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目的探讨肥胖与哮喘控制及气道炎症表型间的关系。方法应用横断面研究方法,前瞻性收集101例哮喘患者临床信息,采用哮喘控制测试(ACT)和GINA哮喘控制标准进行哮喘控制水平评估。测量所有患者身高和体重,并计算体质指数(BMI)。行肺功能检测和痰诱导,对诱导痰和外周血进行细胞分类计数。结果符合研究标准的90例哮喘患者分为正常体重组(n=54)、超重组(n=21)和肥胖组(n=15)。三组间年龄和哮喘发生年龄存在差异(P=0.021和P=0.004)。哮喘控制水平比较,三组间存在明显差异[ACT评分分别为(20.6±2.9)分、(18.6±4.8)分、(18.3±2.9)分,P=0.019;GINA:P=0.014)。相关分析显示,BMI与诱导痰中性粒细胞绝对值呈正相关(r=0.29,P=0.039)。BMI可明显恶化哮喘控制水平[ACT:OR=1.84,95%CI(1.04,3.23),P=0.035;GINA:OR=2.27,95%CI(1.27,4.07),P=0.006],与BMI等级间存在量效关系。经年龄、性别、病程、FEV1%占预计值的百分比、吸烟指数、血中性粒细胞绝对值的校正,肥胖对ACT和GINA控制水平的影响仍然存在统计学意义(P=0.015;P=0.008)。结论在中国人群,肥胖型哮喘呈现以中性粒细胞炎症为主的表型特征,肥胖明显影响哮喘控制水平,且此种效应与BMI存在量效关系。
Objective To explore the relationship between obesity and asthma control and airway inflammation phenotypes. Methods The clinical data of 101 asthmatic patients were prospectively collected by the method of cross-sectional study. The level of asthma control was assessed by asthma control test (ACT) and GINA asthma control standard. All patients were measured for height and weight, and body mass index (BMI) was calculated. Pulmonary function tests and sputum induction, the induced sputum and peripheral blood cell count. Results Ninety asthma patients who met the criteria were divided into normal weight group (n = 54), overweight group (n = 21) and obesity group (n = 15). Age and age at onset of asthma differed between the three groups (P = 0.021 and P = 0.004). There were significant differences among the three groups in the control of asthma (ACT score of (20.6 ± 2.9), (18.6 ± 4.8), (18.3 ± 2.9), P = 0.019, GINA: P = 0.014). Correlation analysis showed that BMI was positively correlated with the absolute value of induced sputum neutrophil (r = 0.29, P = 0.039). BMI significantly reduced the level of asthma control [ACT: OR = 1.84, 95% CI 1.04, 3.23, P = 0.035; GINA: OR = 2.27, 95% CI 1.27, 4.07; There is a dose-effect relationship. The effect of obesity on ACT and GINA control remained statistically significant (P = 0.015; P = 0.008) as a function of age, sex, duration of illness, percentage of predicted FEV1%, smoking index, correction of absolute neutrophil count, ). Conclusions In Chinese population, obesity-type asthma presents the phenotypic characteristic of neutrophilic inflammation. Obesity significantly affects the level of asthma control, and this effect is related to the dose-response relationship of BMI.