黏液栓在哮喘中的不同作用：吸烟的影响及其与气道炎症的关系
2022/11/22
摘要
背景：黏液栓在计算机断层扫描（CT）成像中的生理重要性越来越受到重视。然而，气道炎症和吸烟是否影响哮喘患者黏液栓和临床生理结果之间的关系仍有待阐明。本研究的目的是探讨气道炎症和/或吸烟如何影响基于CT的黏液栓评分与哮喘发作频率和气流限制指数的相关性。
方法：共有168名接受胸部CT和痰液评估的哮喘患者入选，并根据痰液嗜酸性粒细胞百分比（截止值：3%）将其分为嗜酸粒细胞性哮喘（EA；n=103）和非嗜酸粒性哮喘（NEA；n=65）组。黏液栓评分定义为CT上出现黏液栓的肺段数。
结果：无论吸烟状况如何，EA组在CT扫描中发现的黏液栓比NEA组多。在调整人口统计学、血嗜酸性粒细胞计数和呼出一氧化氮分数后，EA组的黏液栓评分和入组后一年内的发作频率显著相关，而NEA组无相关性。在调整人口统计学后，EA和NEA组中的非吸烟个体以及EA组中的吸烟个体（但NEA组没有）中，黏液栓评分与1秒内预测用力呼气量的百分比相关。
结论：由于哮喘患者的气道炎症特征和吸烟状况，黏液栓评分与发作频率和肺功能降低的相关性可能有所不同。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Allergol Int. 2022 Nov 16;S1323-8930(22)00124-1.doi: 10.1016/j.alit.2022.10.007.)
Differential role of mucus plugs in asthma: Effects of smoking and association with airway inflammation
Akira Oguma, Kaoruko Shimizu, Hirokazu Kimura, Naoya Tanabe, Susumu Sato, Isao Yokota, Michiko Takimoto-Sato, Machiko Matsumoto-Sasaki, Yuki Abe, Nozomu Takei, Houman Goudarzi, Masaru Suzuki, Hironi Makita, Toyohiro Hirai, Masaharu Nishimura, Satoshi Konno, Hi-CARAT investigators
Abstract
Background：The physiological importance of mucus plugs in computed tomography (CT) imaging is being increasingly recognized. However, whether airway inflammation and smoking affect the association between mucus plugs and clinical-physiological outcomes in asthma remains to be elucidated. The objective of this study is to examine how airway inflammation and/or smoking affect the correlation of CT-based mucus plug scores with exacerbation frequency and airflow limitation indices in asthma.
Methods：A total of 168 patients with asthma who underwent chest CT and sputum evaluation were enrolled and classified in eosinophilic asthma (EA; n = 103) and non-eosinophilic asthma (NEA; n = 65) groups based on sputum eosinophil percentage (cut-off: 3%). The mucus plug score was defined as the number of lung segments with mucus plugs seen on CT.
Results：More mucus plugs were detected on CT scans in the EA group than in the NEA group, regardless of smoking status. Mucus plug score and exacerbation frequency during one year after enrollment were significantly associated in the EA group but not in the NEA group after adjusting for demographics, blood eosinophil count, and fractional exhaled nitric oxide. Mucus plug score was associated with percentage of predicted forced expiratory volume in 1 s in non-smoking individuals in the EA and NEA group and in smoking individuals in the EA group but not in the NEA group after adjusting for demographics.
Conclusions：The association of mucus plug score with exacerbation frequency and reduced lung function may vary due to airway inflammatory profile and smoking status in asthma.
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儿童血液嗜酸性粒细胞与过敏性疾病症状:中国南方的一项横断面研究
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体外膜氧合(ECMO)治疗难治性哮喘加重合并呼吸衰竭
