摘要
目的探究重度哮喘患者支气管热成形术(Bronchial thermoplasty,BT)及支气管热成形术后使用奥马珠单抗的安全性与有效性。方法收集本院2015年1月—2025年1月间实施BT的重度哮喘患者,术后1年评估疗效、哮喘控制情况及肺功能,根据疗效分为未控制、部分控制、完全控制,对部分控制和未控制的患者进行过敏原和血清总IgE检测,适合奥马珠单抗治疗的患者进行1年的治疗,评估热成形组(BT组)以及热成形后奥马珠单抗组(BT-奥马珠组)患者疗效、哮喘控制情况及生活质量、肺功能、不良反应差异等。结果BT治疗1年后患者ACT评估优于治疗前(P<0.05),但仍有超过一半患者控制不良;部分控制及未控制组的2型炎症水平高于完全控制组(P<0.05),而部分控制组与未控制组间无明显差异(P>0.05)。BT治疗1年后患者的急性发作次数减少、使用口服糖皮质激素(Oral Corticosteroids,OCS)患者比例减少,住院天数缩短、生活质量(MiniAQLQ评分)改善(P均<0.05)。相较于BT前,治疗1年后患者的FEV_(1)、FEV_(1)%、FEV_(1)/FVC、PEF均有改善(P均<0.05),FVC、FVC%、MMEF%无明显变化(P均>0.05)。与BT组相比,BT-奥马珠单抗组可进一步提升FEV_(1)、FEV_(1)%、FEV_(1)/FVC、PEF(P均<0.05),FVC、FVC%、MMEF%在两组治疗间无明显差异(P均>0.05)。BT-奥马珠组显著缩短住院天数,改善哮喘控制情况及生活质量(P均<0.05),减少急性发作次数,但无统计学差异(P>0.05)。两组不良反应情况比较差异无统计学意义(P均>0.05)。结论支气管热成形术可减少哮喘急性发作及OCS使用,缩短住院时间,改善哮喘控制情况及生活质量、肺功能等,但在2型炎症表型患者中效果不理想,这类患者使用奥马珠单抗治疗可更有效控制哮喘,缩短住院时间,提高肺功能,提升生活质量,且安全性较好。
Objective To investigate the safety and efficacy of bronchial thermoplasty and omalizumab after bronchial thermoplasty in severe asthma.Methods Collect patients with severe asthma who underwent BT in our hospital from January 2015 to January 2025.Assess the efficacy,asthma control,and pulmonary function 1 year after surgery,divide into uncontrolled,partially controlled,and completely controlled groups based on efficacy.Allergen and total serum IgE were conducted in partially controlled and uncontrolled patients,and those suitable for treatment with omalizumab underwent a 1-year treatment.The efficacy,asthma control,quality of life,lung function,and adverse reactions of patients in the bronchial thermoplasty group(BT group)and the omalizumab after bronchial thermoplasty group(BT-omalizumab group)were evaluated.Results show that after one year of BT treatment,the ACT assessment of patients is better than before treatment(P<0.05),but more than half of patients still have poor control;The level of type 2 inflammation in the partially controlled and uncontrolled groups was higher than that in the completely controlled group(P<0.05),while there was no significant difference between the partially controlled and uncontrolled groups(P>0.05).After 1 year of BT treatment,the number of acute attacks in patients decreased,and the proportion of patients using OCS decreased,the hospitalization days shortened,and the quality of life(MiniAQLQ score)improved(all P<0.05).Compared with before BT,the FEV_(1),FEV_(1)%,FEV_(1)/FVC,and PEF of patients improved after 1 year of treatment(all P<0.05),while FVC,FVC%,and MMEF%showed no significant changes(all P>0.05).Compared with BT group,BT-omalizumab group can further improve FEV_(1),FEV_(1)%,FEV_(1)/FVC,and PEF(all P<0.05),while there was no significant difference in FVC,FVC%,and MMEF%between the two treatment groups(all P>0.05).The BT-omalizumab group can significantly shorten hospitalization days,improve asthma control and quality of life(all P<0.05);The combination group can further reduce the number of acute attacks compared to the BT group,but there is no statistical difference(P>0.05).There was no statistically significant difference in the occurrence of adverse reactions between the two groups(all P>0.05).Conclusions BT can reduce acute asthma attacks and OCS use,shorten hospitalization time,improve asthma control,quality of life and lung function.However,the effect is not ideal in patients with type 2 inflammatory phenotype.Treatment with omalizumab can more effectively control asthma,shorten hospitalization time,improve lung function,enhance quality of life,and is safer for these patients.
作者
孙兰
胡强
宋本艳
张榆铃
李明风
廖祥莉
SUN Lan;HU Qiang;SONG Benyan;ZHANG Yuling;LI Mingfeng;LIAO Xiangli(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Panzhihua College,Panzhihua,Sichuan 617000,P.R.China)
出处
《中国呼吸与危重监护杂志》
2025年第12期843-849,共7页
Chinese Journal of Respiratory and Critical Care Medicine
基金
四川省医学会科研课题(S22080)。
