Determination of the cutoff values of Th2 markers for the prediction of future exacerbation in severe asthma: An analysis from the Hokkaido Severe Asthma Cohort Study
Determination of the cutoff values of Th2 markers for the prediction of future exacerbation in severe asthma: An analysis from the Hokkaido Severe Asthma Cohort Study
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DOI：
10.1016/j.alit.2020.09.001
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发表时间：
2021-01-01
影响因子：
6.8
通讯作者：
Konno, Satoshi
中科院分区：
文献类型：
--
作者：
Kimura, Hirokazu;Makita, Hironi;Konno, Satoshi
背景：我们最近报道了频繁加重的严重哮喘患者与非加重者相比，血液嗜酸性粒细胞计数（Eo）和呼出一氧化氮（FeNO）分数较高。然而，我们没有确定与恶化相关的确切临界值。本研究的目的是确定可能与严重哮喘加重有关的Eo和FeNO的临界值。我们还旨在确认与病情恶化相关的Th2标志物的临床应用。方法：本研究纳入了105名重度哮喘患者，他们完成了一项为期三年的重度哮喘队列研究，其中包括吸烟者。选择三个Th2标记，即Eo、FeNO和阳性特应性状态。对于Eo和FeNO，我们根据频繁加重者与其他患者的比较，利用受试者工作特征曲线分析确定了定义“阳性”Th2特征的截止值。结果：Th2阳性特征的临界值为Eo >= 250 cells/mL, FeNO >= 31 ppb。无Th2特征16例（15.2%），1例（38.1%），2例（23.8%），3例（22.9%）。高数量的Th2阳性特征与三年内的加重频率显著相关（p < 0.05）。同样，与具有一种或不具有Th2特征的患者相比，具有三种Th2特征的患者发生一次以上加重的概率明显更高（p < 0.05）。结论：当前分析确定的临界值是预测严重哮喘患者未来病情恶化的良好指标。日本过敏症学会版权所有2020制作和托管由爱思唯尔B.V.
Background: We recently reported that severe asthma patients with frequent exacerbations showed high blood eosinophil counts (Eo) and fractions of exhaled nitric oxide (FeNO) compared with non-exacerbators. However, we did not determine exact cutoff values related to exacerbation. The aim of this study was to determine the cutoff values of Eo and FeNO that could be related to the exacerbation of severe asthma. We also aimed to confirm the clinical utility of Th2 markers related to exacerbation.Methods: This study included 105 severe asthma patients who completed a three-year follow-up of a severe asthma cohort study, including smokers. Three Th2 markers were selected, viz., Eo, FeNO, and positive atopic status. Regarding Eo and FeNO, we determined the cutoff values for the definition of "positive" Th2 features using receiver operating characteristic curve analyses, based on the comparisons between frequent exacerbators and other patients.Results: The cutoff values for positive Th2 features were Eo >= 250 cells/mL and FeNO >= 31 ppb. Sixteen patients (15.2%) had no Th2 features, 40 (38.1%) had one, 25 ( 23.8%) had two, and 24 (22.9%) had three. A high number of positive Th2 features was significantly associated with exacerbation frequencies over three years (p < 0.05). Similarly, compared to patients with one or no Th2 features, those with three Th2 features had a significantly higher probability of having more than one exacerbation (p < 0.05).Conclusions: The cutoff values determined in the current analysis were good predictors of future exacerbations in severe asthma patients. Copyright (C) 2020, Japanese Society of Allergology. Production and hosting by Elsevier B.V.