山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (5): 7-15.doi: 10.6040/j.issn.1671-7554.0.2024.0137
• 慢性气道疾病的精准个体化诊疗——专家综述 • 上一篇
王凤燕1,梁振宇1,李雪萍1,陈荣昌1,2
WANG Fengyan1, LIANG Zhenyu1, LI Xueping1, CHEN Rongchang1,2
摘要: 慢性阻塞性肺疾病(简称慢阻肺)是最常见的慢性呼吸系统疾病,因其致残和致死性而备受关注。近年来对其临床研究取得了诸多重要进展。早期诊断和筛查工具的发展,以及基于肺功能发展轨迹、影像学评估和基因表达特征的多维度分型,为慢阻肺的个体化治疗提供了依据。多组学研究在探索慢阻肺生物标志物方面取得重要突破,有助于深入理解疾病的发病机制和病程发展。吸入药物方案的疗效比较和靶向2型炎症的单克隆抗体疗效研究也在不断推进,以期为慢阻肺患者提供更多针对发病机制的个体化治疗手段。
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[1] Li XC, Cao XP, Guo MZ, et al. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017[J]. BMJ, 2020, 368: m234. doi:10.1136/bmj.m234. [2] Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary diseas(2011 report)[EB/OL].(2011-12-01)[2024-01-30]. https://goldcopd.org/. [3] Divo MJ, Liu CJ, Polverino F, et al. From pre-COPD to COPD: a simple, low cost and easy to IMplement(SLIM)risk calculator[J]. Eur Respir J, 2023, 62(3): 2300806. doi:10.1183/13993003.00806-2023. [4] Young AL, Bragman FJS, Rangelov B, et al. Disease progression modeling in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2020, 201(3): 294-302. [5] Moll M, Sakornsakolpat P, Shrine N, et al. Chronic obstructive pulmonary disease and related phenotypes: polygenic risk scores in population-based and case-control cohorts[J]. Lancet Respir Med, 2020, 8(7): 696-708. [6] Cosentino J, Behsaz B, Alipanahi B, et al. Inference of chronic obstructive pulmonary disease with deep learning on raw spirograms identifies new genetic loci and improves risk models[J]. Nat Genet, 2023, 55(5): 787-795. [7] Martinez FJ, Han MK, Lopez C, et al. Discriminative accuracy of the CAPTURE tool for identifying chronic obstructive pulmonary disease in US primary care settings[J]. JAMA, 2023, 329(6): 490-501. [8] Siddharthan T, Pollard SL, Quaderi SA, et al. Discriminative accuracy of chronic obstructive pulmonary disease screening instruments in 3 low- and middle-income country settings[J]. JAMA, 2022, 327(2): 151-160. [9] Huynh C, Whitmore GA, Vandemheen KL, et al. Derivation and validation of the UCAP-Q case-finding questionnaire to detect undiagnosed asthma and COPD[J]. Eur Respir J, 2022, 60(3): 2103243. doi:10.1183/13993003.03243-2021. [10] Liang ZY, Zhong NS, Chen RC, et al. Investigation of the Clinical, Radiological and Biological Factors Associated with Disease Progression, Phenotypes and Endotypes of COPD in China(COMPASS): study design, protocol and rationale[J]. ERJ Open Res, 2021, 7(3): 00201-02021. [11] Li Y, Wen FQ, Ma QL, et al. Use of CAPTURE to identify individuals who may or may not require treatment for chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2023, 208(4): 435-441. [12] Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary diseas(2022 report)[EB/OL].(2021-11-17)[2024-01-30]. https://goldcopd.org/. [13] Martinez FJ, Han MK, Allinson JP, et al. At the root: defining and halting progression of early chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2018, 197(12): 1540-1551. [14] Çolak Y, Afzal S, Nordestgaard BG, et al. Prevalence, characteristics, and prognosis of early chronic obstructive pulmonary disease. The Copenhagen general population study[J]. Am J Respir Crit Care Med, 2020, 201(6): 671-680. [15] Çolak Y, Afzal S, Nordestgaard BG, et al. Importance of early COPD in young adults for development of clinical COPD: findings from the Copenhagen general population study[J]. Am J Respir Crit Care Med, 2021, 203(10): 1245-1256. [16] Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary diseas(2023 report)[EB/OL].