支气管哮喘不同炎症表型的临床特征分析

Clinical characteristic analysis of different inflammatory phenotypes in bronchial asthma

目的通过分析支气管哮喘炎症表型的临床特征并对治疗前后的临床指标进行比较,为哮喘临床诊疗提供依据。方法选取2018年7月—2019年1月于内蒙古自治区人民医院就诊的110例慢性持续期哮喘患者,根据诱导痰结果分为嗜酸粒细胞型哮喘(EA)、中性粒细胞型哮喘(NA)、混合粒细胞型哮喘(MGA)及寡粒细胞型哮喘(PGA)4种炎症表型,比较其临床特征,并分析治疗前后的临床指标。结果4种炎症表型临床症状及控制水平比较差异无统计学意义(均P>0.05)。EA组与部分组对比发现呼出气一氧化氮(FeNO)显著升高,第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)、第1秒用力呼气容积占预计值的百分比(FEV1%)下降显著(均P<0.05)。嗜酸性粒细胞(Eos)与FeNO呈正相关趋势(r=0.541),与FEV1/FVC、FEV1%呈负相关趋势(r=-0.301、-0.284)。比较采用低剂量吸入型糖皮质激素(ICS)+长效β2受体激动剂(LABA)治疗的患者治疗前与治疗1个月的临床指标,发现治疗后EA、MGA组Eos、FeNO较治疗前明显下降(EA:t=3.564、6.761;MGA:t=3.068、4.093,均P<0.05),EA组FEV1/FVC、FEV1%较治疗前显著升高(t=2.755、2.729,均P<0.05)。结论Eos增多的表型(EA)中肺功能下降更明显,FeNO与嗜酸型炎症密切相关;低剂量ICS+LABA在Eos增多表型中效果更显著。

Objective To analyse the clinical characteristics of different inflammatory phenotypes of bronchial asthma(BA)and compare the clinical indicators before and after treatment,so as to provide a basis for clinical diagnosis and treatment of asthma.Methods A total of 110 asthma patients in chronic duration in the Outpatient Ward of Inner Mongolia People’s Hospital were recruited from July 2018 to January 2019,and divided into four groups with different airway inflammation phenotypes based on the results of induced sputum,such as eosinophilic asthma(EA),neutrophilic asthma,mixed granulocytic asthma(MGA)and paucigranulocytic asthma.The differences in clinical characteristics were compared,and the clinical indicators before and after treatment were compared and analysed.Results No significant differences were observed in the clinical symptoms and control level between inflammatory phenotypes(both P>0.05).Compared with the other groups,the EA group showed a significantly increased exhaled nitric oxide(FeNO)and significantly decreased FEV1/FVC and FEV1%(all P<0.05).The number of eosinophil(Eos)was positively correlated trend with the values of FeNO(r=0.541),and negatively correlated with the values of FEV1/FVC and FEV1%(r=-0.301,-0.284).The clinical indicators of asthma before treatment and 1 month after treatment(low-dose inhale corticosteroids+long-acting inhaleβ2-agonist)were compared.The Eos and FeNO in EA and MGA groups significantly decreased after treatment compared with those before treatment(EA:t=3.564,6.761;MGA:t=3.068,4.093,all P<0.05).FEV1/FVC and FEV1%in the EA group were significantly higher than those before treatment(t=-2.755,-2.729,both P<0.05).Conclusion Lung function decline is pronounced in the Eos-increased phenotype(EA),and FeNO is closely associated with eosinophilic inflammation.Low-dose ICS+LABA is effective in Eos-increasing phenotype asthma patients.