CT扫描与功能性MRI对重症哮喘气道粘液的评价
2019/11/04
摘要
背景：在重症哮喘中导致气流阻塞的腔内因素具有个体差异，因此必须进行评估以达到个体化治疗。在嗜酸粒细胞存在与否的情况下，气道粘液的发生和功能结果尚不明确。
目的：本研究旨在了解在嗜酸粒细胞是否存在的情况下，气道粘液的功能结果以及确定与气流阻塞相关的粘液的生物标记物。
方法：通过CT扫描对27例重症哮喘的粘液栓进行了定量分析，并评估了其对通气异质性（使用MRI通气缺陷百分比[VDP]）的贡献。根据痰嗜酸粒细胞将患者进行二分类，以探讨痰液、嗜酸粒细胞和通气异质性之间的关系。检测呼出气一氧化氮（FENO）和痰中相关细胞因子。
结果：痰嗜酸粒细胞哮喘组中100%的患者检测到了粘液栓，痰非嗜酸粒细胞哮喘组中36%的患者检测到了粘液栓（P=.0006）；且粘液栓与支气管扩张前后的MRI VDP相关(r=0.68,P=.0001;r=0.72,P<.0001)。在多元回归中，粘液和嗜酸粒细胞两者均可以预测支气管扩张后的MRI VDP（R2=0.75，P<.0001）。粘液评分高的哮喘患者FENO（P=.03）和IL-4升高（P=.02）。粘液栓与FENO相关（r=0.63,P=.005）。
结论：在重症哮喘中，气道嗜酸粒细胞和气道粘液两者均能导致通气异质性。气流阻塞主要由粘液引起的这部分患者有证据表明存在IL-4/IL-13通路的上调，而这可以根据FENO水平升高来确定。
CT Scan and Functional MRI to Evaluate Airway Mucus in Severe Asthma
Sarah Svenningsen, PhD; Ehsan Haider, MB; Colm Boylan, MB; Manali Mukherjee, PhD; Rachel L. Eddy, BEng; Dante P. I. Capaldi, PhD; Grace Parraga, PhD; and Parameswaran Nair, MD, PhD
Svenningsen S, Haider E, Boylan C, Mukherjee M, Eddy RL, Capaldi DPI, Parraga G, Nair P.
Chest. 2019 Jun;155(6):1178-1189.
Abstract
BACKGROUND: Intraluminal contributor(s) to airflow obstruction in severe asthma are patient-specific and must be evaluated to personalize treatment. The occurrence and functional consequence of airway mucus in the presence or absence of airway eosinophils remain undetermined.
OBJECTIVE: The objective of this study was to understand the functional consequence of airway mucus in the presence or absence of eosinophils and to identify biomarkers of mucus related airflow obstruction.
METHODS: Mucus plugs were quantified on CT scans, and their contribution to ventilation heterogeneity (using MRI ventilation defect percent [VDP]) was evaluated in 27 patients with severe asthma. Patients were dichotomized based on sputum eosinophilia such that the relation between mucus, eosinophilia, and ventilation heterogeneity could be investigated. Fractional exhaled nitric oxide (FENO) and related cytokines in sputum were measured.
RESULTS: Mucus plugging was present in 100% of asthma patients with sputum eosinophils and 36% of those without sputum eosinophils (P= .0006) and was correlated with MRI VDP prebronchodilator (r=0.68; P=.0001) and postbronchodilator (r=0.72; P < .0001). In a multivariable regression, both mucus and eosinophils contributed to the prediction of postbronchodilator MRI VDP (R2=0.75; P < .0001). Patients with asthma in whom the mucus score was high had raised FENO (P = .03) and IL-4 (P = .02) values. Mucus plugging correlated with FENO (r = 0.63; P = .005).
CONCLUSIONS: Both airway eosinophils and mucus can contribute to ventilation heterogeneity in patients with severe asthma. Patients in whom mucus is the dominant cause of airway obstruction have evidence of an upregulated IL-4/IL-13 pathway that could be identified according to increased Feno level.