(2022-11-14)[2023-03-30]. https://goldcopd.org/. [17] Lange P, Celli B, Agustí A, et al. Lung-function trajectories leading to chronic obstructive pulmonary disease[J]. N Engl J Med, 2015, 373(2): 111-122. [18] Marott JL, Ingebrigtsen TS, Çolak Y, et al. Lung function trajectories leading to chronic obstructive pulmonary disease as predictors of exacerbations and mortality[J]. Am J Respir Crit Care Med, 2020, 202(2): 210-218. [19] Bui DS, Lodge CJ, Burgess JA, et al. Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life[J]. Lancet Respir Med, 2018, 6(7): 535-544. [20] Dharmage SC, Bui DS, Walters EH, et al. Lifetime spirometry patterns of obstruction and restriction, and their risk factors and outcomes: a prospective cohort study[J]. Lancet Respir Med, 2023, 11(3): 273-282. [21] Park J, Hobbs BD, Crapo JD, et al. Subtyping COPD by using visual and quantitative CT imaging features[J]. Chest, 2020, 157(1): 47-60. [22] Bodduluri S, Kizhakke Puliyakote A, Nakhmani A, et al. Computed tomography-based airway surface area-to-volume ratio for phenotyping airway remodeling in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2021, 203(2): 185-191. [23] Diaz AA, Orejas JL, Grumley S, et al. Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease[J]. JAMA, 2023, 329(21): 1832-1839. [24] Pistenmaa CL, Nardelli P, Ash SY, et al. Pulmonary arterial pruning and longitudinal change in percent emphysema and lung function: the genetic epidemiology of COPD study[J]. Chest, 2021, 160(2): 470-480. [25] Christenson SA, van den Berge M, Faiz A, et al. An airway epithelial IL-17A response signature identifies a steroid-unresponsive COPD patient subgroup[J]. J Clin Invest, 2019, 129(1): 169-181. [26] Zhang JZ, Xu HF, Qiao DD, et al. A polygenic risk score and age of diagnosis of COPD[J]. Eur Respir J, 2022, 60(3): 2101954. doi:10.1183/13993003.01954-2021. [27] Moll M, Lutz SM, Ghosh AJ, et al. Relative contributions of family history and a polygenic risk score on COPD and related outcomes: COPDGene and ECLIPSE studies[J]. BMJ Open Respir Res, 2020, 7(1): e000755. doi:10.1136/bmjresp-2020-000755. [28] Moll M, Boueiz A, Ghosh AJ, et al. Development of a blood-based transcriptional risk score for chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2022, 205(2): 161-170. doi:10.1164/rccm.202107-1584OC. [29] Wang Z, Locantore N, Haldar K, et al. Inflammatory endotype-associated airway microbiome in chronic obstructive pulmonary disease clinical stability and exacerbations: a multicohort longitudinal analysis[J]. Am J Respir Crit Care Med, 2021, 203(12): 1488-1502. [30] Yan ZZ, Chen BX, Yang YQ, et al. Multi-omics analyses of airway host-microbe interactions in chronic obstructive pulmonary disease identify potential therapeutic interventions[J]. Nat Microbiol, 2022, 7(9): 1361-1375. [31] Calzetta L, Rogliani P, Matera MG, et al. A systematic review with meta-analysis of dual bronchodilation with LAMA/LABA for the treatment of stable COPD[J]. Chest, 2016, 149(5): 1181-1196. [32] Oba Y, Sarva ST, Dias S. Efficacy and safety of long-acting β-agonist/long-acting muscarinic antagonist combinations in COPD: a network meta-analysis[J]. Thorax, 2016, 71(1): 15-25. [33] Donohue JF, Jones PW, Bartels C, et al. Correlations between FEV1 and patient-reported outcomes: a pooled analysis of 23 clinical trials in patients with chronic obstructive pulmonary disease[J]. Pulm Pharmacol Ther, 2018, 49: 11-19. doi:10.1016/j.pupt.2017.12.005. [34] Maltais F, Bjermer L, Kerwin EM, et al. Efficacy of umeclidinium/vilanterol versus umeclidinium and salmeterol monotherapies in symptomatic patients with COPD not receiving inhaled corticosteroids: the EMAX randomised trial[J]. Respir Res, 2019, 20(1): 238. doi:10.1186/s12931-019-1193-9. [35] Ray R, Tombs L, Naya I, et al. Efficacy and safety of the dual bronchodilator combination umeclidinium/vilanterol in COPD by age and airflow limitation severity: a pooled post hoc analysis of seven clinical trials[J]. Pulm Pharmacol Ther, 2019, 57: 