Tashiro Hiroki, Takahashi Koichiro, Sadamatsu Hironori, Kurihara Yuki, Haraguchi Tetsuro, Tajiri Ryo, Takamori Ayako, Kimura Shinya, Sueoka-Aragane Naoko
Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Clinical Research Center, Saga University Hospital, Saga, Japan.
J Asthma Allergy. 2020 Oct 2;13:409-414. doi: 10.2147/JAA.S276371. eCollection 2020.
Overweight and obesity are associated with one of the severe phenotypes of asthma, with an increased rate of exacerbations, low level of lung function, and reduced response to corticosteroid therapy. The present study focused on identifying useful biomarkers of severity in overweight patients with adult-onset asthma using real-world data.
A total of 56 patients with adult-onset asthma who visited Saga University Hospital between 2018 and 2019 were retrospectively reviewed. Overweight was defined as a body mass index (BMI) greater than 25 kg/m. Blood eosinophils, cytokines, and chemokines were compared between non-overweight asthma and overweight asthma patients.
Overweight asthma patients had a higher annual exacerbation rate, lower pulmonary function even when treated frequently with high-dose inhaled corticosteroids, and a significantly lower percentage of eosinophils and lower eosinophil count compared to non-overweight asthma patients (p<0.01, p=0.03). Moreover, the percentage of eosinophils was significantly negatively correlated with BMI (=-0.38, p<0.01) (Figure 1). On serum cytokine and chemokine analyses, the overweight asthma group included significantly more patients with a lower level of tissue growth factor α (TGF-α) (1.1 pg/mL) and higher levels of hsIL-6 (2.5 pg/mL), RANTES/CCL5 (298.5 pg/mL), and vascular endothelial growth factor A (VEGF-A) (63.7 pg/mL), than the non-overweight asthma group (p=0.02, p<0.01, p=0.02, p=0.01, respectively).
The present study showed that overweight patients with adult-onset asthma were characterized by a higher rate of annual exacerbations and worse lung function despite treatment with high-dose inhaled corticosteroids and lower blood eosinophil counts than non-overweight patients with asthma. On blood cytokine and chemokine analyses, a low level of TGF-α and high levels of hsIL-6, RANTES/CCL5, and VEGF-A might be biomarkers reflecting the pathophysiology in overweight patients with asthma.
超重和肥胖与哮喘的一种严重表型相关，其特征为病情加重率增加、肺功能水平低下以及对皮质类固醇治疗的反应降低。本研究旨在利用真实世界数据，确定成年起病的超重哮喘患者病情严重程度的有用生物标志物。
回顾性分析了2018年至2019年间就诊于佐贺大学医院的56例成年起病的哮喘患者。超重定义为体重指数（BMI）大于25kg/m²。比较了非超重哮喘患者和超重哮喘患者的血液嗜酸性粒细胞、细胞因子和趋化因子。
与非超重哮喘患者相比，超重哮喘患者的年加重率更高，即使频繁使用高剂量吸入性皮质类固醇治疗，其肺功能仍较低，嗜酸性粒细胞百分比和嗜酸性粒细胞计数显著更低（p<0.01，p=0.03）。此外，嗜酸性粒细胞百分比与BMI显著负相关（r=-0.38，p<0.01）（图1）。血清细胞因子和趋化因子分析显示，与非超重哮喘组相比，超重哮喘组中组织生长因子α（TGF-α）水平较低（1.1pg/mL）、高敏白细胞介素-6（hsIL-6）（2.5pg/mL）、调节活化正常T细胞表达和分泌因子/CC趋化因子5（RANTES/CCL5）（298.5pg/mL）以及血管内皮生长因子A（VEGF-A）（63.7pg/mL）水平较高的患者明显更多（分别为p=0.02，p<0.01，p=0.02，p=0.01）。
本研究表明，成年起病的超重哮喘患者的特征是年加重率较高，尽管使用高剂量吸入性皮质类固醇治疗，其肺功能仍较差，且血液嗜酸性粒细胞计数低于非超重哮喘患者中。血液细胞因子和趋化因子分析显示，低水平的TGF-α和高水平的hsIL-6、RANTES/CCL5以及VEGF-A可能是反映超重哮喘患者病理生理学的生物标志物。
