Article record

成人难治性哮喘临床表型的性别差异

Sex differences in the clinical phenotype of difficult-to-treat asthma in adults.

临床研究鼻科IF 7.7Q1

文献信息

PMID	42962920
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Zoya Ahsan 查看其他 17 位作者 Anna Freeman；Helen E Moyses；David Charles；Ben Ainsworth；Liuyu Wei；Hans Michael Haitchi；Chellan Eames；J J Hudson-Colby；Adam Lewis；Judit Varkonyi-Sepp；Hitasha Rupani；Patrick Dennison；Syed Hasan Arshad；Ratko Djukanovic；Elena Dabrio-Reina；Elena Vladimirovna Vorobeva；Ramesh Kurukulaaratchy
作者单位	School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK. 查看其他 13 条单位信息 School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.；National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.；National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK.；School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK.；School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.；National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; Physiotherapy Department University Hospital Southampton NHS Foundation Trust, Southampton, UK.；School of Health Sciences, University of Southampton, Southampton, UK.；National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical Health Psychology Department at the University Hospital Southampton NHS Foundation Trust and Hampshire and Isle of Wight Healthcare NHS Foundation Trust Southampton, UK.；Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.；School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.；School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK.；National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK.；School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK. Electronic address: Rjk1s07@soton.ac.uk.
期刊	The journal of allergy and clinical immunology. In practice
SCI 分区	Q1
IF	7.7
研究类型	临床研究 · 临床
所属专科	鼻科

中文摘要

背景： 难治性（difficult）哮喘中已证实存在性别差异，据报道女性疾病严重程度更高且合并症更多。更深入地理解这些差异有助于制定个体化管理策略。
目的： 评估难治性哮喘男性和女性之间疾病特征的差异。
方法： Wessex AsThma CoHort研究收集了英格兰南部500例患者的数据。对患者人口学资料、哮喘及其治疗史、过敏、合并症、影像学、生物样本、肺功能和问卷数据进行单变量分析以识别性别差异。随后在多变量回归模型中对变量进一步评估。
结果： 男性发病年龄更晚，且更常为既往吸烟者。在多变量回归模型中，男性血清免疫球蛋白E更高（比值1.95，95% CI 1.19至3.20），血浆炎症细胞因子表达更高（白细胞介素-17、肿瘤坏死因子-α、C-C基序配体3和11以及几丁质酶3样蛋白1）。男性肺功能更差（第1秒用力呼气容积效应-9.98，95% CI -15.21至-4.74），且更常出现鼻息肉。女性体重指数更高，在多变量回归中血浆脂肪因子更高（比值1.25，95% CI 1.12至1.37）、白细胞介素-5表达更高（效应3.52，95% CI 2.65至4.39）、多病共存负担更重（评分效应0.60，95% CI 0.29至0.92）、焦虑/抑郁更多，以及可诱导性喉梗阻更多（比值比2.38，95% CI 1.20至4.76）。女性自报的Hull咳嗽高敏感性、Nijmegen和鼻窦结局测试评分更差。我们观察到治疗和医疗利用或复合哮喘严重程度评分无差异。
结论： 性别影响难治性哮喘表型，但不同因素与两性相似的总体疾病严重程度相关。男性肺功能和全身炎症特征更差，而女性经历更多心理生理性合并症和多病共存负担。认识到这些差异并在临床上加以考虑以精细调整管理，可能有助于改善难治性哮喘的结局。

英文摘要

BACKGROUND: Sex disparity has been demonstrated within difficult-to-treat (difficult) asthma, with females reported to have greater disease severity and more comorbidities. Deeper understanding of these differences could help personalise management approaches.
OBJECTIVE: To assess differences in disease characteristics between males and females with difficult asthma.
METHODS: The Wessex AsThma CoHort study collected data from 500 patients across Southern England. Patient demographics, asthma and its treatment history, allergies, comorbidities, radiology, biological samples, lung function, and questionnaire data were subjected to univariable analyses to identify sex differences. Variables were then further assessed in multivariable regression models.
RESULTS: Males were older at disease onset and were more often ex-smokers. In multivariable regression models they had higher serum immunoglobulin E (ratio 1.95, 95% CI 1.19 to 3.20) and plasma inflammatory cytokine expression (interleukin-17, tumour necrosis factor - alpha, C-C motif ligands 3 and 11 and chitinase 3-like 1). Males had poorer lung function (forced expiratory volume in 1 second effect -9.98, 95% CI -15.21 to -4.74) and more frequently had nasal polyps. Females had higher Body Mass Index, and in multivariable regression higher plasma adipokine (ratio 1.25, 95% CI 1.12 to 1.37) and interleukin-5 expression (effect 3.52, 95% CI 2.65 to 4.39), multimorbidity burden (score effect 0.60, 95% CI 0.29 to 0.92), anxiety/depression, and inducible laryngeal obstruction (odds ratio 2.38, 95% CI 1.20 to 4.76). They self-reported worse Hull Cough Hypersensitivity, Nijmegen and Sino-Nasal Outcome Test scores. We observed no difference in treatment and healthcare utilisation, or composite asthma severity score.
CONCLUSION: Sex influences difficult asthma phenotype but contrasting factors are associated with similar overall disease severity in both sexes. Males have worse lung function and systemic inflammatory profiles, whilst females experience greater psychophysiological comorbidity and multimorbidity burden. Recognising differences and considering them clinically to fine-tune management may help improve difficult asthma outcomes.