從血常規到精準靶向：嗜酸粒細胞在哮喘診療中的價值_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

李婉瀅 , 陳垚欣 , 趙文驅 ,  趙海金

南方醫科大學南方醫院呼吸與危重癥醫學科慢性氣道疾病實驗室（廣東廣州 510515）;

Corresponding?author：

趙海金, Email: zhjin@smu.edu.cn

Keywords：

DOI：

10.7507/1671-6205.202607039

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

1.	Oh J, Kim S, Yim Y, et al. Global, regional, and national burden of chronic respiratory diseases and impact of the COVID-19 pandemic, 1990-2023: a Global Burden of Disease study[J]. Nat Med, 2026, 32(1): 197-223.
2.	Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study[J]. Lancet, 2019, 394(10196): 407-418.
3.	Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma[J]. Eur Respir J, 2014, 43(2): 343-373.
4.	胡玉玲, 黃海倫, 龔釗乾, 等. 初診哮喘患者呼出氣一氧化氮和血嗜酸性粒細胞雙高表型的危險因素及與肺功能受損的關系[J]. 中國預防醫學雜志, 2026, 27(4): 403-408.
5.	Brusselle GG, Koppelman GH. Biologic therapies for severe asthma[J]. N Engl J Med, 2022, 386(2): 157-171.
6.	Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases[J]. Lancet, 2018, 391(10118): 350-400.
7.	Lommatzsch M, Buhl R, Bergmann KC, et al. Eosinophils in asthma phenotypes: perpetrators or guilty by association?[J]. Lancet Respir Med, 2025, 13(10): 943-950.
8.	Ehrlich P. Beitr?ge zur Kenntnis der granulierten Bindegewebszellen und der eosinophilen Leukocyten[J]. Archiv für Anatomie und Physiologie (Physiologische Abteilung), 1879, 3: 166-169.
9.	Discombe G. Criteria of eosinophilia[J]. Lancet, 1946, 1(6389): 195.
10.	Brown HM. Treatment of chronic asthma with prednisolone; significance of eosinophils in the sputum[J]. Lancet, 1958, 2(7059): 1245-1247.
11.	Horn BR, Robin ED, Theodore J, et al. Total eosinophil counts in the management of bronchial asthma[J]. N Engl J Med, 1975, 292(22): 1152-1155.
12.	Bousquet J, Chanez P, Lacoste JY, et al. Eosinophilic inflammation in asthma[J]. N Engl J Med, 1990, 323(15): 1033-1039.
13.	Sanderson CJ. Interleukin-5, eosinophils, and disease[J]. Blood, 1992, 79(12): 3101-3109.
14.	Leckie MJ, ten Brinke A, Khan J, et al. Effects of an interleukin-5 blocking monoclonal antibody on eosinophils, airway hyper-responsiveness, and the late asthmatic response[J]. Lancet, 2000, 356(9248): 2144-2148.
15.	Haldar P, Brightling CE, Hargadon B, et al. Mepolizumab and exacerbations of refractory eosinophilic asthma[J]. N Engl J Med, 2009, 360(10): 973-984.
16.	Nair P, Pizzichini MM, Kjarsgaard M, et al. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia[J]. N Engl J Med, 2009, 360(10): 985-993.
17.	沈華浩, 張旻, 黃克武. 支氣管哮喘防治指南(2024年版)[J]. 中華結核和呼吸雜志, 2025, 48(3): 208-248.
18.	Djukanovi? R, Wilson SJ, Kraft M, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma[J]. Am J Respir Crit Care Med, 2004, 170(6): 583-593.
19.	Hanania NA, Wenzel S, Rosén K, et al. Exploring the effects of omalizumab in allergic asthma: an analysis of biomarkers in the EXTRA study[J]. Am J Respir Crit Care Med, 2013, 187(8): 804-811.
20.	Humbert M, Taillé C, Mala L, et al. Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study[J]. Eur Respir J, 2018, 51(5): 1702523.
21.	Casale TB, Luskin AT, Busse W, et al. Omalizumab effectiveness by biomarker status in patients with asthma: evidence from PROSPERO, a prospective real-world study[J]. J Allergy Clin Immunol Pract, 2019, 7(1): 156-164,e1.
22.	Menzies-Gow A, Flood-Page P, Sehmi R, et al. Anti-IL-5 (mepolizumab) therapy induces bone marrow eosinophil maturational arrest and decreases eosinophil progenitors in the bronchial mucosa of atopic asthmatics[J]. J Allergy Clin Immunol, 2003, 111(4): 714-719.
23.	Kolbeck R, Kozhich A, Koike M, et al. MEDI-563, a humanized anti-IL-5 receptor alpha mAb with enhanced antibody-dependent cell-mediated cytotoxicity function[J]. J Allergy Clin Immunol, 2010, 125(6): 1344-1353,e2.
24.	Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma[J]. N Engl J Med, 2014, 371(13): 1198-1207.