背景：在重症哮喘中导致气流阻塞的腔内因素具有个体差异，因此必须进行评估以达到个体化治疗。在嗜酸粒细胞存在与否的情况下，气道粘液的发生和功能结果尚不明确。
目的：本研究旨在了解在嗜酸粒细胞是否存在的情况下，气道粘液的功能结果以及确定与气流阻塞相关的粘液的生物标记物。
方法：通过CT扫描对27例重症哮喘的粘液栓进行了定量分析，并评估了其对通气异质性（使用MRI通气缺陷百分比[VDP]）的贡献。根据痰嗜酸粒细胞将患者进行二分类，以探讨痰液、嗜酸粒细胞和通气异质性之间的关系。检测呼出气一氧化氮（FENO）和痰中相关细胞因子。
结果：痰嗜酸粒细胞哮喘组中100%的患者检测到了粘液栓，痰非嗜酸粒细胞哮喘组中36%的患者检测到了粘液栓（P=.0006）；且粘液栓与支气管扩张前后的MRI VDP相关(r=0.68,P=.0001;r=0.72,P<.0001)。在多元回归中，粘液和嗜酸粒细胞两者均可以预测支气管扩张后的MRI VDP（R2=0.75，P<.0001）。粘液评分高的哮喘患者FENO（P=.03）和IL-4升高（P=.02）。粘液栓与FENO相关（r=0.63,P=.005）。
结论：在重症哮喘中，气道嗜酸粒细胞和气道粘液两者均能导致通气异质性。气流阻塞主要由粘液引起的这部分患者有证据表明存在IL-4/IL-13通路的上调，而这可以根据FENO水平升高来确定。
(吴雯雯1 张红萍1 王刚2 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Chest. 2019 Jun;155(6):1178-1189.）
（Chest. 2019 Jun;155(6):1178-1189.）
CT Scan and Functional MRI to Evaluate Airway Mucus in Severe Asthma
Sarah Svenningsen, PhD; Ehsan Haider, MB; Colm Boylan, MB; Manali Mukherjee, PhD; Rachel L. Eddy, BEng; Dante P. I. Capaldi, PhD; Grace Parraga, PhD; and Parameswaran Nair, MD, PhD
Svenningsen S, Haider E, Boylan C, Mukherjee M, Eddy RL, Capaldi DPI, Parraga G, Nair P.
Chest. 2019 Jun;155(6):1178-1189.
Abstract
BACKGROUND: Intraluminal contributor(s) to airflow obstruction in severe asthma are patient-specific and must be evaluated to personalize treatment. The occurrence and functional consequence of airway mucus in the presence or absence of airway eosinophils remain undetermined.
OBJECTIVE: The objective of this study was to understand the functional consequence of airway mucus in the presence or absence of eosinophils and to identify biomarkers of mucus related airflow obstruction.
METHODS: Mucus plugs were quantified on CT scans, and their contribution to ventilation heterogeneity (using MRI ventilation defect percent [VDP]) was evaluated in 27 patients with severe asthma. Patients were dichotomized based on sputum eosinophilia such that the relation between mucus, eosinophilia, and ventilation heterogeneity could be investigated. Fractional exhaled nitric oxide (FENO) and related cytokines in sputum were measured.
RESULTS: Mucus plugging was present in 100% of asthma patients with sputum eosinophils and 36% of those without sputum eosinophils (P= .0006) and was correlated with MRI VDP prebronchodilator (r=0.68; P=.0001) and postbronchodilator (r=0.72; P < .0001). In a multivariable regression, both mucus and eosinophils contributed to the prediction of postbronchodilator MRI VDP (R2=0.75; P < .0001). Patients with asthma in whom the mucus score was high had raised FENO (P = .03) and IL-4 (P = .02) values. Mucus plugging correlated with FENO (r = 0.63; P = .005).
CONCLUSIONS: Both airway eosinophils and mucus can contribute to ventilation heterogeneity in patients with severe asthma. Patients in whom mucus is the dominant cause of airway obstruction have evidence of an upregulated IL-4/IL-13 pathway that could be identified according to increased Feno level.
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加利福尼亚州空气质量变化与儿童哮喘发病率之间的关系，1993-2014
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轻度哮喘患者短期内每日1次糠酸氟替卡松对乙酰甲胆碱诱导的支气管收缩的影响
