慢性鼻窦炎对成人哮喘患者长期临床预后的影响
2026/02/06
背景：慢性鼻窦炎（CRS）是一种常见的合并症，影响成人哮喘患者的临床预后。
目的：在真实世界临床环境中评估CRS对哮喘长期预后的影响。
方法：这项回顾性队列研究分析了韩国亚洲大学医学中心16153名成人哮喘患者的病历。患者被分为合并CRS组和不合并CRS组。根据血液嗜酸性粒细胞（EOS）计数，CRS组进一步分层为T2高（T2-high）和T2低（T2-low）CRS亚组。在10年的随访期间，使用Kaplan-Meier曲线和Cox比例风险模型评估长期临床预后，包括哮喘急性发作（AE）、住院或急诊（ED）就诊以及全身性皮质类固醇的使用；并使用调整后的线性混合效应模型分析纵向检验指标和肺功能指标。
结果：在倾向性评分匹配后，进行了组间比较。CRS组严重AE的风险（风险比[HR], 2.07; 95%置信区间[CI], 1.51-2.87）、总体AE（HR, 1.59; 95% CI, 1.36-1.86）、住院或ED就诊（HR, 1.38; 95% CI, 1.08-1.78）以及全身性皮质类固醇使用（HR, 1.44; 95% CI, 1.25-1.66）均较高。此外，与T2低CRS亚组相比，T2高CRS亚组的这些风险持续更高（均为P<.001）。在整个随访期间，CRS组，尤其是T2高亚组，表现出血液/痰液EOS和FeNO水平升高，且肺功能下降幅度大于非CRS组或T2低CRS亚组。
结论：对于成人哮喘患者，合并CRS（尤其是TA高型）与10年内AE、住院/ED就诊及全身性皮质类固醇使用的风险增加相关，同时也与肺功能下降显著相关。
关键词：哮喘；鼻窦炎；共病；嗜酸性粒细胞；一氧化氮；生物标志物；队列研究；纵向研究
Abstract
Background: Chronic rhinosinusitis (CRS) is a common comorbidity affecting clinical outcomes in adults with asthma.
Objective: To assess the impact of CRS on long-term asthma outcomes in a real-world clinical setting.
Methods: This retrospective cohort study analyzed the medical records of 16,153 adults with asthma at the Ajou University Medical Center (Korea). Patients were classified into those with and without comorbid CRS. The CRS group was further stratified into the T2-high and T2-low CRS subgroups, based on blood eosinophil counts. Over a 10-year follow-up, long-term clinical outcomes, including asthma exacerbation (AE), hospitalization or emergency department (ED) visits, and systemic corticosteroid use, were estimated using Kaplan-Meier curves and Cox proportional hazards models; and longitudinal laboratory and lung function measures were analyzed using adjusted linear mixed-effects models.
Results：After propensity score matching, between-group comparisons were performed. The CRS group had higher risks of severe AE (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.51-2.87), overall AE (HR, 1.59; 95% CI, 1.36-1.86), hospitalization or ED visits (HR, 1.38; 95% CI, 1.08-1.78), and systemic corticosteroid use (HR, 1.44; 95% CI, 1.25-1.66). Further, these risks were persistently higher in the T2-high CRS subgroup than in the T2-low CRS subgroup (P<.001 for all). Throughout the follow-up period, the CRS group—particularly the T2-high subgroup—exhibited elevated blood/sputum eosinophils and FeNO levels, with greater lung function decline than in the non-CRS or T2-low CRS subgroups.
Conclusion：Comorbid CRS – particularly a T2-high CRS endotype – is associated with increased 10-year risks of AEs, hospitalizations/ED visits, and systemic corticosteroid use, as well as greater lung function decline, in adults with asthma.
