过敏性鼻炎会放大慢性鼻窦炎患者的哮喘风险：一项大规模回顾性队列分析
2026/03/30
摘要：
背景： 慢性鼻窦炎（CRS）和过敏性鼻炎（AR）是美国两种高发的呼吸道疾病。尽管CRS与哮喘的共存关系已被广泛认知，但关于CRS患者中新发哮喘的情况，尤其是在合并AR的情况下，目前知之甚少。本研究利用大型电子健康记录（EHR）数据库，评估CRS和AR对哮喘新发风险的影响
方法： 本研究为回顾性队列研究，采用TriNetX美国协作网络，该网络是一个覆盖超过1亿患者的联邦式电子健康记录平台。研究对象为年龄≥18岁，纳入2009年1月至2019年12月期间的CRS成年患者与无CRS的对照者进行比较。第二项分析将同时患有CRS与AR的患者，并与无CRS的患者进行比较。补充分析中将慢性鼻窦炎替换为伴有鼻息肉的慢性鼻窦炎（CRSwNP）。通过倾向评分匹配，使各队列在人口统计学特征和合并症方面达到均衡。主要结局为新发哮喘和哮喘急性加重，分别在1年、2年和5年时进行评估。
结果： 匹配后，与无CRS的对照组相比，既往存在CRS与1年时新发哮喘（调整后相对风险[aRR] = 1.42，95% CI 1.36–1.48）和哮喘急性加重（aRR = 1.87，95% CI 1.75–2.00）的风险升高，2年和5年时的趋势相似。合并AR进一步放大了这一风险：与仅患CRS的患者相比，CRS合并AR的患者在1年（aRR = 1.69，95% CI 1.65–1.73）、2年（aRR = 1.65，95% CI 1.62–1.68）和5年（aRR = 1.58，95% CI 1.56–1.60）的哮喘发病率均更高，且在所有时间点上，哮喘急性加重的风险均超过两倍。在CRSwNP的分析中也观察到了一致性的发现。
结论： CRS与新发哮喘及后续哮喘急性加重的风险增加相关，而合并AR则提示CRS中存在更高风险的表型。这些研究结果强调，需要开展基于表型的研究，以明确针对上气道管理的干预措施是否能够减轻下游哮喘负担。
关键词：过敏性鼻炎;哮喘;呼吸障碍;鼻窦炎
Background: Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are two highly prevalent airway diseases in the United States. While the coexistence of CRS and asthma is well recognized, less is known about the development of new-onset asthma in CRS, particularly in the context of comorbid AR. This study assessed the impact of CRS and AR on incident asthma using a large electronic health record (EHR) database.
Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, a federated EHR platform encompassing over 100 million patients. Adults ≥ 18 years between January 2009 and December 2019 with CRS were compared to controls without CRS. A second analysis compared patients with CRS and concurrent AR to those with CRS alone. Supplemental analyses substituted chronic rhinosinusitis with nasal polyps (CRSwNP) for CRS. Propensity score matching balanced cohorts on demographics and comorbidities. Primary outcomes were new-onset asthma and asthma exacerbations, assessed at 1, 2, and 5 years.
Results: After matching, pre-existing CRS was associated with higher risk of new-onset asthma (adjusted relative risk [aRR] = 1.42, 95% CI 1.36-1.48) and exacerbations (aRR = 1.87, 95% CI 1.75-2.00) at 1 year versus CRS controls, with similar trends at 2 and 5 years. Coexisting AR further amplified risk: patients with CRS + AR had increased asthma incidence relative to CRS alone at 1 year (aRR = 1.69, 95% CI 1.65-1.73), 2 years (aRR = 1.65, 95% CI 1.62-1.68), and 5 years (aRR = 1.58, 95% CI 1.56-1.60), with more than doubled exacerbation risk across all time points. Directionally similar findings were observed in CRSwNP analyses.
Conclusions: CRS is associated with increased risk of incident asthma and subsequent exacerbations, and coexisting AR identifies a higher-risk phenotype within CRS. These findings highlight the need for phenotype-informed studies to determine whether targeted upper-airway management can mitigate downstream asthma burden.
Keywords: allergic rhinitis; asthma; respiration disorders; rhinosinusitis.
