Takada Kazufumi, Suzukawa Maho, Tashimo Hiroyuki, Ohshima Nobuharu, Fukutomi Yuma, Kobayashi Nobuyuki, Taniguchi Masami, Ishii Masaki, Akishita Masahiro, Ohta Ken
Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, 204-8585, Japan.
Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, 113-8655, Japan.
World Allergy Organ J. 2023 Nov 9;16(11):100840. doi: 10.1016/j.waojou.2023.100840. eCollection 2023 Nov.
Asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) is characterized by concurrent features of asthma and COPD. Since disease pathogenesis, severities, and treatments differ between asthma and ACO, it is important to differentiate them.
To clarify and compare the characteristics of ACO and asthma and identify the serum biomarkers for differentiating them, especially in older patients.
This study used the data of 639 participants from the nationwide cohort study, the NHOM-Asthma study, an asthma registry in Japan, with complete information on smoking history, respiratory function, and serum biomarkers. ACO was defined as the self-reported comorbidity of COPD or emphysema, or with obstructive pulmonary function and smoking history (pack-years≥10). The clinical characteristics of patients with ACO and asthma without COPD were compared. The serum biomarkers for differentiation were examined using receiver operating characteristic curves and multivariable analysis. The associations between the biomarkers and age were also analyzed.
Of the 639 asthma patients, 125 (19.6%) were diagnosed with ACO; these patients were older and male-dominant and had a higher prevalence of comorbidities such as hypertension, diabetes, and stroke. Among the serum biomarkers that were significantly different between ACO and asthma without COPD, the YKL-40/CHI3L1, MMP3, and IL-1RA levels showed a high area under the curve for discriminating ACO. Only the MMP3 and IL-1RA levels were significantly higher among ACO patients, regardless of age and sex; the YKL-40/CHI3L1 levels were not different due to the effect of age.
MMP3 and IL-1RA may be useful serum biomarkers for distinguishing ACO from asthma.
哮喘与慢性阻塞性肺疾病（COPD）重叠（ACO）的特征是同时具有哮喘和COPD的特点。由于哮喘和ACO在疾病发病机制、严重程度及治疗方面存在差异，因此进行区分很重要。
阐明并比较ACO和哮喘的特征，确定用于区分二者的血清生物标志物，尤其是在老年患者中。
本研究使用了来自全国队列研究NHOM-Asthma研究（日本一项哮喘登记研究）的639名参与者的数据，这些数据包含吸烟史、呼吸功能和血清生物标志物的完整信息。ACO被定义为自我报告的COPD或肺气肿合并症，或具有阻塞性肺功能和吸烟史（吸烟包年数≥10）。比较了ACO患者和无COPD的哮喘患者的临床特征。使用受试者工作特征曲线和多变量分析来检测用于区分的血清生物标志物。还分析了生物标志物与年龄之间的关联。
在639名哮喘患者中，125名（占19.6%）被诊断为ACO；这些患者年龄较大，以男性为主，并且高血压、糖尿病和中风等合并症的患病率更高。在ACO和无COPD的哮喘之间有显著差异的血清生物标志物中，YKL-40/CHI3L1、MMP3和IL-1RA水平在区分ACO时曲线下面积较高。无论年龄和性别，只有ACO患者的MMP3和IL-1RA水平显著更高；由于年龄的影响，YKL-40/CHI3L1水平没有差异。
MMP3和IL-1RA可能是区分ACO与哮喘的有用血清生物标志物。
