支气管哮喘气道炎症表型临床特征及靶向治疗研究进展

doi:10.19983/j.issn.2096-8493.20230123

摘要/Abstract

摘要：

哮喘是一种气道慢性炎症疾病,其特征是反复出现的胸闷、咳嗽、喘息和气促等症状,以及气流阻塞和气道高反应性。哮喘患者在症状、炎症模式和治疗反应方面存在很大的异质性,通过异质性可以对不同的哮喘表型进行分类。对哮喘表型的深入研究,有助于对哮喘进行精确诊断和精准治疗,从而提高哮喘的治疗效果,减少急性发作,改善预后。使用诱导痰液分析技术检测气道炎症,可以识别4种不同的炎症表型。笔者主要从哮喘患者不同气道炎症表型的临床特征、肺功能特点及治疗进展等方面进行综述。

关键词: 哮喘, 炎症, 疾病特征

Abstract:

Asthma is a chronic inflammatory disease of the airway, characterized by recurrent chest tightness, cough, wheezing and shortness of breath, airflow obstruction and airway hyperresponsiveness. There is great heterogeneity in the symptoms, inflammatory patterns, and response to treatment in asthma patients, the different asthma phenotypes were identified according to the heterogeneity. Further study on the phenotype is helpful to the accurate diagnosis and treatment of asthma, so as to improve the herapeutic effect, reduce the acute attack and improve the prognosis. Using induced sputum analysis techniques to detect airway inflammation, four different inflammatory phenotypes could be identified. This article reviews the clinical characteristics, lung function characteristics and treatment progress in asthma patients with different airway inflammation phenotypes.

Key words: Asthma, Inflammation, Disease attributes

中图分类号:

R256.12

尼尔佳玛丽·木塔力甫, 玛力亚·牙生, 克丽别娜·吐尔逊. 支气管哮喘气道炎症表型临床特征及靶向治疗研究进展[J]. 结核与肺部疾病杂志, 2023, 4(6): 506-510. doi: 10.19983/j.issn.2096-8493.20230123

Nierjiamali·Mutalifu, Maliya·Yasheng, Kelibiena·Tuerxun. Research progress on clinical characteristics and targeted therapy of airway inflammation phenotype in bronchial asthma[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(6): 506-510. doi: 10.19983/j.issn.2096-8493.20230123

