地区登记册中严重支气管哮喘患者的临床和过敏学特征以及选择靶向治疗的表型原则

V. Naumova, E. Beltyukov, O. P. Kovtun, O. Smolenskaya, G. А. Bykova, E. S. Klyachina
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摘要

导言。重症哮喘靶向治疗的有效性取决于所选药物是否能精确地针对发病的关键环节。因此,在实际临床实践中进行重症哮喘表型分析具有重要意义。确定重症哮喘患者的主要临床和过敏学特征,并确定决定重症哮喘靶向药物治疗选择的重要表型标志。这项前瞻性和回顾性研究涉及斯维尔德洛夫斯克地区登记处接受重症哮喘靶向治疗的患者(n = 198)。根据临床和过敏学表现,确定了过敏性、非过敏性嗜酸性和混合性重症哮喘表型。描述了表型的临床和实验室特征。结果。在登记的重症哮喘患者(n = 198)中,非过敏性嗜酸性粒细胞性哮喘占 46.5%,过敏性哮喘占 34.8%,混合性哮喘占 18.7%。确定表型的重要标志有:哮喘发病年龄、已证实的过敏症、Phadiatop ImmunoCAP 水平和基线血液嗜酸性粒细胞、并发过敏性鼻炎、伴有鼻息肉的慢性鼻窦炎和对非甾体抗炎药过敏。确定过敏性重症哮喘的主要标志是:发病早、证实有过敏体质、Phadiatop ImmunoCAP 检测结果呈阳性(Phadiatop ≥ 1.53 PAU/l,过敏表型的可能性增加)。非过敏性嗜酸性粒细胞性哮喘的体征为嗜酸性粒细胞≥150 cells/µl、无过敏、伴有鼻息肉的慢性鼻炎和对非甾体抗炎药过敏、发病较晚(30 岁以后)。混合型哮喘的体征:存在已证实的过敏或潜伏的致敏现象,同时 Phadiatop ImmunoCAP 水平较高,发病较晚,嗜酸性粒细胞≥ 300 cells/µl,伴有鼻息肉的慢性鼻炎,对非甾体抗炎药过敏。提出了基于过敏性和非过敏性嗜酸性粒细胞分离的重症哮喘表型分析算法。可在实际临床实践中进行的重症哮喘表型分析应有助于选择初始靶向药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical and allergological characteristics of patients with severe bronchial asthma in the regional registry and phenotyping principles for the targeted therapy choice
Introduction. Severe asthma targeted therapy effectiveness depends on precise targeting of the selected drug to the key link in pathogenesis. Therefore, severe asthma phenotyping in real clinical practice is relevant.Aim. To determine main clinical and allergological characteristics of patients with severe asthma and to establish important phenotyping signs determined choice of a targeted drug for severe asthma treatment.Materials and methods. The prospective and retrospective study involved patients (n = 198) of the Sverdlovsk region registry receiving targeted therapy of severe asthma. Considering clinical and allergological picture, allergic, non-allergic eosinophilic and mixed severe asthma phenotypes were identified. Clinical and laboratory characteristics of phenotypes were described. A phenotyping algorithm was developed.Results. In the register of patients (n = 198) with severe asthma, non-allergic eosinophilic asthma was 46.5%, allergic – 34.8%, mixed – 18.7%. Significant signs for phenotyping were identified: age of asthma onset, proven allergy, Phadiatop ImmunoCAP level and blood eosinophils on baseline, concomitant allergic rhinitis, chronic rhinosinusitis with nasal polyps and hyper-sensitivity to NSAIDs. The main signs of allergic severe asthma determined: early onset, proven allergy and a positive result of Phadiatop ImmunoCAP (the probability of allergic phenotype increases with Phadiatop ≥ 1.53 PAU/l). Signs of non-allergic eosinophilic asthma were eosinophilia ≥ 150 cells/µl, absence of allergy, concomitant chronic rhinosinusitis with nasal polyps and hypersensitivity to NSAIDs, late onset (after 30 years). Signs were identified for mixed asthma: presence of proven allergy or latent sensitization in combination with high level of Phadiatop ImmunoCAP, late onset, eosinophilia ≥ 300 cells/µl, chronic rhinosinusitis with nasal polyps, hypersensitivity NSAIDs.Conclusions. The algorithm for severe asthma phenotyping based on the isolation of eosinophilia of allergic and non-allergic origin is proposed. Severe asthma phenotyping, which can be carried out in real clinical practice, should facilitate the selection of an initial targeted drug.
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