25.	Park HS, Lee SH, Lee SY, et al. Efficacy and safety of benralizumab for Korean patients with severe, uncontrolled eosinophilic asthma[J]. Allergy Asthma Immunol Res, 2019, 11(4): 508-518.
26.	FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial[J]. Lancet, 2016, 388(10056): 2128-2141.
27.	Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma[J]. N Engl J Med, 2017, 376(25): 2448-2458.
28.	Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β(2)-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial[J]. Lancet, 2016, 388(10056): 2115-2127.
29.	Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial[J]. Lancet, 2012, 380(9842): 651-659.
30.	McDowell PJ, Diver S, Yang F, et al. The inflammatory profile of exacerbations in patients with severe refractory eosinophilic asthma receiving mepolizumab (the MEX study): a prospective observational study[J]. Lancet Respir Med, 2021, 9(10): 1174-1184.
31.	Yao P, Yang L, Liu D, et al. Distribution of blood eosinophil counts in the Chinese general population[J]. Eur Respir J, 2026, 68(3): 2501570.
32.	Liang Z, Zhao H, Lv Y, et al. Moderate accuracy of peripheral eosinophil count for predicting eosinophilic phenotype in steroid-na?ve non-atopic adult asthmatics[J]. Intern Med, 2012, 51(7): 717-722.
33.	Westerhof GA, Korevaar DA, Amelink M, et al. Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes[J]. Eur Respir J, 2015, 46(3): 688-696.
34.	Wagener AH, de Nijs SB, Lutter R, et al. External validation of blood eosinophils, FE(NO) and serum periostin as surrogates for sputum eosinophils in asthma[J]. Thorax, 2015, 70(2): 115-120.
35.	Yi F, Fang Z, Liang H, et al. Diagnostic accuracy of blood eosinophils in comparison to other common biomarkers for identifying sputum eosinophilia in patients with chronic cough[J]. World Allergy Organ J, 2023, 16(9): 100819.
36.	Global Initiative for Asthma. Difficult-to-treat and severe asthma in adolescent and adult patients: diagnosis and management. A short GINA guide for health professionals[R]. Fontana, Wisconsin, USA: Global Initiative for Asthma, 2025.
37.	Heaney LG, Perez de Llano L, Al-Ahmad M, et al. Eosinophilic and noneosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort[J]. Chest, 2021, 160(3): 814-830.
38.	Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia[J]. J Allergy Clin Immunol, 2010, 126(1): 39-44.
39.	陳嚴, 應頌敏, 張超. 哮喘中嗜酸性粒細胞異質性研究進展[J]. 生理學報, 2024, 76(4): 643-652.
40.	Van Hulst G, Bureau F, Desmet CJ. Eosinophils as drivers of severe eosinophilic asthma: endotypes or plasticity?[J]. Int J Mol Sci, 2021, 22(18): 10150.
41.	Mesnil C, Raulier S, Paulissen G, et al. Lung-resident eosinophils represent a distinct regulatory eosinophil subset[J]. J Clin Invest, 2016, 126(9): 3279-3295.
42.	Weller PF, Spencer LA. Functions of tissue-resident eosinophils[J]. Nat Rev Immunol, 2017, 17(12): 746-760.
43.	Fricker M, Harrington J, Hiles SA, et al. Mepolizumab depletes inflammatory but preserves homeostatic eosinophils in severe asthma[J]. Allergy, 2024, 79(11): 3118-3128.
44.	Caminati M, Buhl R, Corren J, et al. Tezepelumab in patients with allergic and eosinophilic asthma[J]. Allergy, 2024, 79(5): 1134-1145.
45.	FitzGerald JM, Bleecker ER, Menzies-Gow A, et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies[J]. Lancet Respir Med, 2018, 6(1): 51-64.
46.	Castro M, Corren J, Pavord ID, et al. Dupilumab Efficacy and safety in moderate-to-severe uncontrolled asthma[J]. N Engl J Med, 2018, 378(26): 2486-2496.
47.	Rabe KF, Nair P, Brusselle G, et al. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma[J]. N Engl J Med, 2018, 378(26): 2475-2485.
48.	Denton E, Price DB, Tran TN, et al. Cluster analysis of inflammatory biomarker expression in the international severe asthma registry[J]. J Allergy Clin Immunol Pract, 2021, 9(7): 2680-2688,e7.
49.	Jackson DJ, Korn S, Mathur SK, et al. Safety of eosinophil-depleting therapy for severe, eosinophilic asthma: focus on benralizumab[J]. Drug Saf, 2020, 43(5): 409-425.

