重症哮喘的表型特征医学课件.ppt

Impact of degree of weight loss on Asthma Control Questionnaire (ACQ) score. a) 10% weight loss; b) ≤10% weight loss. *: p0.05; ***: p0.001; #: p=0.974. Eur Respir J 2014;43:1368-1377 肥胖相关性重症哮喘的治疗：减重对ACQ评分的影响 Impact of degree of weight loss on forced vital capacity (FVC). *: p0.05; #: p=0.546. Eur Respir J 2014;43:1368-1377 肥胖相关性重症哮喘的治疗：减重对FVC的影响 小 结 重症哮喘异质性明显； 重症哮喘表型的具体分型方法尚不统一：临床、炎症、分子； 基于重症哮喘表型特征，特别是基于临床相关生物标记物实施重症哮喘的个体化治疗。 A total of 438 subjects with asthma were studied (204 severe, 70 moderate, 164 mild). Severe subjects with asthma were older with longer disease duration (P .0001), more daily symptoms, intense urgent health care utilization, sinusitis, and pneumonia (P ≤ .0001). Lung function was lower in severe asthma with marked bronchodilator reversibility (P .001). The severe group had less atopy by skin tests (P = .0007), but blood eosinophils, IgE, and exhaled nitric oxide levels did not differentiate disease severity. A reduced FEV1, history of pneumonia, and fewer positive skin tests were risk factors for severe disease. Early disease onset (age 12 years) in severe asthma was associated with longer disease duration (P .0001) and more urgent health care, especially intensive care (P = .002). Later disease onset (age ≥ 12 years) was associated with lower lung function and sinopulmonary infections (P ≤ .02). * Data are shown as lifetime (ever) events and visits in the past year. Hosp, Inpatient hospitalizations; Vent, need for mechanical ventilation. White bars, mild (n = 164); hatched bars, moderate; black bars, severe asthma. *P .0001, all groups are different from each other; ?P .0001, mild and moderate groups are similar, but different from severe group. * * 【研究1-右上】目的：研究气道炎症和疾病严重程度之间的关系。方法：纳入了74例非吸烟哮喘患者（无鼻炎、GERD等影响因素），按GINA分为间断和轻中重度，治疗上按原方案（包括口服激素），22例非过敏健康对照（32mg/ml乙酰甲胆碱阴性），采集诱导痰细胞计数、ECP、MPO、类胰蛋白酶（分别反映Eos、Neu、肥大细胞），评价哮喘严重程度（FEV1、PEF变异率、日间症状评分），计算炎症与严重程度指标间的Rs值，评价其相关性。结果：炎症指标与哮喘控制指标具有良好相关性。结论：提示哮喘存在持续的、和严重程度相关的炎症，包括Eos、肥大细胞、Neu等，即使是有激素治疗。 【