Department of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Thorax. 2015 Jul;70(7):659-67. doi: 10.1136/thoraxjnl-2014-206712. Epub 2015 Apr 30.
The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear.
A longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS-A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months.
Bariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS-A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS-A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5-R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5-R20 between BS+A and BS-A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group.
Bariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity.
肥胖患者哮喘的发病机制尚不清楚，并在这些患者中被描述为一种特定的表型。减肥可以改善哮喘控制和肺功能。这种改善是气道机械性能改善的结果，还是全身和支气管炎症减少的结果尚不清楚。
对 27 例接受减肥手术的肥胖哮喘患者（减肥手术和哮喘组（BS+A））、39 例肥胖对照（减肥手术无哮喘组（BS-A））和 12 例肥胖无干预的哮喘患者（无减肥手术和哮喘组（NBS+A））进行了一项前瞻性纵向研究。在随访期间，测量肺功能、哮喘控制情况、支气管活检细胞浸润和循环系统炎症标志物。
减肥手术后 12 个月体重明显下降。BS+A 组和 BS-A 组的 FEV1、功能残气量和总肺活量均有改善，而 BS-A 组的 FEV1/FVC 仅改善。此外，BS+A 组的哮喘控制问卷（ACQ）、哮喘生活质量问卷、吸入皮质激素使用和 PD20 均改善，而 NBS+A 组仅 ACQ 改善。两组手术患者小气道功能 R5-R20 均有改善，但 BS+A 组改善更为明显，因此在 12 个月随访时，BS+A 与 BS-A 之间 R5-R20 相似。BS 后除全身炎症（高敏 C 反应蛋白、脂联素和瘦素）改善外，BS+A 组仅检测到气道中肥大细胞数量减少。
减肥手术改善了小气道功能，降低了全身炎症和气道中肥大细胞的数量。这些作用可以解释哮喘控制、生活质量和肺功能的改善。因此，减肥手术除了所有其他积极作用外，还改善了病态肥胖患者的哮喘。
3204。