参考文献 36

[1]	Global Initiative for Asthma. The global strategy for asthma management and prevention. California: Global Initiative for Asthma, 2015.
[2]	Brooks CR, Van Dalen CJ, Harding E, et al. Effects of treatment changes on asthma phenotype prevalence and airway neutrophil function. BMC Pulm Med, 2017, 17(1):169. doi:10.1186/s12890-017-0511-6. pmid: 29202821
[3]	王颖, 云春梅, 刘柯含, 等. 支气管哮喘不同炎症表型的临床特征分析. 中华全科医学, 2022, 20(12):2055-2058, 2091. doi:10.16766/j.cnki.issn.1674-4152.002768.
[4]	Wenzel SE. Asthma: defining of the persistent adult phenotypes. Lancet, 2006, 368(9537):804-813. doi:10.1016/S0140-6736(06)69290-8. pmid: 16935691
[5]	Lötvall J, Akdis CA, Bacharier LB, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol, 2011, 127(2):355-360. doi:10.1016/j.jaci.2010.11.037. pmid: 21281866
[6]	Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. California: Global Initiative for Asthma, 2023.
[7]	Raherison-Semjen C, Parrat E, Nocent-Eijnani C, et al. FASE-CPHG Study: identification of asthma phenotypes in the French Severe Asthma Study using cluster analysis. Respir Res, 2021, 22 (1):136. doi:10.1186/s12931-021-01723-x.
[8]	Ricciardolo FLM, Sprio AE, Baroso A, et al. Characterization of T2-Low and T2-High Asthma Phenotypes in Real-Life. Biomedicines, 2021, 9(11):1684. doi:10.3390/biomedicines9111684.
[9]	Green RH, Brightling CE, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet, 2002, 360(9347):1715-1721. doi:10.1016/S0140-6736(02)11679-5. pmid: 12480423
[10]	Feng Y, Liu X, Wang Y, et al. Delineating asthma according to inflammation phenotypes with a focus on paucigranulocytic asthma. Chin Med J (Engl), 2023, 136(13):1513-1522. doi:10.1097/CM9.0000000000002456.
[11]	Simpson JL, Scott R, Boyle MJ, et al. Inflammatory subtypes in asthma: assessment and identification using induced sputum. Respirology, 2006, 11(1):54-61. doi:10.1111/j.1440-1843.2006.00784.x. pmid: 16423202
[12]	Simpson JL, McElduff P, Gibson PG. Assessment and reproducibility of non-eosinophilic asthma using induced sputum. Respiration, 2010, 79(2):147-151. doi:10.1159/000245899. pmid: 19816004
[13]	Wang F, He XY, Baines KJ, et al. Different inflammatory phenotypes in adults and children with acute asthma. Eur Respir J, 2011, 38(3):567-574. doi:10.1183/09031936.00170110. pmid: 21233265
[14]	Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med, 2008, 178(3):218-224. doi:10.1164/rccm.200711-1754OC.
[15]	Flinkman E, Vähätalo I, Tuomisto LE, et al. Association Between Blood Eosinophils and Neutrophils With Clinical Features in Adult-Onset Asthma. J Allergy Clin Immunol Pract, 2023, 11(3):811-821.e5. doi:10.1016/j.jaip.2022.11.025.
[16]	Ntontsi P, Loukides S, Bakakos P, et al. Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes. Allergy, 2017, 72(11):1761-1767. doi:10.1111/all.13184. pmid: 28407269
[17]	Papaioannou AI, Fouka E, Ntontsi P, et al. Paucigranulocytic Asthma: Potential Pathogenetic Mechanisms, Clinical Features and Therapeutic Management. J Pers Med, 2022, 12(5):850. doi:10.3390/jpm12050850.
[18]	Abdo M, Pedersen F, Kirsten AM, et al. Longitudinal Impact of Sputum Inflammatory Phenotypes on Small Airway Dysfunction and Disease Outcomes in Asthma. J Allergy Clin Immunol Pract, 2022, 10(6):1545-1553.e2. doi:10.1016/j.jaip.2022.02.020. pmid: 35257957
[19]	Nadif R, Siroux V, Boudier A, et al. Blood granulocyte patterns as predictors of asthma phenotypes in adults from the EGEA study. Eur Respir J, 2016, 48(4):1040-1051. doi:10.1183/13993003.00336-2016. pmid: 27492832
[20]	Pignatti P, Visca D, Zappa M, et al. Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum. Respiration, 2022, 101(12):1121-1130. doi:10.1159/000527125. pmid: 36327948
[21]	刘志群, 于贺, 王国茗. 探讨哮喘患者的气道炎症表型分布及临床特征. 中国医药指南, 2019, 17(27):135-136. doi:10.15912/j.cnki.gocm.2019.27.114.
[22]	王子江. 532例哮喘患者的气道炎症表型及临床特征分析. 山东医药, 2016, 56(9):46-48. doi:10.3969/j.issn.1002-266X.2016.09.017.
[23]	姚润伟. 哮喘患者气道炎症表型分布及肺功能分析. 广州医药, 2019, 50(1):61-63, 112. doi:10.3969/j.issn.1000-8535.2019.01.015.
[24]	Jung JW, Kim SH, Kwon JW, et al. Clinical characteristics and long-term outcomes related to sputum eosinophilia in Korean asthmatics. Asia Pac Allergy, 2011, 1(1):16-24. doi:10.5415/apallergy.2011.1.1.16.
[25]	乐迎, 史菲. 不同哮喘表型的靶向治疗研究进展. 生物学杂志, 2018, 35(2):81-83, 87. doi:10.3969/j.issn.2095-1736.2018.02.081.
[26]	陈翠仪, 程远雄, 陈美华. 哮喘气道炎症表型与病情严重程度与治疗效果的相关性研究. 中国药业, 2015, 24(3):54-55.
[27]	Lai T, Wang S, Xu Z, et al. Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis. Sci Rep, 2015, 5:8191. doi:10.1038/srep08191. pmid: 25645133
[28]	Israel E, Reddel HK. Severe and Difficult-to-Treat Asthma in Adults. N Engl J Med, 2017, 377(10):965-976. doi:10.1056/NEJMra1608969.
[29]	Li J, Kang J, Wang C, et al. Omalizumab Improves Quality of Life and Asthma Control in Chinese Patients With Moderate to Severe Asthma: A Randomized Phase Ⅲ Study. Allergy Asthma Immunol Res, 2016, 8(4):319-328. doi:10.4168/aair.2016.8.4.319.
[30]	Khatri S, Moore W, Gibson PG, et al. Assessment of the long-term safety of mepolizumab and durability of clinical response in patients with severe eosinophilic asthma. J Allergy Clin Immunol, 2019, 143(5):1742-1751.e7. doi:10.1016/j.jaci.2018.09.033. pmid: 30359681
[31]	Chung KF. 2-year safety and efficacy results for benralizumab. Lancet Respir Med, 2019, 7(1):5-6. doi:10.1016/S2213-2600(18)30468-5. pmid: 30416084
[32]	Castro M, Corren J, Pavord ID, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med, 2018, 378(26):2486-2496. doi:10.1056/NEJMoa1804092.
[33]	Brightling C, Berry M, Amrani Y. Targeting TNF-alpha: a novel therapeutic approach for asthma. J Allergy Clin Immunol, 2008, 121(1):5-10. doi:10.1016/j.jaci.2007.10.028. pmid: 18036647
[34]	Taillé C, Poulet C, Marchand-Adam S, et al. Monoclonal Anti-TNF-α Antibodies for Severe Steroid-Dependent Asthma: A Case Series. Open Respir Med J, 2013, 7:21-25. doi:10.2174/1874306401307010021. pmid: 23526476
[35]	Howarth PH, Babu KS, Arshad HS, et al. Tumour necrosis factor (TNFalpha) as a novel therapeutic target in symptomatic corticosteroid dependent asthma. Thorax, 2005, 60(12):1012-1018. doi:10.1136/thx.2005.045260. pmid: 16166100
[36]	Elsakkar MG, Sharaki OA, Abdallah DM, et al. Adalimumab ameliorates OVA-induced airway inflammation in mice: Role of CD4⁺ CD25⁺ FOXP3⁺ regulatory T-cells. Eur J Pharmacol, 2016, 786:100-108. doi:10.1016/j.ejphar.2016.06.002. pmid: 27262379