Page 44 - 2022-24-中国全科医学

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2.Respiratory Department，the First Affiliated Hospital of Henan University of Chinese Medicine，Zhengzhou 450000，China
3.Gongyi City People's Hospital，Zhengzhou 451200，China
4.Zhumadian Chinese Medicine Hospital，Zhumadian 463000，China
*
Corresponding author：WANG Minghang，Chief physician，Doctoral supervisor；E-mail：wmh107hn@163.com
【Abstract】 Background The various inflammatory phenotypes of asthma，a common heterogeneous respiratory
disease，are closely related to the pathogenesis，treatment，and prognosis of the disease. So screening the associated factors
of inflammatory phenotypes will be helpful for the evaluation of patient condition and delivery of individualized diagnosis and
treatment services. Objective To explore the distribution of inflammatory phenotypes and associated factors in bronchial asthma
patients，providing a basis for the implementation of individualized diagnosis and treatment of the disease. Methods A cross-
sectional study design was used. Clinical data of bronchial asthma outpatients and inpatients（n=184） were collected from
the First Affiliated Hospital of Henan University of Chinese Medicine from November 2018 to December 2020. Inflammatory
phenotypes in the patients were classified into four categories according to the type of inflammatory cells in the induced sputum：
neutrophilic asthma（NA），eosinophilic asthma（EA），mixed granulocytic asthma （MA），and paucigranulocytic asthma
（PA）. Factors possibly associated with each of the inflammatory phenotypes were screened by three statistical methods（univariate
analysis，multivariate Logistic regression analysis，and Spearman rank correlation analysis），and were determined as the
associated factors if they had significant associations with the phenotype by two of the aforementioned three methods. Results The
prevalence of NA，EA，MA，and PA was 45.7%（84/184），20.7%（38/184），20.7%（38/184），and 13.0%（24/184），
respectively. Univariate analysis showed that the prevalence of allergic rhinitis and fractioned exhaled nitric oxide（FeNO） level
differed significantly between NA and non-NA patients（P<0.05）. And they also varied significantly between EA and non-EA
patients（P<0.05）. There was significant difference in FeNO level between MA and non-MA patients（P<0.05）. There were
significant differences in mean age，prevalence of previous respiratory disease and mean FeNO level between PA and non-PA
patients（P<0.05）. Multivariate Logistic regression analysis showed that allergic rhinitis〔OR=0.417，95%CI（0.205，0.848）〕
and FeNO〔OR=0.978，95%CI（0.968，0.989）〕were associated with NA（P<0.05）；FeNO〔OR=1.017，95%CI（1.009，
1.025）〕 was associated with EA（P<0.05）；FeNO〔OR=1.007，95%CI（1.000，1.014）〕was associated with MA（P<0.05）；
BMI〔OR=1.165，95%CI（1.015，1.337）〕 and FeNO〔OR=0.981，95%CI（0.965，0.998）〕were associated with PA（P<0.05）.
Spearman rank correlation analysis indicated that NA prevalence decreased with increased allergic rhinitis prevalence and FeNO
level（r s =-0.244，-0.361，P<0.05）；EA prevalence increased with increased allergic rhinitis prevalence and FeNO level（r s =0.157，
0.341，P<0.05）；MA prevalence increased with increased FeNO（r s =0.236，P<0.05）；PA prevalence decreased with older
age，prevalence of previous respiratory disease and increased FeNO（r s =-0.156，-0.163，-0.159，all P<0.05）. Based on the
above analyses，allergic rhinitis and FeNO were associated factors for both EA and NA；FeNO was associated factors of MA；
age，prevalence of previous respiratory disease and FeNO were associated factors of PA. Conclusion NA accounted for the
largest percentage of the inflammatory phenotypes，while PA accounted for the least. FeNO was the associated factor for each
inflammatory phenotype. It has specificity in recognizing EA and MA. FeNO combined with allergic rhinitis was associated with NA
and EA. FeNO combined with age was associated with PA.
【Key words】 Asthma；Inflammation；Phenotype；Inflammatory phenotype；Cross-sectional studies；Root cause
analysis

支气管哮喘（以下简称哮喘）是一种以慢性气道炎 出哮喘表型并指出对其分类有助于疾病的治疗及预后判
症为特征的异质性疾病 ［1］ 。全球有近 3 亿哮喘患者， 断。哮喘炎症表型与发病机制、治疗反应及预后关系密
我国哮喘患者高达 4 570 万 ［2］ 。哮喘的治疗目标为控 切。基于哮喘炎症表型的异质性，筛选炎症表型识别因
制当前症状、降低未来发作风险，即哮喘的总体控制。 素有助于评估病情和个体化诊疗。因此，本研究基于横
近年来随着我国哮喘规范化诊疗的推广，哮喘的总体控 断面调查，探索哮喘炎症表型分布特点并筛选其识别因
制取得了一定成效，但总体控制率仍不理想，而且仍有 素，以期为哮喘的精准治疗提供参考。
较多的哮喘患者未进行规范诊疗或存在漏诊。目前哮喘 1 资料与方法
的评估方法较多，然而，针对具体表型哮喘特异性的评 1.1 研究对象 选取 2018 年 11 月至 2020 年 12 月就
估方法较少。表型是遗传因素和环境暴露相互作用的结 诊于河南中医药大学第一附属医院呼吸科门诊及住院
果，也是能将生物体分为不同独立类群的系列特征 ［3］ 。 部的 184 例哮喘患者为研究对象。本研究已通过河南
2009 年全球哮喘防治倡议组织（GINA）指南 ［4］ 首次提 中医药大学第一附属医院伦理委员会审查（伦审号：