Heo Jung Won, Lee Hwa Young, Han Solji, Kang Hye Seon, Kwon Soon Seog, Lee Sook Young
Division of Internal Medicine, Chung-Ang University H.C.S Hyundae Hospital, Namyangju-si, Republic of Korea.
Division of Allergy, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2021 Jul;13(7):4195-4206. doi: 10.21037/jtd-20-3314.
Asthma and lipid metabolism are associated with systemic inflammation. However, the studies about the relationship between lipid profile, fractional exhaled nitric acid (FeNO) and pulmonary function test (PFT) results are currently lacking.
We enrolled asthma patients who had serum lipid profiles including apolipoprotein levels from March 1, 2019 to December 31, 2019. We classified the asthma patients into two groups according to the diagnosis method: (I) patients who were diagnosed based on clinical symptoms/signs and PFT results and (II) patients diagnosed with clinical symptoms/signs. Clinical characteristics including age, underlying diseases, smoking status, allergy test results and treatment agents were compared between the two groups. The associations between blood cholesterol levels including apolipoprotein and pulmonary functions were analyzed. Moreover, patients were divided into two groups according to the median value of apolipoprotein B (Apo B), and lung function test results were compared between the patients who had high and low Apo B levels.
Among the 167 patients, 93 (55.7%) were PFT-proven asthma patients. In PFT-proven asthma patients, the levels of total cholesterol (TC) (r =0.37, P=0.03), low-density lipoprotein (LDL) (r =0.46, P=0.01) and Apo B (r =0.38, P=0.02) showed a significant correlation with FeNO, which had no statistical significance in physician-diagnosed asthma group. In multivariate regression analysis, log (FeNO) showed a significant correlation with Apo B (P<0.01) after adjustment for presence of PFT-proven asthma (P=0.01) and current smoking (P=0.01). Patients with high Apo B levels had a lower post-bronchodilator (BD) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio (69.8 74.9, P=0.02) and lower post-BD FEV1 (%) (77.5 85.0, P=0.04) compared with those showing low Apo B levels.
The levels of Apo B and FeNO had positive correlations and high Apo B levels were associated with severe airflow obstruction and low FEV1 (%). Apo B could reflect the uncontrolled status of bronchial asthma and poor lung function.
哮喘与脂质代谢均与全身炎症相关。然而，目前缺乏关于血脂谱、呼出气一氧化氮分数（FeNO）与肺功能测试（PFT）结果之间关系的研究。
我们纳入了2019年3月1日至2019年12月31日期间有血脂谱（包括载脂蛋白水平）的哮喘患者。我们根据诊断方法将哮喘患者分为两组：（I）根据临床症状/体征和PFT结果诊断的患者，以及（II）根据临床症状/体征诊断的患者。比较两组之间的临床特征，包括年龄、基础疾病、吸烟状况、过敏试验结果和治疗药物。分析包括载脂蛋白在内的血胆固醇水平与肺功能之间的关联。此外，根据载脂蛋白B（Apo B）的中位数将患者分为两组，并比较Apo B水平高低患者的肺功能测试结果。
在167例患者中，93例（55.7%）为经PFT证实的哮喘患者。在经PFT证实的哮喘患者中，总胆固醇（TC）水平（r =0.37，P =0.03）、低密度脂蛋白（LDL）水平（r =0.46，P =0.01）和Apo B水平（r =0.38，P =0.02）与FeNO呈显著相关，而在医生诊断的哮喘组中无统计学意义。在多变量回归分析中，调整经PFT证实的哮喘（P =0.01）和当前吸烟情况（P =0.01）后，log（FeNO）与Apo B呈显著相关（P<0.01）。与Apo B水平低的患者相比，Apo B水平高的患者支气管扩张剂（BD）后1秒用力呼气容积（FEV1）/用力肺活量（FVC）比值更低（69.8±74.9，P =0.02），BD后FEV1（%）也更低（77.5±85.0，P =0.04）。
Apo B水平与FeNO呈正相关，Apo B水平高与严重气流受限和低FEV1（%）相关。Apo B可反映支气管哮喘的控制不佳状态和肺功能较差。
