普通人群中慢性气道疾病的2型炎症和肺功能下降
2024/02/23
摘要
背景：目前尚不清楚2型炎症是否与哮喘和慢性阻塞性肺病（COPD）患者的肺功能加速下降有关。我们检验了这样一种假设，即在普通人群中，由血液嗜酸性粒细胞（BE）和呼出一氧化氮（FeNO）含量升高提示的2型炎症与肺功能加速下降有关。
方法：我们纳入哥本哈根普通人群研究的成年人，从随访检查中测量BE（N=15 605）和FeNO（N=2583），并评估在过去10年中1秒用力呼气量（FEV1）的下降。根据支气管扩张前后的肺功能、吸烟史和随访检查时的哮喘，参与者被分为无气道疾病、完全可逆性哮喘（AR）、持续性阻塞性哮喘（APO）、COPD和不可分类的气流受限（NAL）。
结果：每100个细胞/µL的BE升高，FEV1下降1.0（95%CI 0.6至1.4，p<0.0001）（mL/年），每10 ppb的FeNO升高，FEV1下降3.2（95%CI 2.0至4.5，p<0.001）（mL/年）。BE＜300细胞/µL且FeNO＜20 ppb的患者调整后的FEV1下降为18（95%CI 17至20）（mL/年），BE≥300细胞/μL或FeNO≥20 ppb为22（19-25）（mL/年），BE≤300细胞/μL且FeNO≥20ppb为27（21-33）（p＜0.0001）。AR患者FEV1则分别下降24（19-29）（mL/年）、33（25-40）（mL/年）和44（31-56）（mL/年）（p=0.002）；APO患者FEV1则分别下降26 （14-37）（mL/年）, 36 （12-60）（mL/年）、56 （24-89）（mL/年）（p=0.07）；COPD患者FEV1则分别下降32 （27-36） （mL/年）、31 （24-38）（mL/年）、44 （24-65）（mL/年）（p=0.46）; NAL患者FEV1则分别下降27 （21-33）（mL/年）, 35 （26-45）（mL/年）, and 37 （25-49）（mL/年）（p=0.10）。
结论：在普通人群中患有慢性气道疾病的个体中，BE和FeNO升高所指示的2型炎症与FEV1加速下降有关，这种关联在哮喘样表型中最为明显。
Type-2 inflammation and lung function decline in chronic airway disease in the general population
Yunus Çolak, Shoaib Afzal, Jacob Louis Marott, Jørgen Vestbo, Børge Grønne Nordestgaard, Peter Lange
Abstract
Background: It is unclear if type-2 inflammation is associated with accelerated lung function decline in individuals with asthma and chronic obstructive pulmonary disease (COPD). We tested the hypothesis that type-2 inflammation indicated by elevated blood eosinophils (BE) and fraction of exhaled nitric oxide (FeNO) is associated with accelerated lung function decline in the general population.
Methods: We included adults from the Copenhagen General Population Study with measurements of BE (N=15 605) and FeNO (N=2583) from a follow-up examination and assessed forced expiratory volume in 1 s (FEV1) decline in the preceding 10 years. Based on pre- and post-bronchodilator lung function, smoking history and asthma at follow-up examination, participants were assigned as not having airway disease, asthma with full reversibility (AR), asthma with persistent obstruction (APO), COPD, and not classifiable airflow limitation (NAL).
Results: FEV1 decline in mL/year increased with 1.0 (95% CI 0.6 to 1.4, p<0.0001) per 100 cells/µL higher BE and with 3.2 (95% CI 2.0 to 4.5, p<0.0001) per 10 ppb higher FeNO. Adjusted FEV1 decline in mL/year was 18 (95% CI 17 to 20) in those with BE<300 cells/µL and FeNO<20 ppb, 22 (19-25) in BE≥300 cells/µL or FeNO≥20 ppb, and 27 (21-33) in those with BE≥300 cells/µL and FeNO≥20 ppb (p for trend<0.0001). Corresponding FEV1 declines were 24 (19-29), 33 (25-40) and 44 (31-56) in AR (0.002), 26 (14-37), 36 (12-60) and 56 (24-89) in APO (0.07), 32 (27-36), 31 (24-38) and 44 (24-65) in COPD (0.46), and 27 (21-33), 35 (26-45), and 37 (25-49) in NAL (0.10), respectively.
Conclusions: Type-2 inflammation indicated by elevated BE and FeNO is associated with accelerated FEV1 decline in individuals with chronic airway disease in the general population, and this association was most pronounced in an asthma-like phenotype.
