Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents?
Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents?
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DOI：
10.1371/journal.pone.0156141
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Munoz X
中科院分区：
文献类型：
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作者：
Meca O;Cruz MJ;Sánchez-Ortiz M;González-Barcala FJ;Ojanguren I;Munoz X
本研究的目的是分析低分子物质(LMW)引起的职业性哮喘(OA)患者与高分子物质(HMW)引起的OA患者在危险因素、哮喘表现和严重程度以及对各种诊断试验的反应方面是否存在差异。纳入78例经阳性特异性吸入性激发试验(SIC)确诊的骨性关节炎患者。分析人体测量特征、特应性状态、职业、潜伏期、哮喘严重程度(根据全球哮喘倡议(GINA)控制分类)、肺功能测试和SIC结果。23例患者(29%)由HMW试剂诱导，55例(71%)由LMW试剂诱导。Logistic回归分析证实，在调整潜在混杂因素后，根据GINA分类，低分子药物引起的骨性关节炎患者的严重风险显著增加(OR=3.579，95%CI 1.136~11.280；p=0.029)。在SIC期间，高分子药物引起的骨性关节炎患者大多表现为早期反应(82%)，而低分子药物引起的骨性关节炎患者主要表现为晚期反应(73%)(p=0.0001)。类似地，低分子药物引起的骨性关节炎患者与高分子药物引起的骨性关节炎患者(0.87，范围0-72)相比，经历了更严重的支气管高反应性，测量的是SIC前后乙酰甲胆碱剂量反应比的差异(1.77，范围0-16)，(p=0.024)。低分子物质引起的骨性关节炎可能比高分子物质引起的更严重。病情的严重程度可能由这些药物的不同作用机制决定。
The aim of this study was to analyse whether patients with occupational asthma (OA) caused by low molecular weight (LMW) agents differed from patients with OA caused by high molecular weight (HMW) with regard to risk factors, asthma presentation and severity, and response to various diagnostic tests. Seventy-eight patients with OA diagnosed by positive specific inhalation challenge (SIC) were included. Anthropometric characteristics, atopic status, occupation, latency periods, asthma severity according to the Global Initiative for Asthma (GINA) control classification, lung function tests and SIC results were analysed. OA was induced by an HMW agent in 23 patients (29%) and by an LMW agent in 55 (71%). A logistic regression analysis confirmed that patients with OA caused by LMW agents had a significantly higher risk of severity according to the GINA classification after adjusting for potential confounders (OR = 3.579, 95% CI 1.136–11.280; p = 0.029). During the SIC, most patients with OA caused by HMW agents presented an early reaction (82%), while in patients with OA caused by LMW agents the response was mainly late (73%) (p = 0.0001). Similarly, patients with OA caused by LMW agents experienced a greater degree of bronchial hyperresponsiveness, measured as the difference in the methacholine dose-response ratio (DRR) before and after SIC (1.77, range 0–16), compared with patients with OA caused by HMW agents (0.87, range 0–72), (p = 0.024). OA caused by LMW agents may be more severe than that caused by HMW agents. The severity of the condition may be determined by the different mechanisms of action of these agents.