Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation.
Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation.
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DOI：
10.1016/j.jaci.2011.06.009
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发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Irvin CG
中科院分区：
文献类型：
--
作者：
Dixon AE;Pratley RE;Forgione PM;Kaminsky DA;Whittaker-Leclair LA;Griffes LA;Garudathri J;Raymond D;Poynter ME;Bunn JY;Irvin CG
肥胖个体的哮喘尚不清楚，这些患者通常难以接受标准治疗。通过确定肥胖和减肥手术如何影响哮喘控制、气道高反应性和哮喘炎症标志物，深入了解肥胖个体哮喘的发病机制和治疗方法。一项前瞻性研究(i)哮喘和非哮喘减肥手术患者在基线时的比较，（ii）哮喘患者在减肥手术后随访12个月。我们研究了23例接受减肥手术的哮喘患者和21例非哮喘患者。在基线时，哮喘患者FEV1和FVC较低，支气管肺泡灌洗时淋巴细胞水平较低。手术后，哮喘患者的哮喘控制（哮喘控制评分1.55 ~ 0.74,p < 0.0001）和哮喘生活质量（4.87 ~ 5.87,p < 0.0001）均有显著改善。气道对甲胆碱的反应性明显改善（PC20为3.9 ~ 7.28,p = 0.03）。IgE水平与气道反应性变化有显著交互作用（交互作用项p = 0.01）， IgE正常组AHR改善与BMI变化有显著相关（p = 0.02, R2 = 0.46）。支气管肺泡灌洗液中淋巴细胞的比例和活化的外周血CD4+ T细胞产生的细胞因子显著增加。减肥手术改善血清IgE正常的肥胖哮喘患者气道高反应性。体重减轻对气道生理和T细胞功能的双重影响通常涉及哮喘的发病机制，这表明肥胖产生了一种独特的哮喘表型，需要独特的治疗方法。
Asthma in obese individuals is poorly understood, these patients are often refractory to standard therapy. To gain insights into the pathogenesis and treatment of asthma in obese individuals by determining how obesity and bariatric surgery affect asthma control, airway hyperresponsiveness and markers of asthmatic inflammation. A prospective study of (i) asthmatic and non-asthmatic bariatric surgery patients compared at baseline, and (ii) asthmatic patients followed for 12 months after bariatric surgery. We studied 23 asthmatic and 21 non-asthmatic patients undergoing bariatric surgery. At baseline, asthmatics had lower FEV1 and FVC, and lower levels of lymphocytes in bronchoalveolar lavage. Following surgery, asthmatic participants experienced significant improvements in asthma control (asthma control score 1.55 to 0.74, p < 0.0001) and asthma quality of life (4.87 to 5.87, p < 0.0001). Airways responsiveness to methacholine improved significantly (PC20 3.9 to 7.28, p = 0.03). There was a statistically significant interaction between IgE status and change in airways responsiveness (p for interaction term = 0.01), improvement in AHR was significantly related to change in BMI in those with normal IgE (p = 0.02, R2 = 0.46). The proportion of lymphocytes in bronchoalveolar lavage and production of cytokines from activated peripheral blood CD4+ T cells increased significantly. Bariatric surgery improves airway hyperresponsiveness in obese asthmatics with normal serum IgE. Weight loss has dichotomous effects on airway physiology and T cell function typically involved in the pathogenesis of asthma, suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach.
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影响因子：
10
作者：
Chinn, S;Jarvis, D;Burney, P
通讯作者：
Burney, P
影响因子：
14.2
作者：
Cui, JQ;Pazdziorko, S;Marusic, S
通讯作者：
Marusic, S
DOI：
10.1164/rccm.200702-323oc
发表时间：
2007-10-01
影响因子：
24.7
作者：
Johnston, Richard A.;Zhu, Ming;Shore, Stephanie A.
通讯作者：
Shore, Stephanie A.
影响因子：
4.3
作者：
Maniscalco, Mauro;Zedda, Anna;Sofia, Matteo
通讯作者：
Sofia, Matteo
影响因子：
--
作者：
Camargo, CA;Weiss, ST;Speizer, FE
通讯作者：
Speizer, FE