哮喘表型和2型炎症哮喘研究进展

doi:10.19983/j.issn.2096-8493.2024107

摘要/Abstract

摘要：

支气管哮喘(简称“哮喘”)是一种异质性疾病,根据临床特征、触发因素、气道炎症、生理及病理特征等差异存在多种表型。全球哮喘防治倡议(GINA)指南提出哮喘存在2型炎症,并可通过检测嗜酸性粒细胞、呼出气一氧化氮和过敏原等方法诊断2型炎症型哮喘。现已发现50%~70%的哮喘患者与2型炎症有关,中国超过75%的重度哮喘患者存在2型炎症,因此,针对2型炎症哮喘的药物研发和治疗至关重要。作者针对2型炎症哮喘的概念、分类、发病机制、生物标志物及判断标准,以及靶向治疗的研究进展进行综述,为哮喘诊断和生物制剂的治疗提供借鉴。

关键词: 炎症介导素类, 支气管高反应性, 哮喘, 生物学标记

Abstract:

Bronchial asthma (asthma) is a heterogeneous disease with multiple phenotypes based on differences in clinical features, triggers, airway inflammation, physiological and pathological features. The Global Initiative for Asthma (GINA) guidelines suggest that type 2 inflammation exists in asthma and can be diagnosed by testing for eosinophils, exhaled nitric oxide, and allergens. It has been found that 50% to 70% of asthma patients are related to type 2 inflammation, and the proportion of type 2 inflammation in severe asthma patients in China is more than 75%. Therefore, drug development and treatment for type 2 inflammation are critical. The authors review the concept, classification, pathogenesis, biomarkers and judgment criteria, asthma and the research progress of targeted therapy of type 2 inflammatory, and provides reference for the diagnostic and treatment of asthma biologics.

Key words: Inflammation mediators, Bronchial hyperreactivity, Asthma, Biological markers

中图分类号:

时旭, 陈如冲, 李靖. 哮喘表型和2型炎症哮喘研究进展[J]. 结核与肺部疾病杂志, 2024, 5(5): 489-494. doi: 10.19983/j.issn.2096-8493.2024107

Shi Xu, Chen Ruchong, Li Jing. Research progress on the concept discrimination and treatment of type 2 inflammation in asthma[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(5): 489-494. doi: 10.19983/j.issn.2096-8493.2024107

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通用名	靶点	适用人群	生物标志物指导临床应用	推荐
奥马珠单抗 (omalizumab)	IgE	6岁及以上儿童和成人的中、重度过敏性患者	基线血清总IgE水平在30~1300IU/ml(6~12岁)和30~700IU/ml(12岁以上),可以选择抗IgE抗体	中国:√ GINA:√
瑞替珠单抗 (reslizumab)	IL-5	18岁及以上成人重度EOS型患者	血EOS≥150个/μl或300个/μl可作为使用抗IL-5或IL-5R抗体的指征	中国:√ GINA:√
美泊利珠单抗 (mepolizumab)	IL-5	6岁及以上儿童和成人重度EOS型患者		中国:√ GINA:√
本瑞利珠单抗 (benralizumab)	IL-5R	12岁及以上青少年和成人重度EOS型患者		中国:√ GINA:√
度普利尤单抗 (dupilumab)	IL-4R	6岁及以上儿童和成人重度EOS型/2型患者或OCS依赖型患者	基线血清总IgE水平≥150个/μl且≤1500个/μl,或FeNO≥25ppb	中国:√ GINA:√
特泽鲁单抗 (tezepelumab)	TSLP	12岁及以上青少年和成人重度患者	血EOS或FeNO升高	中国:× GINA:√