Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Respiratory Medicine, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China.
Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):1960-1967. doi: 10.1016/j.jaip.2018.02.012. Epub 2018 Mar 1.
Asthma is a heterogeneous disease with diverse clinical manifestations and inflammatory pathologies that is punctuated by exacerbations.
To describe the clinical and inflammatory characteristics of patients with asthma treated in hospital for an acute exacerbation.
Data from 320 adult patients receiving treatment for an acute exacerbation of asthma were obtained. In 218 patients with complete data, we used the Ward hierarchical clustering to obtain clusters. Pulmonary function, blood cell counts, sputum cell counts, serum IgE levels, and fractional exhaled nitric oxide were measured on hospital admission. We selected 13 variables with which we performed the Ward minimum-variance hierarchical clustering.
Four clusters were defined. Clusters 1 (24.5%) and 3 (36.7%) were characterized by predominantly female patients with asthma with sputum neutrophilia, with cluster 1 associated with a small degree of airflow obstruction and early-onset asthma and cluster 3 with a moderate degree of reduction in FEV. Clusters 2 (22.0%) and 4 (16.5%) were associated with high sputum eosinophilia and severe airflow obstruction. Cluster 4 was made exclusively of male smoking subjects, whereas cluster 2 was made up of predominantly female nonsmoking subjects with the worst FEV, forced expiratory flow at 25% to 75% of forced vital capacity (% predicted), and partial pressure of oxygen in arterial blood on admission. There were no differences between clusters in terms of atopy, serum IgE, prevalence of nasal disease, dose of maintenance inhaled corticosteroids, or oral/systemic corticosteroid use and asthma exacerbations.
The clusters during recovery from an exacerbation of asthma were distinguished by airflow obstruction and a neutrophilic, eosinophilic, or mixed inflammation. Eosinophilic inflammation was found in smoking and nonsmoking patients with asthma during an exacerbation.
哮喘是一种具有多种临床表现和炎症病理学的异质性疾病，其特点是发作。
描述因急性加重而住院治疗的哮喘患者的临床和炎症特征。
我们收集了 320 名接受急性哮喘加重治疗的成年患者的数据。在 218 名数据完整的患者中，我们使用 Ward 分层聚类法获得聚类。入院时测量肺功能、血细胞计数、痰细胞计数、血清 IgE 水平和呼出气一氧化氮分数。我们选择了 13 个具有变量，使用 Ward 最小方差分层聚类进行分析。
定义了 4 个聚类。聚类 1（24.5%）和 3（36.7%）主要为女性哮喘患者，痰中性粒细胞增多，聚类 1 与轻度气流阻塞和早发性哮喘相关，聚类 3 与中度 FEV 降低相关。聚类 2（22.0%）和 4（16.5%）与高痰嗜酸性粒细胞增多和严重气流阻塞相关。聚类 4 仅由吸烟的男性组成，而聚类 2 主要由女性非吸烟者组成，他们的 FEV 最差，用力呼气流量在 25%至 75%用力肺活量（预计值），以及入院时的动脉血氧分压。在过敏、血清 IgE、鼻部疾病患病率、维持吸入皮质类固醇剂量或口服/全身皮质类固醇使用和哮喘加重方面，各组之间没有差异。
哮喘加重恢复期的聚类可通过气流阻塞和中性粒细胞、嗜酸性粒细胞或混合炎症来区分。在哮喘加重期间，吸烟和非吸烟的哮喘患者都存在嗜酸性粒细胞炎症。
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