Key words: Asthma；Rhinosinusitis；Comorbidity；Eosinophils；Nitric oxide；Biomarkers；Cohort studies；Longitudinal studies
目的：在真实世界临床环境中评估CRS对哮喘长期预后的影响。
方法：这项回顾性队列研究分析了韩国亚洲大学医学中心16153名成人哮喘患者的病历。患者被分为合并CRS组和不合并CRS组。根据血液嗜酸性粒细胞（EOS）计数，CRS组进一步分层为T2高（T2-high）和T2低（T2-low）CRS亚组。在10年的随访期间，使用Kaplan-Meier曲线和Cox比例风险模型评估长期临床预后，包括哮喘急性发作（AE）、住院或急诊（ED）就诊以及全身性皮质类固醇的使用；并使用调整后的线性混合效应模型分析纵向检验指标和肺功能指标。
结果：在倾向性评分匹配后，进行了组间比较。CRS组严重AE的风险（风险比[HR], 2.07; 95%置信区间[CI], 1.51-2.87）、总体AE（HR, 1.59; 95% CI, 1.36-1.86）、住院或ED就诊（HR, 1.38; 95% CI, 1.08-1.78）以及全身性皮质类固醇使用（HR, 1.44; 95% CI, 1.25-1.66）均较高。此外，与T2低CRS亚组相比，T2高CRS亚组的这些风险持续更高（均为P<.001）。在整个随访期间，CRS组，尤其是T2高亚组，表现出血液/痰液EOS和FeNO水平升高，且肺功能下降幅度大于非CRS组或T2低CRS亚组。
结论：对于成人哮喘患者，合并CRS（尤其是TA高型）与10年内AE、住院/ED就诊及全身性皮质类固醇使用的风险增加相关，同时也与肺功能下降显著相关。
关键词：哮喘；鼻窦炎；共病；嗜酸性粒细胞；一氧化氮；生物标志物；队列研究；纵向研究
（南方医科大学南方医院 黄海伦 龚钊乾 赵海金）
(Woo S D, Seo J, Shin Y S, et al. Impact of chronic rhinosinusitis on long-term clinical outcomes in adults with asthma[J]. J Allergy Clin Immunol Pract, 2026: S221321982600005X. DOI: 10.1016/j.jaip.2026.01.002.)
(Woo S D, Seo J, Shin Y S, et al. Impact of chronic rhinosinusitis on long-term clinical outcomes in adults with asthma[J]. J Allergy Clin Immunol Pract, 2026: S221321982600005X. DOI: 10.1016/j.jaip.2026.01.002.)
Abstract
Background: Chronic rhinosinusitis (CRS) is a common comorbidity affecting clinical outcomes in adults with asthma.
Objective: To assess the impact of CRS on long-term asthma outcomes in a real-world clinical setting.
Methods: This retrospective cohort study analyzed the medical records of 16,153 adults with asthma at the Ajou University Medical Center (Korea). Patients were classified into those with and without comorbid CRS. The CRS group was further stratified into the T2-high and T2-low CRS subgroups, based on blood eosinophil counts. Over a 10-year follow-up, long-term clinical outcomes, including asthma exacerbation (AE), hospitalization or emergency department (ED) visits, and systemic corticosteroid use, were estimated using Kaplan-Meier curves and Cox proportional hazards models; and longitudinal laboratory and lung function measures were analyzed using adjusted linear mixed-effects models.
Results：After propensity score matching, between-group comparisons were performed. The CRS group had higher risks of severe AE (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.51-2.87), overall AE (HR, 1.59; 95% CI, 1.36-1.86), hospitalization or ED visits (HR, 1.38; 95% CI, 1.08-1.78), and systemic corticosteroid use (HR, 1.44; 95% CI, 1.25-1.66). Further, these risks were persistently higher in the T2-high CRS subgroup than in the T2-low CRS subgroup (P<.001 for all). Throughout the follow-up period, the CRS group—particularly the T2-high subgroup—exhibited elevated blood/sputum eosinophils and FeNO levels, with greater lung function decline than in the non-CRS or T2-low CRS subgroups.
Conclusion：Comorbid CRS – particularly a T2-high CRS endotype – is associated with increased 10-year risks of AEs, hospitalizations/ED visits, and systemic corticosteroid use, as well as greater lung function decline, in adults with asthma.
Key words: Asthma；Rhinosinusitis；Comorbidity；Eosinophils；Nitric oxide；Biomarkers；Cohort studies；Longitudinal studies
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基于多基因风险评分与生存分析的哮喘-抑郁症共病遗传关联研究
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