背景： 慢性鼻窦炎（CRS）和过敏性鼻炎（AR）是美国两种高发的呼吸道疾病。尽管CRS与哮喘的共存关系已被广泛认知，但关于CRS患者中新发哮喘的情况，尤其是在合并AR的情况下，目前知之甚少。本研究利用大型电子健康记录（EHR）数据库，评估CRS和AR对哮喘新发风险的影响
方法： 本研究为回顾性队列研究，采用TriNetX美国协作网络，该网络是一个覆盖超过1亿患者的联邦式电子健康记录平台。研究对象为年龄≥18岁，纳入2009年1月至2019年12月期间的CRS成年患者与无CRS的对照者进行比较。第二项分析将同时患有CRS与AR的患者，并与无CRS的患者进行比较。补充分析中将慢性鼻窦炎替换为伴有鼻息肉的慢性鼻窦炎（CRSwNP）。通过倾向评分匹配，使各队列在人口统计学特征和合并症方面达到均衡。主要结局为新发哮喘和哮喘急性加重，分别在1年、2年和5年时进行评估。
结果： 匹配后，与无CRS的对照组相比，既往存在CRS与1年时新发哮喘（调整后相对风险[aRR] = 1.42，95% CI 1.36–1.48）和哮喘急性加重（aRR = 1.87，95% CI 1.75–2.00）的风险升高，2年和5年时的趋势相似。合并AR进一步放大了这一风险：与仅患CRS的患者相比，CRS合并AR的患者在1年（aRR = 1.69，95% CI 1.65–1.73）、2年（aRR = 1.65，95% CI 1.62–1.68）和5年（aRR = 1.58，95% CI 1.56–1.60）的哮喘发病率均更高，且在所有时间点上，哮喘急性加重的风险均超过两倍。在CRSwNP的分析中也观察到了一致性的发现。
结论： CRS与新发哮喘及后续哮喘急性加重的风险增加相关，而合并AR则提示CRS中存在更高风险的表型。这些研究结果强调，需要开展基于表型的研究，以明确针对上气道管理的干预措施是否能够减轻下游哮喘负担。
关键词：过敏性鼻炎;哮喘;呼吸障碍;鼻窦炎
（南方医科大学南方医院 汤亦心 赵海金）
(Lee AJ, Chaaban MR. Allergic Rhinitis Amplifies Asthma Risk in Patients With Chronic Rhinosinusitis: A Large-Scale Retrospective Cohort Analysis. Int Forum Allergy Rhinol. 2026 Mar 13. doi: 10.1002/alr.70141. Epub ahead of print. PMID: 41830158.)
Abstract(Lee AJ, Chaaban MR. Allergic Rhinitis Amplifies Asthma Risk in Patients With Chronic Rhinosinusitis: A Large-Scale Retrospective Cohort Analysis. Int Forum Allergy Rhinol. 2026 Mar 13. doi: 10.1002/alr.70141. Epub ahead of print. PMID: 41830158.)
Background: Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are two highly prevalent airway diseases in the United States. While the coexistence of CRS and asthma is well recognized, less is known about the development of new-onset asthma in CRS, particularly in the context of comorbid AR. This study assessed the impact of CRS and AR on incident asthma using a large electronic health record (EHR) database.
Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, a federated EHR platform encompassing over 100 million patients. Adults ≥ 18 years between January 2009 and December 2019 with CRS were compared to controls without CRS. A second analysis compared patients with CRS and concurrent AR to those with CRS alone. Supplemental analyses substituted chronic rhinosinusitis with nasal polyps (CRSwNP) for CRS. Propensity score matching balanced cohorts on demographics and comorbidities. Primary outcomes were new-onset asthma and asthma exacerbations, assessed at 1, 2, and 5 years.
Results: After matching, pre-existing CRS was associated with higher risk of new-onset asthma (adjusted relative risk [aRR] = 1.42, 95% CI 1.36-1.48) and exacerbations (aRR = 1.87, 95% CI 1.75-2.00) at 1 year versus CRS controls, with similar trends at 2 and 5 years. Coexisting AR further amplified risk: patients with CRS + AR had increased asthma incidence relative to CRS alone at 1 year (aRR = 1.69, 95% CI 1.65-1.73), 2 years (aRR = 1.65, 95% CI 1.62-1.68), and 5 years (aRR = 1.58, 95% CI 1.56-1.60), with more than doubled exacerbation risk across all time points. Directionally similar findings were observed in CRSwNP analyses.
Conclusions: CRS is associated with increased risk of incident asthma and subsequent exacerbations, and coexisting AR identifies a higher-risk phenotype within CRS. These findings highlight the need for phenotype-informed studies to determine whether targeted upper-airway management can mitigate downstream asthma burden.
Keywords: allergic rhinitis; asthma; respiration disorders; rhinosinusitis.
上一篇：
特泽鲁单抗治疗激素依赖型重度哮喘：90%减量、超半数停用口服糖皮质激素
下一篇：
布地奈德-福莫特罗对比特布他林缓解剂用于维持ICS的成人哮喘：一项IV期试验
