种族与哮喘患者气道炎症的差异相关。
Race is associated with differences in airway inflammation in patients with asthma.
作者信息
Nyenhuis Sharmilee M, Krishnan Jerry A, Berry Alalia, Calhoun William J, Chinchilli Vernon M, Engle Linda, Grossman Nicole, Holguin Fernando, Israel Elliot, Kittles Rick A, Kraft Monica, Lazarus Stephen C, Lehman Erik B, Mauger David T, Moy James N, Peters Stephen P, Phipatanakul Wanda, Smith Lewis J, Sumino Kaharu, Szefler Stanley J, Wechsler Michael E, Wenzel Sally, White Steven R, Ackerman Steven J
机构信息
Department of Medicine, University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill.
Department of Medicine, University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill.
出版信息
J Allergy Clin Immunol. 2017 Jul;140(1):257-265.e11. doi: 10.1016/j.jaci.2016.10.024. Epub 2017 Jan 6.
BACKGROUND
African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear.
OBJECTIVE
We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS-, respectively).
METHODS
We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute-sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype.
RESULTS
Among 1018 participants, African American subjects (n = 264) had a lower FEV percent predicted (80% vs 85%, P < .01), greater total IgE levels (197 vs 120 IU/mL, P < .01), and a greater proportion with uncontrolled asthma (43% vs 28%, P < .01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS- group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P = .28; ICS- group: 39% vs 35%, P = .65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P = .046) but not in the ICS- group (P = .984).
CONCLUSION
African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.
背景
与白人受试者相比，非裔美国受试者的哮喘负担更重。非裔美国人和白人受试者之间气道炎症模式是否存在差异尚不清楚。
目的
我们试图比较接受或未接受吸入性糖皮质激素（ICSs；分别为ICS+和ICS-）治疗的非裔美国人和白人受试者的痰液气道炎症表型。
方法
我们对参与由美国国立心肺血液研究所资助的哮喘临床研究网络和哮喘网开展的临床试验的自我认定的非裔美国人和白人哮喘受试者进行了二次分析。检查了人口统计学、临床特征以及痰液诱导后的痰液细胞学。我们使用2%的痰液嗜酸性粒细胞切点来定义具有嗜酸性粒细胞性（≥2%）或非嗜酸性粒细胞性（<2%）炎症表型的受试者。
结果
在1018名参与者中，与白人受试者（n = 754）相比，非裔美国受试者（n = 264）的预测FEV百分比更低（80%对85%，P <.01），总IgE水平更高（197对120 IU/mL，P <.01），且哮喘控制不佳的比例更高（43%对28%，P <.01）。ICS+组有922名受试者（248名非裔美国人和674名白人受试者），ICS-组有298名受试者（49名非裔美国人和249名白人受试者）。两组中非裔美国人和白人受试者的嗜酸性粒细胞性气道炎症均无显著差异（嗜酸性粒细胞表型的百分比：ICS+组：19%对16%，P =.28；ICS-组：39%对35%，P =.65）。然而，在调整混杂因素后，ICS+组中非裔美国受试者比白人受试者更有可能表现出嗜酸性粒细胞性气道炎症（比值比，1.58；95% CI，1.01 - 2.48；P =.046），但ICS-组中并非如此（P =.984）。
结论
非裔美国受试者表现出更严重的嗜酸性粒细胞性气道炎症，这可能解释了该人群中更大的哮喘负担。
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