支气管热成形术治疗重度支气管哮喘的有效性和安全性研究

Effectiveness and safety of bronchial thermoplasty in patients with severe asthma

目的 探讨支气管热成形术治疗重度支气管哮喘（哮喘）的有效性和安全性.方法 2014年3-11月中日友好医院招募入组12例重度哮喘患者,自愿接受支气管热成形术治疗.检测支气管热成形术治疗前患者的气道炎症及生物标志物水平（血嗜酸粒细胞百分比、诱导痰嗜酸粒细胞百分比、血清IgE、呼出气一氧化氮水平）,以评估气道炎症类型;收集12例患者治疗前1年内重度哮喘急性发作次数及因哮喘急性发作住院情况;观察治疗后3周内不良反应发生情况,评估治疗后1年内重度哮喘急性发作次数、重度哮喘急性发作率、因哮喘急性发作住院次数及住院率、口服激素剂量等变化.结果 12例患者术前及术后1年内重度哮喘急性发作患者分别为11和6例,重度哮喘急性发作累计次数分别为76和16次,因哮喘急性发作住院患者分别为10及3例,累计住院次数分别为56和6次,术后1年内重度哮喘急性发作率、因哮喘急性发作住院率、口服激素剂量均较术前1年明显下降[分别为（1.3±0.5）和（6.3±1.9）次183;例^-1·年^-1;（0.50±0.26）和（4.67±1.90）次·例^-1·年^-1;（8.5±4.6）和（22.0±2.6）mg/d,均P＜0.05].术后重度哮喘急性发作率下降79.4％,因哮喘急性发作住院率下降89.4％.术后3周最常见不良事件为咳嗽（8例次）、咳痰量增加（20例次）、PEF短暂下降（7例次）、喘息（4例次）,多数在术后1周内缓解.1例患者3次术后均出现肺炎,经抗感染治疗痊愈.术后3周内无严重不良事件发生,术后1年胸部CT未见气道结构性改变.结论 应用支气管热成形术治疗重度哮喘,可减少重度哮喘急性发作并降低急性发作住院率,无严重不良事件发生.

Objective To assess the effectiveness and safety of bronchial thermoplasty （BT）in patients with severe asthma.Method The China-Japan Friendship Hospital recruited 12 patients with severe asthma who were voluntary to take BT treatment from March 2014 to November 2014.The levels of airway inflammation and biological markers （percentage of blood eosinophils,percentage of sputum eosinophils,serum IgE,fractional exhaled nitric oxide） of the patients were examined before the treatment in order to identify the types of airway inflammation.The numbers of severe exacerbations and related hospitalizations within 1 year before and after BT were obtained for each patient.The occurrence of adverse events within 3 weeks after the treatment was collected.And the patient status within 1 year after the BT treatment was compared with that before the treatment,in terms of the number of severe exacerbations,exacerbation rate,the number of related hospitalizations,hospitalization rate and oral corticosteroid dose.Results For before and 1 year after the treatment,the numbers of subjects suffering severe exacerbations were 11 and 6,the numbers of total severe exacerbation were 76 and 16,the numbers of patients hospitalized due to acute attacks were 10 and 3,and the numbers of total hospitalizations were 56 and 6,respectively.The severe exacerbation rate,hospitalization rate and oral corticosteroid dose were significantly reduced 1 year after the treatment [（1.3 ± 0.48 vs.6.3 ± 1.9） events/subject/year,（0.50 ± 0.26 vs.4.67 ± 1.90） events/subject/year,（8.5 ± 4.6 vs.22.0 ± 2.6） mg/d,P 〈 0.05].The most common adverse events within 3 weeks after BT treatment were cough （8 events）,expectoration （20 events）,temporary PEF reduction （7 events）,wheezing （4 events）,but most of these symptoms were relieved in 1 week.One subject suffered pneumonia after each of the 3 procedures but also recovered soon after an antibiotic therapy.No adverse events occurred because of BT treatment within 3 weeks after the treatment.Computed tomographic scans from baseline to 1 year after the BT treatment showed no structural abnormalities related to BT.Conclusions These data demonstrate the benefits of BT with regard to both asthma control （based on reduction in severe exacerbations and hospitalizations due to acute exacerbations） and safety.BT might offer a new approach to treating severe asthma.