高血清TSLP是迟发性，长病程，嗜酸性粒细胞性哮喘的特征
2025/10/31
摘要
背景：胸腺基质淋巴细胞生成素（TSLP）是2型免疫反应的关键调节因子；然而，血清TSLP水平与成人哮喘特征之间的关联尚未完全阐明。本研究旨在确定高血清TSLP成人哮喘的特征，并探讨TSLP与迟发性嗜酸性粒细胞性哮喘表型的关联。
方法：本研究使用了TNH-Azma研究（一项在日本30家医院开展的针对1344名哮喘患者的真实世界观察性队列研究）的基线数据，并测量了血清细胞因子。根据基线血清TSLP水平将患者按四分位数分层，并比较其临床特征。采用多变量回归分析确定与血清TSLP相关的临床变量，以及与迟发性嗜酸性粒细胞性哮喘表型相关的细胞因子。
结果：TSLP高水平哮喘患者年龄更大、发病较晚、呈嗜酸性粒细胞性、特应性较低；体重指数更高；吸烟史更长；且更多合并哮喘-慢阻肺重叠综合征、睡眠呼吸暂停综合征、高血压和心脏病。他们还表现出更低的肺功能、更重的哮喘症状，并且更频繁地使用口服皮质类固醇。经年龄和性别调整的多变量回归分析表明，高TSLP水平与较晚的哮喘发病年龄、较长的哮喘病程、高血压、较高的血嗜酸性粒细胞计数、体重指数、吸烟史、生物制剂使用、睡眠呼吸暂停综合征以及高Fres呈正相关，与花粉症呈负相关。在血清细胞因子中，TSLP与晚发性嗜酸性粒细胞性哮喘的关联最强。
结论：高血清TSLP是迟发性、长病程、嗜酸性粒细胞性哮喘的一个显著特征。具有此特征的哮喘患者可能是特定哮喘疗法的一个独特目标人群。
High Serum TSLP Is Characteristic of Late-Onset, Long-Duration, Eosinophilic Asthma.
Maho, Suzukawa; Ken, Ohta; Hiroyuki,
Abstrast
BACKGROUND: Thymic stromal lymphopoietin (TSLP) is a master regulator of type 2 immune responses; however, the associations between serum TSLP and the characteristics of adult asthma have not been fully clarified. The aim of this study was to determine the characteristics of adult asthma with high serum TSLP and explore TSLP's association with the late-onset eosinophilic asthma phenotype.
METHODS: Baseline data of the TNH-Azma study (a real-world observational cohort study conducted in Japan on 1344 patients with asthma from 30 hospitals) was used and serum cytokines were measured. Patients were stratified into quartile groups based on the baseline serum TSLP levels, and their clinical characteristics were compared. Multivariable regression analyses were used to determine clinical variables associated with serum TSLP and cytokines associated with the late-onset eosinophilic asthma phenotype.
RESULTS: Patients with TSLP-high asthma were older, late-onset, eosinophilic, and less atopic; had a higher BMI; more smoking history; and more asthma-COPD overlap, sleep apnea syndrome (SAS), hypertension, and heart disease. They also exhibited lower lung function with worse asthma symptoms and were more frequently on oral corticosteroids. Multivariable regression analyses adjusted for age and sex demonstrated that a high TSLP level was positively associated with later asthma onset, longer asthma duration, hypertension, higher blood eosinophils, BMI, smoking history, use of biologics, SAS, and high Fres, and was negatively associated with pollinosis. Among the serum cytokines, TSLP exhibited the strongest association with late-onset, eosinophilic asthma.
CONCLUSION: High serum TSLP is a distinctive feature of late-onset, long-duration, eosinophilic asthma. Patients with asthma with this feature may be a unique target population for specific asthma therapy.
背景：胸腺基质淋巴细胞生成素（TSLP）是2型免疫反应的关键调节因子；然而，血清TSLP水平与成人哮喘特征之间的关联尚未完全阐明。本研究旨在确定高血清TSLP成人哮喘的特征，并探讨TSLP与迟发性嗜酸性粒细胞性哮喘表型的关联。
方法：本研究使用了TNH-Azma研究（一项在日本30家医院开展的针对1344名哮喘患者的真实世界观察性队列研究）的基线数据，并测量了血清细胞因子。根据基线血清TSLP水平将患者按四分位数分层，并比较其临床特征。采用多变量回归分析确定与血清TSLP相关的临床变量，以及与迟发性嗜酸性粒细胞性哮喘表型相关的细胞因子。
结果：TSLP高水平哮喘患者年龄更大、发病较晚、呈嗜酸性粒细胞性、特应性较低；体重指数更高；吸烟史更长；且更多合并哮喘-慢阻肺重叠综合征、睡眠呼吸暂停综合征、高血压和心脏病。他们还表现出更低的肺功能、更重的哮喘症状，并且更频繁地使用口服皮质类固醇。经年龄和性别调整的多变量回归分析表明，高TSLP水平与较晚的哮喘发病年龄、较长的哮喘病程、高血压、较高的血嗜酸性粒细胞计数、体重指数、吸烟史、生物制剂使用、睡眠呼吸暂停综合征以及高Fres呈正相关，与花粉症呈负相关。在血清细胞因子中，TSLP与晚发性嗜酸性粒细胞性哮喘的关联最强。
结论：高血清TSLP是迟发性、长病程、嗜酸性粒细胞性哮喘的一个显著特征。具有此特征的哮喘患者可能是特定哮喘疗法的一个独特目标人群。
（中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校）
（Allergy 2025 Oct 21;(0);DOI:10.1111/all.70109.IF: 8.706 ）
High Serum TSLP Is Characteristic of Late-Onset, Long-Duration, Eosinophilic Asthma.
Maho, Suzukawa; Ken, Ohta; Hiroyuki,
Abstrast
BACKGROUND: Thymic stromal lymphopoietin (TSLP) is a master regulator of type 2 immune responses; however, the associations between serum TSLP and the characteristics of adult asthma have not been fully clarified. The aim of this study was to determine the characteristics of adult asthma with high serum TSLP and explore TSLP's association with the late-onset eosinophilic asthma phenotype.
METHODS: Baseline data of the TNH-Azma study (a real-world observational cohort study conducted in Japan on 1344 patients with asthma from 30 hospitals) was used and serum cytokines were measured. Patients were stratified into quartile groups based on the baseline serum TSLP levels, and their clinical characteristics were compared. Multivariable regression analyses were used to determine clinical variables associated with serum TSLP and cytokines associated with the late-onset eosinophilic asthma phenotype.
RESULTS: Patients with TSLP-high asthma were older, late-onset, eosinophilic, and less atopic; had a higher BMI; more smoking history; and more asthma-COPD overlap, sleep apnea syndrome (SAS), hypertension, and heart disease. They also exhibited lower lung function with worse asthma symptoms and were more frequently on oral corticosteroids. Multivariable regression analyses adjusted for age and sex demonstrated that a high TSLP level was positively associated with later asthma onset, longer asthma duration, hypertension, higher blood eosinophils, BMI, smoking history, use of biologics, SAS, and high Fres, and was negatively associated with pollinosis. Among the serum cytokines, TSLP exhibited the strongest association with late-onset, eosinophilic asthma.
CONCLUSION: High serum TSLP is a distinctive feature of late-onset, long-duration, eosinophilic asthma. Patients with asthma with this feature may be a unique target population for specific asthma therapy.
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