Biomarkers predicting response to corticosteroid therapy in asthma.
Biomarkers predicting response to corticosteroid therapy in asthma.
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DOI：
10.2165/00151829-200504050-00002
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发表时间：
2005-01-01
期刊：
影响因子：
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通讯作者：
Pavord, Ian D
中科院分区：
文献类型：
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作者：
Brightling, Christopher E;Green, Ruth H;Pavord, Ian D
哮喘管理的国际指南支持早期引入皮质类固醇以控制症状并通过减少气道炎症来改善肺功能。然而，并非所有个体对皮质类固醇的反应程度相同，能够预测对皮质类固醇治疗的反应将是一个优势。已经在用皮质类固醇治疗后评估了几种生物标志物，包括肺功能、外周血和炎症的痰指数、呼出气体和呼吸冷凝物的测量。预测皮质类固醇反应的最广泛研究的指标是气道高反应性、呼出一氧化氮（eNO）和诱导痰。其中，痰嗜酸性粒细胞增多已被证明是皮质类固醇短期反应的最佳预测因子。更重要的是，指导治疗使痰嗜酸性粒细胞计数正常化可以大大减少严重急性发作。痰诱导的广泛应用受到阻碍，因为该过程相对劳动密集。eNO的测量更简单，但将NO评估纳入哮喘管理策略并没有导致急性发作率的降低。现在的挑战是简化痰嗜酸性粒细胞计数的测量，或者确定另一种炎症标志物，其在预测糖皮质激素的短期和长期反应方面具有与痰嗜酸性粒细胞计数相似的功效。
International guidelines on the management of asthma support the early introduction of corticosteroids to control symptoms and to improve lung function by reducing airway inflammation. However, not all individuals respond to corticosteroids to the same extent and it would be an advantage to be able to predict the response to corticosteroid treatment. Several biomarkers have been assessed following treatment with corticosteroids including measures of lung function, peripheral blood and sputum indices of inflammation, exhaled gases and breath condensates. The most widely examined measures in predicting a response to corticosteroids are airway hyperresponsiveness, exhaled nitric oxide (eNO) and induced sputum. Of these, sputum eosinophilia has been demonstrated to be the best predictor of a short-term response to corticosteroids. More importantly, directing treatment at normalizing the sputum eosinophil count can substantially reduce severe exacerbations. The widespread utilization of sputum induction is hampered because the procedure is relatively labor intensive. The measurement of eNO is simpler, but incorporating the assessment of NO in an asthma management strategy has not led to a reduction in exacerbation rates. The challenge now is to either simplify the measurement of a sputum eosinophilia or to identify another inflammatory marker with a similar efficacy as the sputum eosinophil count in predicting both the short- and long-term responses to corticosteroids.