Assessment of serum periostin level as a predictor of requirement for intensive treatment for type-2 inflammation in asthmatics in future: A follow-up study of the KiHAC cohort
Assessment of serum periostin level as a predictor of requirement for intensive treatment for type-2 inflammation in asthmatics in future: A follow-up study of the KiHAC cohort
复制标题
评估血清骨膜素水平作为未来哮喘患者 2 型炎症强化治疗需求的预测因子：KiHAC 队列的后续研究
DOI：
10.1016/j.alit.2020.10.006
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发表时间：
2021
影响因子：
6.8
通讯作者：
Hirai
中科院分区：
文献类型：
--
作者：
Sunadome H;Matsumoto H;Tohda Y;Horiguchi T;Kita H;Kuwabara K;Tomii K;Otsuka K;Fujimura M;Ohkura N;Iwanaga T;Hozawa S;Niimi A;Kanemitsu Y;Nagasaki T;Tashima N;Ishiyama Y;Morimoto C;Oguma T;Tajiri T;Ito I;Ono J;Ohta S;Izuhara K;Hirai
最近，对未控制哮喘的管理需要一种系统的方法得到了广泛的接受；这些方法包括诸如修订诊断、评估依从性和评估合并症等策略。1这一护理途径是实用的，可以通过结合包括哮喘内型和表型的生物标记物来进一步改善，并预测未来需要对2型炎症进行高强度治疗。Periostin是一种细胞外基质蛋白，在血清2、3中检测到；血清Periostin水平升高与Th2型哮喘表型/内型4、5相关，其稳定性已被反复报道。6、7最耐人寻味的是，血清骨膜蛋白水平可能预测目前采用吸入性皮质类固醇(ICS)治疗的哮喘的长期预后。在这里，我们评估了血清Periostin作为未来治疗需求的预测指标的有效性，特别是对2型炎症进行强化治疗的必要性。我们的研究结果是Kinki Hokuriku呼吸道疾病会议(KiHAC)队列的观察性后续研究的一部分。4简而言之，KiHAC研究的参与者包括2009年9月至2011年12月期间招募的目前正在接受ICS治疗的哮喘患者。最初的KiHAC研究不包括吸烟10年以上的前吸烟者或在登记前一年内吸烟或患有其他呼吸系统疾病(如间质性肺病)的受试者。在这项随访研究中，我们招募了自基线登记以来随访5年的患者中的78名患者(补充图1)。如果患者在基线时曾接受每日500毫克的ics<；治疗(nž86)，在基线时已在接受奥马珠单抗治疗(nž4)，或由于经济原因、超出允许范围或其他原因而经常恶化，但没有接受奥马珠单抗治疗(nž7)，则不包括在内。获得登记后5年的临床数据，包括ICS剂量、哮喘伴随药物的数量、全身皮质类固醇(SCS)的使用、用于未控制的过敏性哮喘的奥马珠单抗的引入，以及在此期间需要SCS治疗的恶化次数。内科医生无法获得基线血清Periostin水平。
The need for a systematic approach for the management of uncontrolled asthma has recently gained broad acceptance; these approaches include strategies, such as revision of diagnosis, evaluation of adherence, and assessment of comorbidities. 1 This care pathway is pragmatically useful and can be improved even further by incorporating biomarkers that include asthma endotypes and phenotypes and predict the need for future highintensity treatment for type-2 inflammation. Periostin is an extracellular matrix protein that is detected in serum 2, 3; elevated levels of serum periostin have been associated with the Th2-type asthma phenotype/endotype, 4, 5 and its stability is repeatedly reported. 6, 7 Most intriguing is the possibility that serum periostin levels might predict the long-term prognosis of asthma currently managed with inhaled corticosteroid (ICS) treatment. Here we assessed the usefulness of serum periostin as a predictor of future treatment requirements, notably the need for treatment intensification for type-2 inflammation.Our findings are part of an observational follow-up study of the Kinki Hokuriku Airway disease Conference (KiHAC) cohort. 4 Briefly, participants in the KiHAC study included asthmatics currently undergoing treatment with ICS who were recruited between September 2009 and December 2011. Ex-smokers with more than 10 pack-years or who smoked in the year prior to enrollment or subjects with other respiratory diseases such as interstitial lung disease were not included in the original KiHAC study. In this follow-up study, we enrolled 78 patients among those who had been followed for 5 years since baseline enrollment (Supplementary Fig. 1). Patients were excluded if they had been treated with ICS< 500 mg/day at baseline (n ž 86), who were already under treatment with omalizumab at baseline (n ž 4) or who did not receive treatment with omalizumab despite frequent exacerbations due to economic reasons, being outside the permitted range, or other reasons (n ž 7). Clinical data were obtained for the 5 years after enrollment, including ICS doses, the number of concomitant drugs for asthma, systemic corticosteroid (SCS) use, introduction of omalizumab for uncontrolled allergic asthma, and the number of exacerbations during this time interval that required SCS treatment. Baseline serum periostin levels were not available to physicians.