重度哮喘临床特征、炎症标志物特点及危险因素分析

Analysis of clinical and inflammatory characteristics and risk factors of severe asthma

目的探讨重度哮喘的临床特征、炎症标志物特点及危险因素,以提高临床医生对该疾病的认知。方法收集2018年5月—2021年5月就诊于山西医科大学第一医院呼吸科门诊的支气管哮喘患者一般情况、疾病诊治情况、个人史、共患病、辅助检查、哮喘控制测试(asthma control test,ACT)评分等资料,共纳入127例患者,其中重度哮喘组40例,轻中度哮喘组87例,采用χ^(2)检验、独立样本t检验以及Logistic回归分析重度哮喘的临床特征、炎症标志物特点及危险因素。结果与轻中度哮喘患者比较,重度哮喘患者年龄更大[(51.0±12.0)岁比(40.7±12.8)岁,P<0.05)],吸烟者更多(32.5%比14.9%,P<0.05),男性患者为主(67.5%比40.2%,P<0.05),肺功能更差[第1秒用力呼气容积占预计值百分比为(56.1±23.8)%比(93.2±18.0)%,第1秒用力呼气容积与用力肺活量比值为(56.7±13.2)%比(75.8±9.0)%,均P<0.05],前1年急性加重次数更多(2.7±3.1比0.1±0.4,P<0.05),ACT评分更低(14.4±3.7比18.0±5.0,P<0.05),血和诱导痰嗜酸性粒细胞计数更高[(0.54±0.44)×10^(9)/L比(0.27±0.32)×10^(9)/L,(25.9±24.2)%比(9.8±17.5)%,均P<0.05]。两组哮喘患者相比,诱导痰中性粒细胞比例、呼出气一氧化氮相比差异无统计学意义(P>0.05)。相关多危险因素分析显示吸烟[比值比(odds ratio,OR)=2.740,95%可信区间(confidence interval,CI)1.053~7.130,P<0.05]、合并过敏性鼻炎(OR=14.388,95%CI 1.486~139.296,P<0.05)、胃食管反流(OR=2.514,95%CI 1.105~5.724,P<0.05)是重度哮喘患病的危险因素。结论与轻中度哮喘患者相比,重度哮喘患者存在肺功能差、急性加重次数多、嗜酸性粒细胞炎症表型为主等特征,即使给予更高级别治疗仍然控制较差,患病危险因素包括吸烟、过敏性鼻炎、胃食管反流等。

Objective To explore the clinical and inflammatory characteristics and risk factors of severe asthma to improve clinicians'awareness of the disease.Methods The general information of patients with asthma who visited the Department of Respiratory Medicine,the First Hospital of Shanxi Medical University from May 2018 to May 2021,as well as the diagnosis and treatment of asthma,personal history,comorbidities,auxiliary examination,asthma control test(ACT)score were collected.A total of 127 patients were included,including 40 in the severe asthma group and 87 in the mild-to-moderate asthma group.Chi-square test,independent sample t test and logistic regression were used to analyze the clinical characteristics,inflammatory markers and risk factors of severe asthma.Results Compared with the patients with mild to moderate asthma,the patients with severe asthma were more older(51.0±12.0 years vs 40.7±12.8 years,P<0.05),had more smokers(32.5%vs.14.9%,P<0.05),and more males(67.5%vs.40.2%,P<0.05).The patients with severe asthma got poor FEV_(1)%pred[(56.1±23.8)%vs.(93.2±18.0)%,P<0.05]and FEV_(1)/FVC[(56.7±13.2)%vs.(75.8±9.0)%,P<0.05)],and more exacerbations in the previous year(2.7±3.1 vs.0.1±0.4,P<0.05),lower ACT score(14.4±3.7 vs.18.0±5.0,P<0.05),and higher blood and induced sputum eosinophil counts[(0.54±0.44)×10^(9)/L vs.(0.27±0.32)×10^(9)/L,P<0.05;(25.9±24.2)%vs.(9.8±17.5)%,P<0.05].There was no significant difference in the proportion of neutrophils in the induced sputum or FeNO between the two groups(P>0.05).Analysis of related risk factors showed that smoking(OR=2.740,95%CI 1.053-7.130),combined with allergic rhinitis(OR=14.388,95%CI 1.486-139.296)and gastroesophageal reflux(OR=2.514,95%CI 1.105-5.724)were risk factors for severe asthma.Conclusions Compared with patients with mild to moderate asthma,patients with severe asthma are characterized by poor lung function,more exacerbations,and a dominant eosinophil inflammatory phenotype,which is still poorly controlled even with higher level of treatment.Risk factors include smoking,allergic rhinitis,and gastroesophageal reflux,etc.