支气管哮喘不同炎症表型的临床特征分析

王颖; 云春梅; 刘柯含; 贾培峰; 刘红艳; 高笑宇

doi:10.16766/j.cnki.issn.1674-4152.002768

支气管哮喘不同炎症表型的临床特征分析

doi: 10.16766/j.cnki.issn.1674-4152.002768

内蒙古自治区人民医院呼吸与危重症医学科国家卫健委慢阻肺诊治重点实验室内蒙古自治区呼吸疾病重点实验室，内蒙古呼和浩特 010017

基金项目:

内蒙古自治区科技计划项目 201802161

内蒙古自治区人民医院院内重大基金项目 201703

内蒙古自治区人民医院博士科研启动资金项目 2019BS08

内蒙古自然科学基金面上项目 2021MS08165

内蒙古自然科学基金面上项目 2021MS08112

详细信息

通讯作者:
高笑宇, E-mail: xiaoyugao2015@hotmail.com

中图分类号: R562.25
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出版历程
- 收稿日期: 2021-03-18
- 网络出版日期: 2023-02-07

Clinical characteristic analysis of different inflammatory phenotypes in bronchial asthma

Department of Pulmonary and Critical Care Medicine, Inner Mongolia People' s Hospital/National Key Laboratory for Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease/Inner Mongolia Autonomous Region Key Laboratory of Respiratory Diseases, Huhhot, Inner Mongolia 010017, China

摘要

摘要: 目的通过分析支气管哮喘炎症表型的临床特征并对治疗前后的临床指标进行比较，为哮喘临床诊疗提供依据。方法选取2018年7月—2019年1月于内蒙古自治区人民医院就诊的110例慢性持续期哮喘患者，根据诱导痰结果分为嗜酸粒细胞型哮喘(EA)、中性粒细胞型哮喘(NA)、混合粒细胞型哮喘(MGA)及寡粒细胞型哮喘(PGA)4种炎症表型，比较其临床特征，并分析治疗前后的临床指标。结果 4种炎症表型临床症状及控制水平比较差异无统计学意义(均P＞0.05)。EA组与部分组对比发现呼出气一氧化氮(FeNO)显著升高，第1秒用力呼气容积与用力肺活量的比值(FEV₁ /FVC)、第1秒用力呼气容积占预计值的百分比(FEV₁ %)下降显著(均P < 0.05)。嗜酸性粒细胞(Eos)与FeNO呈正相关趋势(r=0.541)，与FEV₁/FVC、FEV₁%呈负相关趋势(r=-0.301、-0.284)。比较采用低剂量吸入型糖皮质激素(ICS)+长效β₂受体激动剂(LABA)治疗的患者治疗前与治疗1个月的临床指标，发现治疗后EA、MGA组Eos、FeNO较治疗前明显下降(EA：t=3.564、6.761;MGA：t=3.068、4.093，均P＜0.05)，EA组FEV₁/FVC、FEV₁%较治疗前显著升高(t=2.755、2.729，均P＜0.05)。结论 Eos增多的表型(EA)中肺功能下降更明显，FeNO与嗜酸型炎症密切相关；低剂量ICS+LABA在Eos增多表型中效果更显著。
- 支气管哮喘 /
- 炎症表型 /
- 诱导痰细胞学分析 /
- 呼出气一氧化氮 /
- 肺功能
Abstract: Objective To analyse the clinical characteristics of different inflammatory phenotypes of bronchial asthma (BA) and compare the clinical indicators before and after treatment, so as to provide a basis for clinical diagnosis and treatment of asthma. Methods A total of 110 asthma patients in chronic duration in the Outpatient Ward of Inner Mongolia People ' s Hospital were recruited from July 2018 to January 2019, and divided into four groups with different airway inflammation phenotypes based on the results of induced sputum, such as eosinophilic asthma (EA), neutrophilic asthma, mixed granulocytic asthma (MGA) and paucigranulocytic asthma. The differences in clinical characteristics were compared, and the clinical indicators before and after treatment were compared and analysed. Results No significant differences were observed in the clinical symptoms and control level between inflammatory phenotypes (both P>0.05). Compared with the other groups, the EA group showed a significantly increased exhaled nitric oxide (FeNO) and significantly decreased FEV₁ /FVC and FEV₁ % (all P < 0.05). The number of eosinophil (Eos) was positively correlated trend with the values of FeNO (r=0.541), and negatively correlated with the values of FEV₁ /FVC and FEV₁ % (r=-0.301, -0.284). The clinical indicators of asthma before treatment and 1 month after treatment (low-dose inhale corticosteroids+long-acting inhale β₂-agonist) were compared. The Eos and FeNO in EA and MGA groups significantly decreased after treatment compared with those before treatment (EA: t=3.564, 6.761; MGA: t=3.068, 4.093, all P < 0.05). FEV₁ /FVC and FEV₁ % in the EA group were significantly higher than those before treatment (t=-2.755, -2.729, both P < 0.05). Conclusion Lung function decline is pronounced in the Eos-increased phenotype (EA), and FeNO is closely associated with eosinophilic inflammation. Low-dose ICS+LABA is effective in Eos-increasing phenotype asthma patients.
- Bronchial asthma /
- Inflammatory phenotype /
- Induced sputum cytology analysis /
- Exhaled nitric oxide /
- Lung function

