ALIMENT PHARM THERAP:过敏体质是哮喘病人发生嗜酸性粒细胞性食管炎的预测因素

　　近日，《营养药理学与治疗学（Alimentary Pharmacology & Therapeutics）》杂志报道，过敏体质和是否使用糖皮质激素吸入治疗是哮喘病人发生嗜酸性粒细胞性食管炎的预测因素。

　　嗜酸性粒细胞性食管炎病人常伴有哮喘和过敏反应。美国明尼苏达州的Harer医生的研究小组确定了哮喘病人发生嗜酸性粒细胞性食管炎的预测因素。研究小组对2000年至2010年间156例伴有嗜酸性粒细胞性食管炎的哮喘病人和276例不办嗜酸性粒细胞性食管炎的哮喘病人的数据进行了回顾性分析。他们分析了每组半数病例的临床和实验室检查特征，具有显著性的因素和模型用于另一半病例的分析。

　　哮喘病人出现嗜酸性粒细胞性食管炎的预测因素包括过敏性和非过敏性哮喘、食物过敏、过敏性鼻炎和外周血嗜酸性粒细胞增多。

　　研究小组发现使用吸入糖皮质激素与哮喘病人和过敏性哮喘病人发生嗜酸性粒细胞性食管炎的可能性呈负相关。

　　研究者还指出，发生嗜酸性粒细胞性食管炎的患者更加年轻。过敏性哮喘、外周血嗜酸性粒细胞增多和使用吸入糖皮质激素具有显著性。研究者根据这些因素编制了总分为3.5分的哮喘病人嗜酸性粒细胞性食管炎的评分系统，在分组分析中ROC为0.8。

　　Harer医生的小组总结道：“外周血嗜酸性粒细胞增多、过敏性哮喘和过敏性鼻炎这三个因素对哮喘病人发生嗜酸性粒细胞性食管炎的影响依次降低。吸入糖皮质激素可能是嗜酸性粒细胞性食管炎的保护性因素。一项简单而准确的评分可以用于评价哮喘病人和吞咽困难病人发生嗜酸性粒细胞性食管炎的可能性。嗜酸性粒细胞性食管炎应被视为过敏体质的一部分，而不是一个单独的食管疾病。”

An allergic phenotype and the use of steroid inhalers predict eosinophilic oesophagitis in patients with asthma

Background

Patients with eosinophilic oesophagitis (EoE) commonly have asthma and atopy.

Aims

To determine the predictive factors of EoE in patients with asthma.

Methods

A retrospective analysis of a large database identified 156 asthma patients with EoE and 276 patients without EoE between 2000 and 2010. Clinical and laboratory characteristics were first analyzed in half of each group. Significant differences and modelling were then applied to the other half of each group in a split half analysis.

Results

Odds ratios and P-values found to predict the presence of EoE in asthma patients were: allergic vs. non-allergic asthma (4.07, <0.01), food allergies (45, <0.01), allergic rhinitis (2.13, =0.01) and peripheral eosinophilia (4.51, <0.01). The use of inhaled corticosteroids was negatively associated with EoE (0.41, <0.01) for asthma patients and (0.37, P < 0.01) for allergic type asthma patients. EoE patients were also younger (27.4 vs. 41.6 years old, P < 0.01). By logistic regression analysis, allergic asthma, presence of peripheral eosinophilia and use of inhaled steroids remained significant. From these parameters, a 3.5-point scoring system model for EoE in asthma was formed with an ROC = 0.787 on split analysis.

Conclusions

In descending order, peripheral eosinophilia, allergic asthma and allergic rhinitis are associated with EoE in patients with asthma. Steroid inhalers appear to have a protective effect against EoE. An accurate and simple scoring system can be used as a screening tool to predict the presence of EoE in patients with asthma and dysphagia. EoE should be viewed as part of a generalised allergic phenotype rather than isolated oesophageal disease.