背景：目前尚不清楚2型炎症是否与哮喘和慢性阻塞性肺病（COPD）患者的肺功能加速下降有关。我们检验了这样一种假设，即在普通人群中，由血液嗜酸性粒细胞（BE）和呼出一氧化氮（FeNO）含量升高提示的2型炎症与肺功能加速下降有关。
方法：我们纳入哥本哈根普通人群研究的成年人，从随访检查中测量BE（N=15 605）和FeNO（N=2583），并评估在过去10年中1秒用力呼气量（FEV1）的下降。根据支气管扩张前后的肺功能、吸烟史和随访检查时的哮喘，参与者被分为无气道疾病、完全可逆性哮喘（AR）、持续性阻塞性哮喘（APO）、COPD和不可分类的气流受限（NAL）。
结果：每100个细胞/µL的BE升高，FEV1下降1.0（95%CI 0.6至1.4，p<0.0001）（mL/年），每10 ppb的FeNO升高，FEV1下降3.2（95%CI 2.0至4.5，p<0.001）（mL/年）。BE＜300细胞/µL且FeNO＜20 ppb的患者调整后的FEV1下降为18（95%CI 17至20）（mL/年），BE≥300细胞/μL或FeNO≥20 ppb为22（19-25）（mL/年），BE≤300细胞/μL且FeNO≥20ppb为27（21-33）（p＜0.0001）。AR患者FEV1则分别下降24（19-29）（mL/年）、33（25-40）（mL/年）和44（31-56）（mL/年）（p=0.002）；APO患者FEV1则分别下降26 （14-37）（mL/年）, 36 （12-60）（mL/年）、56 （24-89）（mL/年）（p=0.07）；COPD患者FEV1则分别下降32 （27-36） （mL/年）、31 （24-38）（mL/年）、44 （24-65）（mL/年）（p=0.46）; NAL患者FEV1则分别下降27 （21-33）（mL/年）, 35 （26-45）（mL/年）, and 37 （25-49）（mL/年）（p=0.10）。
结论：在普通人群中患有慢性气道疾病的个体中，BE和FeNO升高所指示的2型炎症与FEV1加速下降有关，这种关联在哮喘样表型中最为明显。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（Thorax. 2024 Jan 9:thorax-2023-220972. doi: 10.1136/thorax-2023-220972.）
（Thorax. 2024 Jan 9:thorax-2023-220972. doi: 10.1136/thorax-2023-220972.）
Type-2 inflammation and lung function decline in chronic airway disease in the general population
Yunus Çolak, Shoaib Afzal, Jacob Louis Marott, Jørgen Vestbo, Børge Grønne Nordestgaard, Peter Lange
Abstract
Background: It is unclear if type-2 inflammation is associated with accelerated lung function decline in individuals with asthma and chronic obstructive pulmonary disease (COPD). We tested the hypothesis that type-2 inflammation indicated by elevated blood eosinophils (BE) and fraction of exhaled nitric oxide (FeNO) is associated with accelerated lung function decline in the general population.
Methods: We included adults from the Copenhagen General Population Study with measurements of BE (N=15 605) and FeNO (N=2583) from a follow-up examination and assessed forced expiratory volume in 1 s (FEV1) decline in the preceding 10 years. Based on pre- and post-bronchodilator lung function, smoking history and asthma at follow-up examination, participants were assigned as not having airway disease, asthma with full reversibility (AR), asthma with persistent obstruction (APO), COPD, and not classifiable airflow limitation (NAL).
Results: FEV1 decline in mL/year increased with 1.0 (95% CI 0.6 to 1.4, p<0.0001) per 100 cells/µL higher BE and with 3.2 (95% CI 2.0 to 4.5, p<0.0001) per 10 ppb higher FeNO. Adjusted FEV1 decline in mL/year was 18 (95% CI 17 to 20) in those with BE<300 cells/µL and FeNO<20 ppb, 22 (19-25) in BE≥300 cells/µL or FeNO≥20 ppb, and 27 (21-33) in those with BE≥300 cells/µL and FeNO≥20 ppb (p for trend<0.0001). Corresponding FEV1 declines were 24 (19-29), 33 (25-40) and 44 (31-56) in AR (0.002), 26 (14-37), 36 (12-60) and 56 (24-89) in APO (0.07), 32 (27-36), 31 (24-38) and 44 (24-65) in COPD (0.46), and 27 (21-33), 35 (26-45), and 37 (25-49) in NAL (0.10), respectively.
Conclusions: Type-2 inflammation indicated by elevated BE and FeNO is associated with accelerated FEV1 decline in individuals with chronic airway disease in the general population, and this association was most pronounced in an asthma-like phenotype.
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空气中花粉对中国北京不同年龄段变应性鼻炎和哮喘的影响
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新生儿气道细菌定植与18岁前哮喘和过敏风险的关系