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图 1 FeNO在4种炎症表型中的差异

Figure 1. The differences of FeNO in four inflammatory phenotypes

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图 2 FEV₁/FVC、FEV₁%在4种炎症表型中的差异

Figure 2. The differences of FEV1/FVC and FEV1% in the four inflammatory phenotypes

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表 1 4种炎症表型哮喘患者一般资料比较

Table 1. The analysis of general data of four inflammatory phenotypes of asthma patients

组别	例数	年龄(x±s，岁)	性别(男/女，例)	BMI(x±s)	吸烟情况[例(%)]		过敏史[例(%)]
组别	例数	年龄(x±s，岁)	性别(男/女，例)	BMI(x±s)	现在吸烟	被动吸烟	过敏性鼻炎	过敏原	哮喘家族史
EA	26	39.88±11.41	13/13	23.30±2.83	8(30.8)	7(26.9)	15(57.7)	19(73.1)	4(15.4)
NA	45	47.42±12.13	12/33	23.55±5.00	3(6.7)	3(6.7)	14(31.1)	27(60.0)	5(11.1)
MGA	18	47.11±10.21	5/13	25.14±3.41	1(5.6)	4(22.2)	8(44.4)	13(72.2)	2(11.1)
PGA	21	47.76±12.60	8/13	24.53±2.89	2(9.5)	2(9.5)	8(38.1)	14(66.7)	2(9.5)
统计量		2.738^a	4.463^b	1.073^a	10.135^b	6.731^b	4.979^b	1.619^b	0.454^b
P值		0.047	0.216	0.364	0.017	0.081	0.173	0.655	0.929
注: ^a为F值，^b为χ²值。

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表 2 4种炎症表型哮喘患者临床症状及控制情况比较

Table 2. The analysis of the clinical symptoms and control status of four inflammatory phenotypes of asthma patients

组别	例数	咳嗽 [例(%)]	气短 [例(%)]	胸闷 [例(%)]	喘息 [例(%)]	夜间加重 [例(%)]	胸部喘鸣 [例(%)]	ACT (x±s，分)
EA	26	22(84.6)	12(46.2)	13(50.0)	5(19.2)	16(61.5)	14(53.8)	17.91±3.92
NA	45	36(80.0)	23(51.1)	29(64.4)	10(22.2)	25(55.6)	20(44.4)	19.22±2.58
MGA	18	15(83.3)	12(66.7)	8(44.4)	6(33.3)	9(50.0)	14(77.8)	19.44±3.09
PGA	21	18(85.7)	12(57.1)	14(66.7)	6(28.6)	10(47.6)	9(42.9)	18.43±2.34
统计量		0.435^a	2.034^a	3.458^a	1.462^a	1.088^a	6.557^a	1.508^b
P值		0.933	0.565	0.326	0.691	0.780	0.087	0.217
注：^a为χ²值，^b为F值。

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表 3 4种炎症表型哮喘患者FeNO水平分布情况比较(例)

Table 3. The comparison of four inflammatory phenotype distribution of different FeNO levels in asthma(cases)

组别	例数	FeNO低水平	FeNO中水平	FeNO高水平	H值	P值
EA	26	6	4	16	24.010	＜0.001
NA^a	45	31	8	6
MGA^b	18	3	10	5
PGA^a	21	13	4	4
注：与EA比较，^aP＜0.05；与NA比较，^bP＜0.05。

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表 4 不同炎症表型哮喘患者治疗前后临床指标比较(x±s)

Table 4. Comparison of clinical indicators of different inflammatory phenotypes of asthma patients before and after treatmen(x±s)

组别	例数	时间	Eos(%)	Neu(%)	FeNO(μg/L)	FEV₁/FVC(%)	FEV₁%
EA	18	治疗前	23.33±17.08	34.62±17.09	80.94±47.37	72.22±10.69	81.17±19.32
		治疗1个月	9.76±4.56	33.72±15.59	47.44±28.04	77.60±4.22	89.21±8.67
		t值	3.564	0.859	6.761	2.755	2.729
		P值	0.002	0.402	< 0.001	0.014	0.014
NA	18	治疗前	0.36±0.61	86.07±7.65	24.61±12.07	79.09±6.09	90.83±9.03
		治疗1个月	0.31±0.49	82.24±8.31	20.83±5.61	80.15±5.53	91.74±7.02
		t值	0.383	1.971	1.789	1.274	0.898
		P值	0.707	0.065	0.092	0.220	0.382
MGA	11	治疗前	11.82±8.87	74.95±8.66	42.73±14.88	77.42±9.48	81.91±20.38
		治疗1个月	7.86±5.35	72.31±6.10	24.64±6.36	81.37±5.33	90.13±7.92
		t值	3.068	1.723	4.093	2.150	2.029
		P值	0.012	0.116	0.002	0.057	0.070
PGA	12	治疗前	0.43±0.71	29.97±16.21	22.17±12.82	75.96±5.14	93.27±9.24
		治疗1个月	0.25±0.34	28.83±11.07	17.83±6.94	78.12±3.21	95.82±7.10
		t值	1.297	0.533	1.967	1.765	1.409
		P值	0.221	0.605	0.075	0.105	0.186
注：因追踪患者治疗情况部分患者丢失，且有部分治疗有所不同，故数据不足。

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