Richards Levi B, Neerincx Anne H, van Bragt Job J M H, Sterk Peter J, Bel Elisabeth H D, Maitland-van der Zee Anke H
Department of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Curr Opin Allergy Clin Immunol. 2018 Apr;18(2):96-108. doi: 10.1097/ACI.0000000000000426.
Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or monitor treatment response. However, the newly identified as well as more established biomarkers have different applications and limitations.
Conventional markers for type 2-high asthma, such as blood eosinophils, fraction of exhaled nitric oxide, serum IgE and periostin, feature limited sensitivity and specificity despite their significant correlations. More distinctive models have been developed by combining biomarkers and/or using omics techniques. Recently, a model with a positive predictive value of 100% for identification of type 2-high asthma based on a combination of minimally invasive biomarkers was developed.
Individualisation of asthma treatment regimens on the basis of biomarkers is necessary to improve asthma control. However, the suboptimal properties of currently available conventional biomarkers limit its clinical utility. Newly identified biomarkers and models based on combinations and/or omics analysis must be validated and standardised before they can be routinely applied in clinical practice. The development of robust biomarkers will allow development of more efficacious precision medicine-based treatment approaches for asthma.
哮喘在病理生理学和治疗反应方面具有高度异质性，导致许多哮喘患者治疗不充分。指示潜在病理过程的生物标志物可用于识别疾病亚型、确定预后以及预测或监测治疗反应。然而，新发现的以及较为成熟的生物标志物具有不同的应用和局限性。
2型高哮喘的传统标志物，如血液嗜酸性粒细胞、呼出一氧化氮分数、血清IgE和骨膜蛋白，尽管它们之间存在显著相关性，但其敏感性和特异性有限。通过组合生物标志物和/或使用组学技术已经开发出更具特色的模型。最近，基于微创生物标志物组合开发了一种对识别2型高哮喘具有100%阳性预测值的模型。
基于生物标志物的哮喘治疗方案个体化对于改善哮喘控制是必要的。然而，目前可用的传统生物标志物的次优特性限制了其临床应用。新发现的生物标志物以及基于组合和/或组学分析的模型在能够常规应用于临床实践之前，必须进行验证和标准化。强大的生物标志物的开发将有助于开发更有效的基于精准医学的哮喘治疗方法。
