法国COBRA研究：成年哮喘患者的临床生物学特征
2017/12/29
摘要
背景：支气管阻塞和哮喘队列研究（COBRA）是一项包含了12家法国研究机构的纵向队列研究。
方法：在患者入组时收集其DNA，血清样本和临床数据等信息，并每隔6个月随访一次。
结果：在2007年到2015年间，我们一共招募了1080位哮喘患者，其中401位是轻中度哮喘，613位是重度哮喘。横断面分析的结果如下：与更轻程度的哮喘患者相比，重症哮喘患者在前12个月里具有着更加频繁发作的症状，急性加重，住院治疗和急诊访视次数，更高的血嗜酸性粒细胞水平和更多的合并症。超过60%的患者在入组时哮喘都处于未控制状态，有152名患者在接受奥马珠单抗治疗。此外，与具有较低嗜酸性粒细胞水平的患者相比，具有极高嗜酸性粒细胞水平(>300/mm3)的哮喘患者具有着更短的哮喘持续时间，更低的肺功能，更高的急性加重率和哮喘不达标控制的几率。
在427名哮喘患者中，对至少3项不同的血细胞计数进行纵向分析发现，随着时间的推移，血嗜酸性粒细胞的数量和增量均与哮喘患者下次问诊前的哮喘加重次数有关，以及与Juniper评分有关。
结论：COBRA队列研究将有助于提升我们对哮喘严重程度相关风险和生物学因素的认识，以及更好地理解这些因素对哮喘病程的影响。
Clinical and biological characteristics of the French COBRA cohort of adult subjects with asthma
Marina Pretolani, David Soussan, Isabelle Poirier, et al
Abstract
BACKGROUND:The COhort of BRonchial obstruction and Asthma (COBRA) is a longitudinal cohort that involves 12 French academic institutions.
Method：DNA, serum samples and clinical data are collected at entry and every 6 months thereafter.
Results:Of 1080 patients with asthma recruited between 2007 and 2015, 401 had mild/moderate and 613 had severe asthma. In cross-sectional analyses, compared with patients with milder disease, patients with severe asthma had more symptoms, exacerbations, hospitalisations and visits to the emergency department during the preceding 12 months, higher numbers of blood eosinophils, and more comorbidities. More than 60% of patients with severe asthma were therapy-uncontrolled at entry, and 152 of them were being treated with omalizumab. In addition, patients with asthma who had the highest eosinophilia levels (>300/mm3) had shorter asthma duration, lower lung function, and higher rates of severe exacerbations and unacceptable asthma control than patients with lower eosinophil counts.
Longitudinal analyses performed in 427 patients with asthma with at least three differential blood cell counts demonstrated that both eosinophil numbers and eosinophil increase over time were associated with the number of exacerbations occurring until the next visit and with Juniper score.
Conclusions：Studies with the COBRA cohort will help to improve knowledge concerning the risk and biological factors associated with asthma severity and to better understand their influence on the disease trajectory.
背景：支气管阻塞和哮喘队列研究（COBRA）是一项包含了12家法国研究机构的纵向队列研究。
方法：在患者入组时收集其DNA，血清样本和临床数据等信息，并每隔6个月随访一次。
结果：在2007年到2015年间，我们一共招募了1080位哮喘患者，其中401位是轻中度哮喘，613位是重度哮喘。横断面分析的结果如下：与更轻程度的哮喘患者相比，重症哮喘患者在前12个月里具有着更加频繁发作的症状，急性加重，住院治疗和急诊访视次数，更高的血嗜酸性粒细胞水平和更多的合并症。超过60%的患者在入组时哮喘都处于未控制状态，有152名患者在接受奥马珠单抗治疗。此外，与具有较低嗜酸性粒细胞水平的患者相比，具有极高嗜酸性粒细胞水平(>300/mm3)的哮喘患者具有着更短的哮喘持续时间，更低的肺功能，更高的急性加重率和哮喘不达标控制的几率。
在427名哮喘患者中，对至少3项不同的血细胞计数进行纵向分析发现，随着时间的推移，血嗜酸性粒细胞的数量和增量均与哮喘患者下次问诊前的哮喘加重次数有关，以及与Juniper评分有关。
结论：COBRA队列研究将有助于提升我们对哮喘严重程度相关风险和生物学因素的认识，以及更好地理解这些因素对哮喘病程的影响。
(复旦大学附属中山医院 呼吸科 胡湘麟 摘译 杨冬 审校)
(European Respiratory Journal 2017 50)
(European Respiratory Journal 2017 50)
Clinical and biological characteristics of the French COBRA cohort of adult subjects with asthma
Marina Pretolani, David Soussan, Isabelle Poirier, et al
Abstract
BACKGROUND:The COhort of BRonchial obstruction and Asthma (COBRA) is a longitudinal cohort that involves 12 French academic institutions.
Method：DNA, serum samples and clinical data are collected at entry and every 6 months thereafter.
Results:Of 1080 patients with asthma recruited between 2007 and 2015, 401 had mild/moderate and 613 had severe asthma. In cross-sectional analyses, compared with patients with milder disease, patients with severe asthma had more symptoms, exacerbations, hospitalisations and visits to the emergency department during the preceding 12 months, higher numbers of blood eosinophils, and more comorbidities. More than 60% of patients with severe asthma were therapy-uncontrolled at entry, and 152 of them were being treated with omalizumab. In addition, patients with asthma who had the highest eosinophilia levels (>300/mm3) had shorter asthma duration, lower lung function, and higher rates of severe exacerbations and unacceptable asthma control than patients with lower eosinophil counts.
Longitudinal analyses performed in 427 patients with asthma with at least three differential blood cell counts demonstrated that both eosinophil numbers and eosinophil increase over time were associated with the number of exacerbations occurring until the next visit and with Juniper score.
Conclusions：Studies with the COBRA cohort will help to improve knowledge concerning the risk and biological factors associated with asthma severity and to better understand their influence on the disease trajectory.
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