Abstract：
BACKGROUND: Recent evidence suggests that insulin resistance affects asthma outcomes. However, the effect of the homeostatic measure of insulin resistance (HOMA-IR) on airway inflammation and asthma exacerbations (AEs) is poorly understood.
OBJECTIVE: To analyze the relationship between HOMA-IR and clinical and inflammatory characteristics in patients with asthma, and the association between HOMA-IR and AEs in the following year.
METHODS: A prospective cohort study recruited participants with asthma, who were classified into the HOMA-IRhigh group and HOMA-IRlow group based on the cutoff value of 3.80 for HOMA-IR and were observed within 12 months. We evaluated the clinical and inflammatory features and conducted a 1-year follow-up to study the exacerbations. We used negative binomial regression models to analyze the association between HOMA-IR and AEs.
RESULTS: Compared with patients in the HOMA-IRlow group (n = 564), those in the HOMA-IRhigh group (n = 61) had higher levels of body mass index, a higher waist circumference and waist-hip ratio, higher triglycerides, lower cholesterol high-density lipoproteins, more neutrophils in the peripheral blood, and elevated IL-5 levels in the induced sputum. Furthermore, patients in the HOMA-IRhigh group had a significantly increased risk for moderate to severe AEs (adjusted incidence rate ratio [aIRR] = 2.26; 95% CI, 1.38-3.70), severe AEs (aIRR = 2.42; 95% CI, 1.26-4.67), hospitalization (aIRR = 2.54; 95% CI, 1.20-5.38), and emergency visits (aIRR = 3.04; 95% CI, 1.80-8.53).
CONCLUSIONS: The homeostatic measure of insulin resistance was associated with asthma-related clinical features and airway inflammation, and was an independent risk factor for future AEs. Therefore, insulin resistance may have important implications for managing asthma as a potential treatable trait.
OBJECTIVE: To analyze the relationship between HOMA-IR and clinical and inflammatory characteristics in patients with asthma, and the association between HOMA-IR and AEs in the following year.
METHODS: A prospective cohort study recruited participants with asthma, who were classified into the HOMA-IRhigh group and HOMA-IRlow group based on the cutoff value of 3.80 for HOMA-IR and were observed within 12 months. We evaluated the clinical and inflammatory features and conducted a 1-year follow-up to study the exacerbations. We used negative binomial regression models to analyze the association between HOMA-IR and AEs.
RESULTS: Compared with patients in the HOMA-IRlow group (n = 564), those in the HOMA-IRhigh group (n = 61) had higher levels of body mass index, a higher waist circumference and waist-hip ratio, higher triglycerides, lower cholesterol high-density lipoproteins, more neutrophils in the peripheral blood, and elevated IL-5 levels in the induced sputum. Furthermore, patients in the HOMA-IRhigh group had a significantly increased risk for moderate to severe AEs (adjusted incidence rate ratio [aIRR] = 2.26; 95% CI, 1.38-3.70), severe AEs (aIRR = 2.42; 95% CI, 1.26-4.67), hospitalization (aIRR = 2.54; 95% CI, 1.20-5.38), and emergency visits (aIRR = 3.04; 95% CI, 1.80-8.53).
CONCLUSIONS: The homeostatic measure of insulin resistance was associated with asthma-related clinical features and airway inflammation, and was an independent risk factor for future AEs. Therefore, insulin resistance may have important implications for managing asthma as a potential treatable trait.
摘要：
目的：最近的证据表明胰岛素抵抗影响哮喘的预后；然而，胰岛素抵抗稳态测量(HOMA-IR)对气道炎症和哮喘加重(AE)的影响尚不清楚.
目的：分析哮喘患者HOMA-IR与临床及炎症特征的关系。以及下一年HOMA-IR与哮喘急性加重（AE）之间的关联。
方法：一项前瞻性队列研究招募了哮喘患者，根据HOMA-IR的截止值3.80分为HOMA-IRhigh组和HOMA-IRlow组，并在12个月内观察到。我们评估了临床和炎症特征，并进行了1年的随访以研究急性加重.采用负二项回归模型分析HOMA-IR与AEs的相关性。
结果：与HOMA-IRlow组患者（n=564）相比，HOMA-IRhigh组（n=61）患者的BMI水平较高，较高的腰围和腰/臀比，更高的甘油三酯，低胆固醇高密度脂蛋白（HDL），外周血中嗜中性粒细胞增多，诱导痰中IL-5水平升高。此外，HOMA-IRhigh组患者发生中度至重度不良事件的风险显著增加(调整后发生率比(aIRR)=2.26,95%置信区间(CI)=[1.38,3.70]),严重不良事件（aIRR=2.42，95%CI=[1.26，4.67]），住院（aIRR=2.54，95%CI=[1.20，5.38]），和紧急就诊(aIRR=3.04，95%CI=[1.80，8.53])。
结论：HOMA-IR与哮喘相关的临床特征相关，和气道炎症，以及未来AE的独立风险因素。因此,胰岛素抵抗可能对作为潜在可治疗特征的哮喘的治疗具有重要意义.
目的：分析哮喘患者HOMA-IR与临床及炎症特征的关系。以及下一年HOMA-IR与哮喘急性加重（AE）之间的关联。
方法：一项前瞻性队列研究招募了哮喘患者，根据HOMA-IR的截止值3.80分为HOMA-IRhigh组和HOMA-IRlow组，并在12个月内观察到。我们评估了临床和炎症特征，并进行了1年的随访以研究急性加重.采用负二项回归模型分析HOMA-IR与AEs的相关性。
结果：与HOMA-IRlow组患者（n=564）相比，HOMA-IRhigh组（n=61）患者的BMI水平较高，较高的腰围和腰/臀比，更高的甘油三酯，低胆固醇高密度脂蛋白（HDL），外周血中嗜中性粒细胞增多，诱导痰中IL-5水平升高。此外，HOMA-IRhigh组患者发生中度至重度不良事件的风险显著增加(调整后发生率比(aIRR)=2.26,95%置信区间(CI)=[1.38,3.70]),严重不良事件（aIRR=2.42，95%CI=[1.26，4.67]），住院（aIRR=2.54，95%CI=[1.20，5.38]），和紧急就诊(aIRR=3.04，95%CI=[1.80，8.53])。
结论：HOMA-IR与哮喘相关的临床特征相关，和气道炎症，以及未来AE的独立风险因素。因此,胰岛素抵抗可能对作为潜在可治疗特征的哮喘的治疗具有重要意义.
