypes is improved by repeated measures to account for fluctuations in lung function, biomarkers and asthma control.
Allergy 2014; 69: 1198–1204
上一篇：
儿童支气管哮喘发病机制的初步研究
下一篇：
青春期哮喘转变的病理生理学特征
