肥胖与哮喘严重程度和加重有关，并与城市内成年人的血清免疫球蛋白 E 增加有关。
Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults.
机构信息
Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
出版信息
Clin Exp Allergy. 2012 May;42(5):747-59. doi: 10.1111/j.1365-2222.2011.03863.x. Epub 2011 Sep 21.
BACKGROUND
Obesity is associated with increased asthma and atopy.
OBJECTIVE
To determine whether or not obesity in inner-city adults is associated with increased asthma prevalence, severity and exacerbations and IgE responses.
METHODS
This retrospective study involved 246 adults with asthma and other atopic disorders who were seen at an asthma clinic in New York City between 1997 and 2010. Height, weight, asthma diagnosis and symptoms, peak flow (PF), spirometry, serum IgE levels and white blood cell differentials were recorded.
RESULTS
Asthmatic patients had higher body mass index than non-asthmatics (median, interquartile range: 30.5, 10.2 vs. 27.8, 8.8; Mann-Whitney U-test, P = 0.0006). Class I and II/III obesity were associated with increased asthma (I: OR: 2.35, 95% CI: 1.04-5.34, P = 0.04; II/III: OR: 3.25, 95% CI: 1.36-7.74, P = 0.008). Class I and II/III obesity were associated with worsened asthma severity (ordinal logistic regression; I: OR: 4.23, 95% CI: 1.61-11.06, P = 0.003; II/III: OR: 2.76, 95% CI: 1.08-7.09, P = 0.03). Class II/III obesity was associated with increased asthma exacerbations requiring oral corticosteroids (repeated measures logistic regression, OR: 1.13, 95% CI: 1.03-1.25; P = 0.01) and increased requirement of inhaled corticosteroid for long-term asthma management (OR: 1.45, 95% CI: 1.29-1.62; P < 0.0001). In asthmatics, class II/III obesity was associated with decreased PF (general linear model, least squares mean ± SEM: 333.8 ± 37.4 vs. 396.2 ± 32.1 L/min; P = 0.007), forced expiratory volume in 1 s (75.2 ± 4.6 vs. 88.4 ± 5.6%; P = 0.03) and forced vital capacity (83.2 ± 4.7 vs. 109.2 ± 6.0%; P = 0.0002) and increased serum IgE (480.2 ± 88.3 vs. 269.0 ± 66.6 IU/mL; P = 0.04) and neutrophils (66.6 ± 3.7 vs. 60.1 ± 3.8%; P = 0.02). Class I obesity was also associated with increased serum IgE (458.7 ± 68.9, P = 0.03).
CONCLUSION AND CLINICAL RELEVANCE
Obesity in inner-city adults may be both a risk and exacerbating factor for atopic asthma.
背景
肥胖与哮喘和过敏有关。
目的
确定城市成年人肥胖是否与哮喘患病率、严重程度和加重以及 IgE 反应增加有关。
方法
本回顾性研究纳入了 1997 年至 2010 年期间在纽约市哮喘诊所就诊的 246 名哮喘和其他过敏疾病患者。记录身高、体重、哮喘诊断和症状、峰值流量（PF）、肺量计检查、血清 IgE 水平和白细胞分类计数。
结果
哮喘患者的体重指数高于非哮喘患者（中位数，四分位距：30.5，10.2 与 27.8，8.8；Mann-Whitney U 检验，P=0.0006）。I 型和 II/III 型肥胖与哮喘增加相关（I：比值比：2.35，95%可信区间：1.04-5.34，P=0.04；II/III：比值比：3.25，95%可信区间：1.36-7.74，P=0.008）。I 型和 II/III 型肥胖与哮喘严重程度恶化相关（有序逻辑回归；I：比值比：4.23，95%可信区间：1.61-11.06，P=0.003；II/III：比值比：2.76，95%可信区间：1.08-7.09，P=0.03）。II/III 型肥胖与需要口服皮质类固醇的哮喘加重相关（重复测量逻辑回归，比值比：1.13，95%可信区间：1.03-1.25；P=0.01）和需要长期哮喘管理的吸入皮质类固醇增加相关（比值比：1.45，95%可信区间：1.29-1.62；P<0.0001）。在哮喘患者中，II/III 型肥胖与 PF 降低相关（一般线性模型，最小二乘均数±SEM：333.8±37.4 与 396.2±32.1 L/min；P=0.007）、FEV1（75.2±4.6 与 88.4±5.6%；P=0.03）和 FVC（83.2±4.7 与 109.2±6.0%；P=0.0002）以及血清 IgE 增加相关（480.2±88.3 与 269.0±66.6 IU/mL；P=0.04）和中性粒细胞增加（66.6±3.7 与 60.1±3.8%；P=0.02）。I 型肥胖也与血清 IgE 增加相关（458.7±68.9，P=0.03）。
结论和临床意义
城市成年人的肥胖可能是特应性哮喘的风险因素和加重因素。
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