Schleich Florence, Demarche Sophie, Louis Renaud
Respiratory Medicine, CHU Sart-Tilman B35, 4000 Liège, Belgium.
Curr Top Med Chem. 2016;16(14):1561-73. doi: 10.2174/1568026616666151015093406.
Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is timeconsuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma.
难治性哮喘是一种气道的异质性疾病，包括各种类型的支气管炎症和不同程度的气道重塑。重度哮喘患者的治疗反应可通过使用2型高炎症或2型低炎症的生物标志物来预测。基于痰液细胞分析，已描述了四种炎症表型。由于诱导痰液是一项耗时且昂贵的技术，替代生物标志物在临床实践中很有用。嗜酸性粒细胞表型可能反映了针对过敏原的持续适应性免疫。嗜酸性粒细胞性哮喘的几种生物标志物在临床实践中很容易获得（血液嗜酸性粒细胞、血清IgE、呼出一氧化氮、血清骨膜蛋白）。中性粒细胞性哮喘被认为反映了针对污染物或感染因子的固有免疫系统激活，而少粒细胞性哮喘被认为无炎症，其特征为平滑肌功能障碍。我们目前缺乏用于中性粒细胞性哮喘和气道重塑的便捷生物标志物。在本综述中，我们总结了可用于难治性哮喘管理的生物标志物。
