成人哮喘患者在实际临床中慢性鼻-鼻窦炎的诊断生物标志物
Diagnostic biomarkers for chronic rhinosinusitis in adult asthmatics in real-world practice.
作者信息
Jang Jae-Hyuk, Yang Eun-Mi, Lee Youngsoo, Shin Yoo Seob, Ye Young-Min, Park Hae-Sim
机构信息
Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea.
出版信息
World Allergy Organ J. 2024 Feb 15;17(3):100879. doi: 10.1016/j.waojou.2024.100879. eCollection 2024 Mar.
BACKGROUND
Chronic rhinosinusitis (CRS) is a common comorbid condition of asthma that affects the long-term outcome of asthmatic patients. CRS is a heterogeneous disease requiring multiple biomarkers to explain its pathogenesis. This study aimed to develop potential biomarkers for predicting CRS in adult asthmatic patients in a real-world clinical setting.
METHODS
This study enrolled 108 adult asthmatic patients who had maintained anti-asthmatic medications, including medium-to-high doses of inhaled corticosteroid plus long-acting β2-agonists, and compared clinical characteristics between patients with CRS (CRS group) and those without CRS (non-CRS group). CRS was diagnosed based on the results of paranasal sinus X-ray and/or osteomeatal-unit CT as well as clinical symptoms. Type-2 parameters, including blood eosinophil count, serum levels of periostin/dipeptidyl peptidase 10 (DPP10) and clinical parameters, such as FEV1% and fractional exhaled nitric oxide (FeNO), were analyzed. All biomarkers were evaluated by logistic regression and classification/regression tree (CRT) analyses.
RESULTS
The CRS group had higher blood eosinophil counts/FeNO levels and prevalence of aspirin-exacerbated respiratory disease (AERD) than the non-CRS group (n = 57, 52.8% n = 75, 47.2%; < 0.05), but no differences in sex/smoking status or asthma control status were noted. The CRS group had higher serum periostin/DPP10 levels than the non-CRS group. Moreover, logistic regression demonstrated that serum periostin/DPP10 and the AERD phenotype were significant factors for predicting CRS in asthmatic patients (adjusted odds ratio, 2.14/1.94/12.39). A diagnostic algorithm and the optimal cutoff values determined by CRT analysis were able to predict CRS with 86.27% sensitivity (a 0.17 negative likelihood ratio).
CONCLUSION
Serum periostin, DPP10 and the phenotype of AERD are valuable biomarkers for predicting CRS in adult asthmatic patients in clinical practice.
背景
慢性鼻-鼻窦炎（CRS）是哮喘常见的共病情况，会影响哮喘患者的长期预后。CRS是一种异质性疾病，需要多种生物标志物来解释其发病机制。本研究旨在开发在真实临床环境中预测成年哮喘患者CRS的潜在生物标志物。
方法
本研究纳入了108例维持使用抗哮喘药物（包括中高剂量吸入性糖皮质激素加长效β2受体激动剂）的成年哮喘患者，比较了CRS患者（CRS组）和无CRS患者（非CRS组）的临床特征。CRS根据鼻窦X线和/或骨窦口复合体CT结果以及临床症状进行诊断。分析了2型参数，包括血嗜酸性粒细胞计数、骨膜蛋白/二肽基肽酶10（DPP10）血清水平以及临床参数，如第1秒用力呼气容积百分比（FEV1%）和呼出一氧化氮分数（FeNO）。所有生物标志物均通过逻辑回归和分类/回归树（CRT）分析进行评估。
结果
CRS组的血嗜酸性粒细胞计数/FeNO水平以及阿司匹林加重的呼吸系统疾病（AERD）患病率高于非CRS组（n = 57，52.8% n = 75，47.2%； < 0.05），但在性别/吸烟状况或哮喘控制状态方面未发现差异。CRS组的血清骨膜蛋白/DPP10水平高于非CRS组。此外，逻辑回归表明血清骨膜蛋白/DPP10和AERD表型是预测哮喘患者CRS的重要因素（调整比值比，2.14/1.94/12.39）。CRT分析确定的诊断算法和最佳截断值能够以86.27%的灵敏度预测CRS（阴性似然比为0.17）。
结论
血清骨膜蛋白、DPP10和AERD表型是临床实践中预测成年哮喘患者CRS的有价值生物标志物。
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