Long F, Zhong D, Huang W T, Long L, Hu F B, Fu P, Hu S Y
Department of Respiratory Medicine, Shenzhen Hospital of Chinese Academy of Sciences, Shenzhen 518106, China.
Zhonghua Yi Xue Za Zhi. 2020 Jul 14;100(26):2023-2027. doi: 10.3760/cma.j.cn112137-20200119-00127.
To investigate the efficacy and safety of bronchial thermoplasty (BT) in severe asthma patients with the first second forced expiratory volume (FEV(1)) as a percentage of the predicted value (FEV(1)%pred) <60%. A retrospective analysis was performed on 75 patients with asthma who were treated with BT at Shenzhen University Hospital of the Chinese Academy of Sciences from January 2016 to January 2018. The patients were divided into two groups based on the FEV(1)%pred before treatment: FEV(1)%pred <60% group (39 cases) and FEV(1)%pred ≥60% group (36 cases). Comparative analysis of glucocorticoid consumption, times of acute attack, asthma control test (ACT) score, changes in lung function, and adverse reactions at 3 weeks after treatment were performed between the two groups of patients. Before BT treatment, the consumption of oral prednisone, the amount of budesonide inhaled, and the times of acute attack [ ((1), (3))] in the FEV(1)%pred <60% group were significantly greater than those in the FEV(1)%pred ≥60% group, and the ACT score was significantly lower than the FEV(1)%pred ≥60% group [10.00 (0, 20.00) vs 0(0, 3.75) mg/d, 960 (320, 960) vs 320 (320, 640) μg/d, 5(4, 8) vs 4 (4, 5) times/year, 13 (9, 15) vs 17 (13, 19) scores] (all 0.05). Except that the oral prednisone dosage in the FEV(1)%pred<60% group was still higher 1 year after treatment [0 (0, 5.00) vs 0 (0, 0) mg/d] (0.009), there was no significant difference in the remaining indicators between the two groups 1 year after treatment and 2 years after treatment (all 0.05). After 1 year and 2 years of treatment, all indicators in the two groups were better than before treatment (all 0.05). The inhaled budesonide amount and the times of acute exacerbation in the FEV(1)%pred <60% group 2 years after treatment were less than those 1 year after treatment [320 (320, 320) vs 320 (320, 640) μg/d, 0 (0, 0) vs 0(0, 1) times/year] (all 0.05), and there was no significant difference in the remaining indicators. In the FEV(1)%pred ≥60% group, there was no significant difference between 2 years after treatment and 1 year after treatment in the above indicators except the amount of inhaled budesonide (all 0.05). In the FEV(1)%pred <60% group, FEV(1) and the FEV(1)%pred were significantly lower than the FEV(1)%pred ≥60% group before treatment, 1 year after treatment and 2 years after treatment [FEV(1):(1.21±0.41) vs (2.26±0.80)L, (1.84±0.73) vs (2.30±0.78)L, (1.70±0.66) vs (2.38±0.76)L; FEV(1)%pred:46.2 (38.5, 53.7)% vs 80.8(66.5, 93.6)%, 60.1 (48.2, 71.6)% vs 87.4 (68.5, 96.5)%, 58.5 (48.6, 74.8)% vs 86.6 (73.0, 97.3)%] (all 0.05). In the FEV(1)%pred <60% group, FEV(1) and FEV(1)%pred 1 year after treatment and 2 years after treatment were all increased compared with before treatment (all 0.05). In the FEV(1)%pred ≥60% group, there was no statistical difference in FEV(1) at each time point before and after treatment (all 0.05), but the FEV(1)%pred at 2 years after treatment was higher than before treatment (0.05). There were no significant differences in adverse events between the two groups (all 0.05). BT can significantly improve the lung function, reduce the times of acute attack and the dosage of glucocorticoids in severe asthma patients with FEV(1)% pred<60%, which is safe and effective.
为研究支气管热成形术（BT）在第1秒用力呼气容积（FEV₁）占预计值百分比（FEV₁%pred）<60%的重度哮喘患者中的疗效和安全性。对2016年1月至2018年1月在中国科学院大学深圳医院接受BT治疗的75例哮喘患者进行回顾性分析。根据治疗前FEV₁%pred将患者分为两组：FEV₁%pred<60%组（39例）和FEV₁%pred≥60%组（36例）。对两组患者治疗后3周的糖皮质激素用量、急性发作次数、哮喘控制测试（ACT）评分、肺功能变化及不良反应进行对比分析。BT治疗前，FEV₁%pred<60%组口服泼尼松用量、布地奈德吸入量及急性发作次数[（1，3）]均显著高于FEV₁%pred≥60%组，ACT评分显著低于FEV₁%pred≥60%组[10.00（0，20.00）vs 0（0，3.75）mg/d，960（320，960）vs 320（320，640）μg/d，5（4，8）vs 4（4，5）次/年，13（9，15）vs 17（13，19）分]（均P<0.05）。治疗1年后，FEV₁%pred<60%组口服泼尼松用量仍高于FEV₁%pred≥60%组[0（0，5.00）vs 0（0，0）mg/d]（P=0.009），治疗1年和2年后两组其余指标差异均无统计学意义（均P>0.05）。治疗1年和2年后，两组各项指标均优于治疗前（均P<0.05）。治疗2年后，FEV₁%pred<60%组布地奈德吸入量及急性加重次数少于治疗1年后[320（320，320）vs 320（320，640）μg/d，0（0，0）vs 0（0，1）次/年]（均P<0.05），其余指标差异无统计学意义。FEV₁%pred≥60%组治疗2年后与治疗1年后上述指标比较，除布地奈德吸入量外差异均无统计学意义（均P>0.05）。治疗前、治疗1年后和治疗2年后，FEV₁%pred<60%组FEV₁及FEV₁%pred均显著低于FEV₁%pred≥60%组[FEV₁：（1.21±0.41）vs（2.26±0.80）L，（1.84±0.73）vs（2.30±0.78）L，（1.70±0.66）vs（2.38±0.76）L；FEV₁%pred：46.2（38.5，53.7）%vs 80.8（66.5，93.6）%，60.1（48.2，71.6）%vs 87.4（68.5，96.5）%，58.5（48.6，74.8）%vs 86.6（73.0，97.3）%]（均P<0.05）。治疗1年后和治疗2年后，FEV₁%pred<60%组FEV₁及FEV₁%pred均较治疗前升高（均P<0.05）。FEV₁%pred≥60%组治疗前后各时间点FEV₁差异无统计学意义（均P>0.05），但治疗2年后FEV₁%pred高于治疗前（P<0.05）。两组不良反应差异无统计学意义（均P>0.05）。BT可显著改善FEV₁%pred<60%的重度哮喘患者的肺功能，减少急性发作次数及糖皮质激素用量，安全有效。
