成年过敏性及非过敏性哮喘的临床特征分析

Clinical features of allergic and non-allergic asthma in adults

目的探讨成年过敏性及非过敏性哮喘患者的临床特征及意义。方法连续纳入2014年10月至2016年6月于四川大学华西医院哮喘专病门诊初诊未治疗的成年哮喘患者,以抗原特异性IgE阳性或常见过敏原皮肤点刺试验阳性分为过敏性哮喘(AAS)组和非过敏性哮喘(NAAS)组,纳入性别、发病年龄、哮喘控制测试(ACT)评分、肺功能、气流受限类型、呼出气一氧化氮分数(FeNO)、体重指数、疾病严重程度等指标进行分析。结果共纳入131例患者。其中,AAS组72例,NAAS组59例。NAAS组FeNO水平为(51.1±32.6)ppb,与AAS组(69.1±41.7)ppb相比,差异有统计学意义(t=–2.762,P=0.007);NAAS组合并鼻炎(17/59)与AAS组合并鼻炎(48/72)相比,差异有统计学意义(χ~2=19.396,P=0.000);NAAS组中无气流受限(NAO)、可逆性气流受限(RAO)、不可逆性气流受限(IAO)分别为20例(33.9%)、22例(37.3%)、17例(28.8%),AAS组分别为37例(51.4%)、26例(36.1%)、9例(12.5%),两组比较差异有统计学意义(Z=–2.461,P=0.014);NAAS组中轻度间歇/持续型、中度持续型、重度持续型分别为20例(33.9%)、18例(30.5%)、21例(35.6%),AAS组分别为37例(51.4%)、19例(26.4%)、16例(22.2%),两组比较差异有统计学意义(Z=–2.115,P=–0.034);NAAS组发病年龄[(28.9±16.3)岁]、ACT评分[(15.6±4.1)分]、FEV1%pred[(67.64±22.81)%]、体重指数[(23.8±4.74)kg/m^2],与AAS组[分别为(25.5±15.0)岁,(16.7±4.2)分,(74.42±21.05)%,(22.5±4.1)kg/m^2]相比,差异均无统计学意义(P>0.05)。结论与AAS相比,NAAS病情更重,合并鼻炎的较少,FeNO水平较低,发生IAO的比例更高。

Objective To investigate the clinical characteristics of allergic and non-allergic asthma in Chinese adult asthmatic patients. Methods Consecutive treatment-naive adult outpatients with asthma were retrospectively analyzed in West China Hospital, Sichuan University from October 2014 to June 2016. The patients were classified into a non-allergic asthma （NAAS） group and an allergic asthma （AAS） group by skin prick test or antigen-specific IgE test. The differences between allergic and non-allergic asthma were compared in respect of gender, age, asthma control test （ACT） score, lung function, fractional exhaled nitric oxide （FeNO） level, body mass index （BMI）, disease severity,etc. Results A total of 131 patients were enrolled in which 72 cases （54.96%） were allergic asthmatics and 59 cases （45.04%） were non-allergic asthmatics. The level of FeNO was statistically different （t=–2.762,P=0.007） between the NAAS group and the AAS group [（51.1±32.6）ppbvs. （69.1±41.7）ppb]. Seventeen cases of the NAAS group and 48 cases of the AAS group were complicated with rhinitis with statistically significant difference （χ^2 =19.396,P=0.000）. Airway limitation reversibility test showed that there were 37 cases in AAS and 20 cases in NAAS with no airway obstruction （NAO）, 26 cases in AAS and 22 cases in NAAS with reversible airflow obstruction （RAO）, 9 cases in AAS and 17 cases in NAAS with irreversible airflow obstruction （IAO）, respectively, with statistically significant difference between two groups （Z=–2.461,P=0.014）. There were 20 cases （33.9%） in NAAS and 37 cases （51.4%） in AAS with mild intermittent or persistent asthma, 18 cases （30.5%） in NAAS and 19 cases （26.4%） in AAS with moderate persistent asthma, 21 cases （35.6%） in NAAS and 16 （22.2%） in AAS with severe persistent asthma, respectively, with statistically significant difference （Z=–2.115,P=–0.034）. The age, ACT score, FEV1%pred, and BMI had no statistical difference between two groups （allP〉0.05）. Conclusion Compared with allergic asthma, non-allergic asthma has less rhinitis, lower FeNO levels and higher prevalence of irreversible airflow obstruction.