101802. doi:10.1016/j.pupt.2019.101802. [36] Ferguson GT, Rabe KF, Martinez FJ, et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease(KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial[J]. Lancet Respir Med, 2018, 6(10): 747-758. [37] Muro S, Sugiura H, Darken P, et al. Efficacy of budesonide/glycopyrronium/formoterol metered dose inhaler in patients with COPD: post-hoc analysis from the KRONOS study excluding patients with airway reversibility and high eosinophil counts[J]. Respir Res, 2021, 22(1): 187. doi:10.1186/s12931-021-01773-1. [38] Rabe KF, Martinez FJ, Ferguson GT, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD[J]. N Engl J Med, 2020, 383(1): 35-48. [39] Martinez FJ, Rabe KF, Ferguson GT, et al. Reduced all-cause mortality in the ETHOS trial of budesonide/glycopyrrolate/formoterol for chronic obstructive pulmonary disease. A randomized, double-blind, multicenter, parallel-group study[J]. Am J Respir Crit Care Med, 2021, 203(5): 553-564. [40] Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD[J]. N Engl J Med, 2018, 378(18): 1671-1680. [41] Halpin DMG, Dransfield MT, Han MK, et al. The effect of exacerbation history on outcomes in the IMPACT trial[J]. Eur Respir J, 2020, 55(5): 1901921. doi:10.1183/13993003.01921-2019. [42] Lipson DA, Crim C, Criner GJ, et al. Reduction in all-cause mortality with fluticasone furoate/umeclidinium/vilanterol in patients with chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2020, 201(12): 1508-1516. [43] Han MK, Criner GJ, Dransfield MT, et al. The effect of inhaled corticosteroid withdrawal and baseline inhaled treatment on exacerbations in the IMPACT study. A randomized, double-blind, multicenter clinical trial[J]. Am J Respir Crit Care Med, 2020, 202(9): 1237-1243. [44] Calzetta L, Cazzola M, Matera MG, et al. Adding a LAMA to ICS/LABA therapy: a meta-analysis of triple combination therapy in COPD[J]. Chest, 2019, 155(4): 758-770. [45] Suissa S, DellAniello S, Ernst P. Comparative effects of LAMA-LABA-ICS vs LAMA-LABA for COPD: cohort study in real-world clinical practice[J]. Chest, 2020, 157(4): 846-855. [46] Pascoe S, Barnes N, Brusselle G, et al. Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial[J]. Lancet Respir Med, 2019, 7(9): 745-756. [47] Kerkhof M, Voorham J, Dorinsky P, et al. Association between COPD exacerbations and lung function decline during maintenance therapy[J]. Thorax, 2020, 75(9): 744-753. [48] Bafadhel M, Peterson S, De Blas MA, et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials[J]. Lancet Respir Med, 2018, 6(2): 117-126. [49] Martinez-Garcia MA, Faner R, Oscullo G, et al. Inhaled steroids, circulating eosinophils, chronic airway infection, and pneumonia risk in chronic obstructive pulmonary disease. A network analysis[J]. Am J Respir Crit Care Med, 2020, 201(9): 1078-1085. [50] Yun JH, Lamb A, Chase R, et al. Blood eosinophil count thresholds and exacerbations in patients with chronic obstructive pulmonary disease[J]. J Allergy Clin Immunol, 2018, 141(6): 2037-2047.e10. [51] Criner GJ, Celli BR, Brightling CE, et al. Benralizumab for the prevention of COPD exacerbations[J]. N Engl J Med, 2019, 381(11): 1023-1034. [52] Criner GJ, Celli BR, Singh D, et al. Predicting response to benralizumab in chronic obstructive pulmonary disease: analyses of GALATHEA and TERRANOVA studies[J]. Lancet Respir Med, 2020, 8(2): 158-170. [53] Le Floch A, Allinne J, Nagashima K, et al. Dual blockade of IL-4 and IL-13 with dupilumab, an IL-4Rα antibody, is required to broadly inhibit type 2 inflammation[J]. Allergy, 2020, 75(5): 1188-1204. [54] Bhatt SP, Rabe KF, Hanania NA, et al. Dupilumab for COPD with type 2 inflammation indicated by eosinophil counts[J]. N Engl J Med, 2023, 389(3): 205-214. |
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