生物与非生物制剂治疗哮喘患者中哮喘控制测试与生活质量评分间的差异
2025/12/23
背景和目的：在追求哮喘临床缓解的背景下，患者日常活动中的生活质量日益受到关注，其重要性不亚于对急性发作的控制。然而，哮喘控制测试（ACT）在评估生活质量方面的价值尚不明确。本研究旨在比较ACT与哮喘生活质量问卷在评估患者状况时的差异，重点关注活动受限维度。
方法：研究首先纳入接受生物制剂治疗的哮喘患者，分析其在病情稳定期的ACT评分与哮喘生活质量问卷评分（包括总分及各领域得分）之间的关联。采用受试者工作特征曲线分析，确定预测良好生活质量的ACT最佳阈值，并将结果在非生物制剂治疗组中进行验证。
结果：在生物制剂治疗组（n=69）中，ACT与哮喘生活质量问卷评分的中位数分别为22分和5.5分。两者差异在活动受限领域最为明显：即使在ACT显示控制良好（≥20分）的患者中，仍有一半报告存在高强度运动困难和环境诱因回避行为，且该现象与哮喘病程无关。受试者工作特征曲线分析显示，ACT≥23分可较好预测良好的活动受限评分（≥6分），曲线下面积为0.83，灵敏度86%，特异度76%。与评分为20–22分的患者相比，≥23分组的患者获得良好生活质量评分的比例显著更高（p<0.01）。在非生物制剂治疗组（n=123）中也观察到相似结果。
结论：ACT评分≥23的分界值可能比传统的20分分界值更能反映患者感知的生活质量。
关键词：成人哮喘；哮喘控制测试；哮喘生活质量问卷；生物制；生活质量
方法：研究首先纳入接受生物制剂治疗的哮喘患者，分析其在病情稳定期的ACT评分与哮喘生活质量问卷评分（包括总分及各领域得分）之间的关联。采用受试者工作特征曲线分析，确定预测良好生活质量的ACT最佳阈值，并将结果在非生物制剂治疗组中进行验证。
结果：在生物制剂治疗组（n=69）中，ACT与哮喘生活质量问卷评分的中位数分别为22分和5.5分。两者差异在活动受限领域最为明显：即使在ACT显示控制良好（≥20分）的患者中，仍有一半报告存在高强度运动困难和环境诱因回避行为，且该现象与哮喘病程无关。受试者工作特征曲线分析显示，ACT≥23分可较好预测良好的活动受限评分（≥6分），曲线下面积为0.83，灵敏度86%，特异度76%。与评分为20–22分的患者相比，≥23分组的患者获得良好生活质量评分的比例显著更高（p<0.01）。在非生物制剂治疗组（n=123）中也观察到相似结果。
结论：ACT评分≥23的分界值可能比传统的20分分界值更能反映患者感知的生活质量。
关键词：成人哮喘；哮喘控制测试；哮喘生活质量问卷；生物制；生活质量
（南方医科大学南方医院 黄海伦 龚钊乾 赵海金）
(Sunadome H, Matsumoto H, Hayashi Y, et al. Discrepancies between the asthma control test and quality of life scores among biologic- and nonbiologic-treated asthma patients[J]. Allergology International, 2025: S1323893025001200. DOI: 10.1016/j.alit.2025.11.003.)
(Sunadome H, Matsumoto H, Hayashi Y, et al. Discrepancies between the asthma control test and quality of life scores among biologic- and nonbiologic-treated asthma patients[J]. Allergology International, 2025: S1323893025001200. DOI: 10.1016/j.alit.2025.11.003.)
Abstract
Background: In the era of asthma remission, quality of life (QOL) in daily activities is increasingly valued in addition to exacerbation control. However, the value of the Asthma Control Test (ACT) for assessing QOL remains unclear. This study compared the use of the ACT with the Asthma Quality of Life Questionnaire (AQLQ), with a focus on activity limitations.
Objective: Our aim was to generate a sputum protein signature associated with future exacerbations.
Methods: We first analyzed biologic-treated asthma patients who were attending our institution and assessed the relationship between stable-phase ACT scores and AQLQ scores (including both overall scores and domain-specific scores). Receiver operating characteristic (ROC) curves were analyzed to identify the optimal ACT threshold for predicting favorable AQLQ scores. The findings were subsequently validated in a nonbiologic-treated group.
Results：Among biologic-treated patients (n = 69), the median ACT and AQLQ scores were 22 (IQR: 18–25) and 5.5 (IQR: 4.7–6.4), respectively. Discrepancies between the ACT and AQLQ were most evident in the activity limitation domain. Half of the patients with well-controlled ACT scores (≥20) reported difficulty with high-intensity exercise and avoiding environmental triggers, regardless of asthma duration. ROC curve analysis revealed that an ACT score ≥23 predicted favorable AQLQ activity limitation scores (≥6) (AUC: 0.83; sensitivity: 86 %; specificity: 76 %). Favorable scores were more commonly observed in the ACT ≥23 group than in the 20–22 group (p < 0.01). Similar findings were observed in the nonbiologic group (n = 123).
Conclusion：A cutoff score of ≥23 for the ACT may better reflect patient-perceived QOL than the conventional cutoff score of 20.
Key words: Adult asthma; Asthma control test; Asthma quality of life questionnaire; Biologics; Quality of life
上一篇：
哮喘患者气道高水平TSLP与2型炎症、黏液栓形成及气道重塑密切相关：UCSF与SARP-3队列分析
下一篇：
利用自然语言处理提取哮喘症状并探讨其与成人轻度哮喘急性加重的关联
