中国成年人咳嗽变异性哮喘临床特征的回顾性研究。
A retrospective study of clinical features of cough variant asthma in Chinese adults.
作者信息
Liu Weiping, Chen Huaping, Zhang Dehua, Wu Feng, Zhou Liqin
机构信息
1Department of Respiratory Medicine, Huizhou Third People's Hospital, Guangzhou Medical University, 1# Xuebei Avenue, Huizhou, 516002 Guangdong China.
2Department of Reproductive Medicine, Huizhou Central People's Hospital, National Sun Yat-sen University, Huizhou, Guangdong China.
出版信息
Allergy Asthma Clin Immunol. 2019 Jan 17;15:3. doi: 10.1186/s13223-019-0318-5. eCollection 2019.
BACKGROUND
Clinical features of cough variant asthma (CVA) in Chinese adults are largely uncertain.
METHODS
A total of 303 patients newly diagnosed as uncontrolled asthma (symptom control and future risk of adverse outcomes), including 175 CVA and 128 classic asthma (CA), were enrolled in this retrospective survey. Clinical features including basic characteristics, pulmonary function, airway hyperresponsiveness (AHR) and cell counts of induced sputum, were compared retrospectively. All patients were classified into four inflammatory subtypes based on the counts of induced sputum eosinophils and neutrophils as eosinophilic (E), neutrophilic (N), mixed granulocytic (M), and paucigranulocytic (P) subtypes. Inflammatory subtype distribution was also compared.
RESULTS
Compared with CA patients, CVA patients were younger (P = 0.009), had a higher prevalence of female patients (P = 0.001), higher parameter values of baseline pulmonary function (P ≤ 0.01 for all), shorter duration of disease (P = 0.002), lower AHR (P = 0.001) and lower sputum eosinophil% (P = 0.009). There was a difference in the AHR distribution as the percentage of moderate and severe AHR in CVA was significantly lower than in CA (41.72% VS 64.70%, P = 0.001). The inflammatory subtype distribution was different as the proportion of E and M subtypes in CVA was lower than in CA (56.0% vs 67.19%, P = 0.049). The proportion of subtype P was the lowest and subtype M was the highest in both CVA and CA patients. There was a similar negative correlation of sputum eosinophil% with AHR in CVA and CA (r = - 0.337, P < 0.0001 and r = - 0.27, P = 0.026, respectively), and a positive correlation between sputum eosinophil% and improvement rate of FEV after inhalation of bronchodilator (ΔFEV%) (r = 0.33, P = 0.01).
CONCLUSIONS
CVA patients showed a better pulmonary function and lower airway inflammation in contrast to CA patients, which may participate in the pathogenesis of chronic cough in CVA.
背景
中国成年咳嗽变异性哮喘（CVA）的临床特征在很大程度上尚不确定。
方法
本回顾性研究纳入了303例新诊断为未控制哮喘（症状控制及未来不良结局风险）的患者，其中包括175例CVA患者和128例典型哮喘（CA）患者。对临床特征进行回顾性比较，包括基本特征、肺功能、气道高反应性（AHR）及诱导痰细胞计数。根据诱导痰嗜酸性粒细胞和中性粒细胞计数，将所有患者分为四种炎症亚型，即嗜酸性粒细胞型（E）、中性粒细胞型（N）、混合粒细胞型（M）和少粒细胞型（P），并比较炎症亚型分布情况。
结果
与CA患者相比，CVA患者更年轻（P = 0.009），女性患病率更高（P = 0.001），基线肺功能参数值更高（所有P≤0.01），病程更短（P = 0.002），AHR更低（P = 0.001），痰嗜酸性粒细胞百分比更低（P = 0.009）。AHR分布存在差异，CVA中重度AHR的百分比显著低于CA（41.72%对64.70%，P = 0.001）。炎症亚型分布不同，CVA中E和M亚型的比例低于CA（56.0%对67.19%，P = 0.049）。在CVA和CA患者中，P亚型比例最低，M亚型比例最高。CVA和CA中痰嗜酸性粒细胞百分比与AHR均呈相似的负相关（分别为r = - 0.337，P < 0.0001和r = - 0.27，P = 0.026），且痰嗜酸性粒细胞百分比与吸入支气管扩张剂后FEV改善率（ΔFEV%）呈正相关（r = 0.33，P = 0.01）。
结论
与CA患者相比，CVA患者肺功能更好，气道炎症更低，这可能参与了CVA慢性咳嗽的发病机制。
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