夜间哮喘2型炎症特征及吸入性糖皮质激素联合治疗方案的效果评价  

Characteristics of type 2 inflammation in nocturnal asthma and evaluation of the effectiveness of inhaled corticosteroids combination therapy

作　　者：马妍妍 许懋升 徐桂铃 龚钊乾 黄俊文 陈颖 胡大鹏 王燕红[1] 梁健鹏[1] 赵文驱 刘来昱[1] 蔡绍曦[1] 赵海金[1] Ma Yanyan;Xu Maosheng;Xu Guiling;Gong Zhaoqian;Huang Junwen;Chen Ying;Hu Dapeng;Wang Yanhong;Liang Jianpeng;Zhao Wenqu;Liu Laiyu;Cai Shaoxi;Zhao Haijin(Department of Respiratory and Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou510515,China)

机构地区：[1]南方医科大学南方医院呼吸与危重症医学科,广州510515

出　　处：《中华医学杂志》2025年第2期155-162,共8页National Medical Journal of China

摘　　要：目的探讨夜间哮喘患者2型炎症特征,并分析使用吸入性糖皮质激素(ICS)联合不同长效支气管扩张剂后哮喘症状的改善情况。方法回顾性纳入2020年1月至2023年6月首次就诊于南方医科大学南方医院呼吸科门诊且支气管舒张试验(BDT)阳性的231例哮喘患者,根据有无夜间症状分为夜间哮喘组和非夜间哮喘组;再根据呼出气一氧化氮(FeNO)水平将夜间哮喘患者分为2型炎症组[FeNO≥20 ppb(×10^(-12))]和非2型炎症组(FeNO<20 ppb),并根据不同用药方案分为ICS+长效β_(2)受体激动剂(LABA)组和ICS+LABA+长效抗胆碱能药物(LAMA)组,于入组后第3、6、12个月进行随访,评估患者的哮喘控制测试(ACT)问卷得分、实际用药情况及急性发作次数等指标,对比不同分组患者的临床特征、治疗及预后差异。结果231例患者中,男152例,女79例;年龄[M(Q1,Q3)]为52(42,60)岁;夜间哮喘组144例,非夜间哮喘组87例。144例夜间哮喘组患者中,完成FeNO检测者133例,其中2型炎症组95例(71.4%),非2型炎症组38例(28.6%)。夜间哮喘组外周血嗜酸性粒细胞(EOS)计数和FeNO均高于非夜间哮喘组[(0.45±0.40)×10^(9)/L比(0.25±0.20)×10^(9)/L,38(18,82)比29(15,48)ppb,均P<0.05];夜间哮喘组基线ACT评分低于非夜间哮喘组[16(14,18)比21(19,23)分,P<0.001];两组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和呼气峰流速(PEF)差异均无统计学意义(均P>0.05);在第3、6和12个月的随访中,夜间哮喘组ACT评分改善值(ΔACT)均高于非夜间哮喘组[5(3,7)比2(1,3)、7(4,9)比3(1,4)和7(6,9)比3(1,5)分,均P<0.05]。2型炎症组EOS计数[0.40(0.29,0.80)×10^(9)/L比0.20(0.12,0.29)×10^(9)/L]和百分比[5.10%(3.55%,9.10%)比2.20%(1.65%,3.85%)]均高于非2型炎症组(均P<0.05)。夜间哮喘组中,ICS+LABA组与ICS+LABA+LAMA组ΔACT差异无统计学意义(均P>0.05)。结论夜间哮喘患者有更明显的2型炎症,且症状往往控制不佳甚至更差,给予含ICS联合治疗1年后可观�Objective To investigate the characteristics of type 2 inflammation in patients with nocturnal asthma,and analyze the improvement of asthma symptoms after the use of inhaled corticosteroids(ICS)combined with different long-acting bronchodilators.MethodsData of 231 asthma patients who first visited the Respiratory and Critical Care Medical Clinic of Nanfang Hospital of Southern Medical University from January 2020 to June 2023 and had positive bronchodilator tests(BDT),were retrospectively analyzed.These patients were divided into nocturnal asthma group and non-nocturnal asthma group based on the presence or absence of nocturnal symptoms.According to fractional exhaled nitric oxide(FeNO)levels,patients were divided into type 2 inflammatory group[FeNO≥20 ppb(×10^(-12))]and non-type 2 inflammatory group(FeNO<20 ppb).Patients were further divided into ICS+long-actingβ_(2) agonist(LABA)group and ICS+LABA+long-acting anticholinergic agent(LAMA)group based on medication regimens.Patients were followed-up at the 3rd,6th,and 12th months after enrollment to evaluate the patient′s asthma control test(ACT)questionnaire,actual medication status and number of acute attacks.The clinical characteristics,treatment and prognosis of different groups were compared.ResultsA total of 231 asthma patients were included,including 152 males and 79 females,with a age[M(Q 1,Q 3)]of 52(42,60)years.There were 144 cases(62.3%)in the nocturnal asthma group and 87 cases(37.7%)in the non-nocturnal asthma group.Among the 144 patients with nocturnal asthma,133 patients completed FeNO testing,of which 95 were classified into the type 2 inflammation group and 38 to the non-type 2 inflammation group.The eosinophil(EOS)count and FeNO level in the nocturnal asthma group were both higher than those in the non-nocturnal asthma group[(0.45±0.40)×10^(9)/L vs(0.25±0.20)×10^(9)/L,38(18,82)vs 29(15,48)ppb,both P<0.05].Baseline ACT score was lower in nocturnal asthma group than in non-nocturnal asthma group[16(14,18)vs 21(19,23)scores,P<0.001].There w

关 键 词：哮喘 夜间哮喘 2型炎症 嗜酸性粒细胞 随访 

分 类 号：R562.25[医药卫生—呼吸系统]