[哮喘患者的气道炎症表型]

Zhang Yongming, Lin Jiangtao, Su Nan, Liu Guoliang, Nong Ying, Zhang Xiaoyan, Ren Zhencui, Li Xiaopan

Department of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China.

Department of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Email:

Zhonghua Jie He He Hu Xi Za Zhi. 2015 May;38(5):348-51.

OBJECTIVE

To analyze the airway inflammatory phenotypes and clinical features of severe asthma compared to mild-moderate ("common") asthma.

METHODS

A total of 946 cases of asthma were retrospectively analyzed in our hospital from January 2013 to December 2014. Sixty-one patients were classified to the severe asthma group, and 885 patients to the common asthma group. Severe asthma was diagnosed based on the protocol from ATS/ERS guidelines. All patients received induced sputum cell counts and pulmonary function tests, and 543 of them received fractional exhaled nitric oxide (FeNO) tests. The airway inflammatory phenotypes were defined and the clinical features of patients of severe asthma were studied.

RESULTS

The distribution of airway inflammatory phenotypes of asthma was as follows: eosinophilic subtype (46.6%, 441/946), mixed granulocytic subtype (27.5%, 260/946), neutrophilic subtype (21.5%, 203/946), and paucigranulocytic subtype (4.4%, 42/946). There were no differences between the severe asthma group and the common asthma group in the distributions. Compared with common asthma patients, severe asthma patients had higher sputum eosinophil percentages (29.1 % ± 28.5% vs 22.2% ± 25.2%, t = 1.98, P < 0.05), higher FeNO values [(66.4 ± 64.1) ppb vs (48.0 ± 43.7) ppb, P < 0.01], lower percentages of FEV1% pred [(63.7 ± 24.1) % vs (84.7 ± 23.7)%, P < 0.01], and lower ratios of FEV1/FVC [(56.4 ± 15.1) % vs (69.1 ± 14.5)% P < 0.01]. In severe asthma patients, FeNO values were higher in the eosinophilic subtype and mixed granulocytic subtype (P < 0.05). Neutrophilic subtype patients had the lowest sputum eosinophil percentage [(1.8 ± 0.8)%, P < 0.01], the lowest percentage of FEV1% pred [(46.6 ± 16.1)%, P < 0.01], and the lowest ratios of FEV1/FVC [(45.2 ± 16.1)%, P < 0.01].

CONCLUSIONS

The common airway inflammatory phenotypes included eosinophilic subtype, mixed granulocytic subtype and neutrophilic subtype, in both severe and common asthma patients. Severe asthma patients had more severe eosinophilic airway inflammation and poorer lung function. Neutrophilic subtype might be the most intractable subtype with severely damaged pulmonary function in severe asthma.

目的

分析重度哮喘与轻中度（“普通”）哮喘相比的气道炎症表型及临床特征。

方法

回顾性分析2013年1月至2014年12月我院收治的946例哮喘患者。61例患者被归入重度哮喘组，885例患者被归入普通哮喘组。重度哮喘根据美国胸科学会/欧洲呼吸学会指南的方案进行诊断。所有患者均接受诱导痰细胞计数和肺功能测试，其中543例接受呼出一氧化氮分数（FeNO）测试。定义气道炎症表型并研究重度哮喘患者的临床特征。

结果

哮喘气道炎症表型分布如下：嗜酸性粒细胞亚型（4第6.6%，441/946）、混合粒细胞亚型（27.5%，260/946）、中性粒细胞亚型（21.5%，203/946）和少粒细胞亚型（4.4%，42/946）。重度哮喘组和普通哮喘组在分布上无差异。与普通哮喘患者相比，重度哮喘患者痰液嗜酸性粒细胞百分比更高（29.1%±28.5%对22.2%±25.2%，t = 1.98，P < 0.05），FeNO值更高[（66.4±64.1）ppb对（48.0±43.7）ppb，P < 0.01]，第一秒用力呼气容积占预计值百分比更低[（63.7±24.1）%对（84.7±23.7）%，P < 0.01]，第一秒用力呼气容积与用力肺活量比值更低[（56.4±15.1）%对（69.1±14.5）%，P < 0.01]。在重度哮喘患者中，嗜酸性粒细胞亚型和混合粒细胞亚型的FeNO值更高（P < 0.05）。中性粒细胞亚型患者的痰液嗜酸性粒细胞百分比最低[（1.8±0.8）%，P < 0.01]，第一秒用力呼气容积占预计值百分比最低[（46.6±16.1）%，P < 0.01]，第一秒用力呼气容积与用力肺活量比值最低[（45.2±16.1）%，P < 0.01]。