1. Oh J, Kim S, Yim Y, et al. Global, regional, and national burden of chronic respiratory diseases and impact of the COVID-19 pandemic, 1990-2023: a Global Burden of Disease study[J]. Nat Med, 2026, 32(1): 197-223.
2. Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study[J]. Lancet, 2019, 394(10196): 407-418.
3. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma[J]. Eur Respir J, 2014, 43(2): 343-373.
4. 胡玉玲, 黃海倫, 龔釗乾, 等. 初診哮喘患者呼出氣一氧化氮和血嗜酸性粒細胞雙高表型的危險因素及與肺功能受損的關系[J]. 中國預防醫學雜志, 2026, 27(4): 403-408.
5. Brusselle GG, Koppelman GH. Biologic therapies for severe asthma[J]. N Engl J Med, 2022, 386(2): 157-171.
6. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases[J]. Lancet, 2018, 391(10118): 350-400.
7. Lommatzsch M, Buhl R, Bergmann KC, et al. Eosinophils in asthma phenotypes: perpetrators or guilty by association?[J]. Lancet Respir Med, 2025, 13(10): 943-950.
8. Ehrlich P. Beitr?ge zur Kenntnis der granulierten Bindegewebszellen und der eosinophilen Leukocyten[J]. Archiv für Anatomie und Physiologie (Physiologische Abteilung), 1879, 3: 166-169.
9. Discombe G. Criteria of eosinophilia[J]. Lancet, 1946, 1(6389): 195.
10. Brown HM. Treatment of chronic asthma with prednisolone; significance of eosinophils in the sputum[J]. Lancet, 1958, 2(7059): 1245-1247.
11. Horn BR, Robin ED, Theodore J, et al. Total eosinophil counts in the management of bronchial asthma[J]. N Engl J Med, 1975, 292(22): 1152-1155.
12. Bousquet J, Chanez P, Lacoste JY, et al. Eosinophilic inflammation in asthma[J]. N Engl J Med, 1990, 323(15): 1033-1039.
13. Sanderson CJ. Interleukin-5, eosinophils, and disease[J]. Blood, 1992, 79(12): 3101-3109.
14. Leckie MJ, ten Brinke A, Khan J, et al. Effects of an interleukin-5 blocking monoclonal antibody on eosinophils, airway hyper-responsiveness, and the late asthmatic response[J]. Lancet, 2000, 356(9248): 2144-2148.
15. Haldar P, Brightling CE, Hargadon B, et al. Mepolizumab and exacerbations of refractory eosinophilic asthma[J]. N Engl J Med, 2009, 360(10): 973-984.
16. Nair P, Pizzichini MM, Kjarsgaard M, et al. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia[J]. N Engl J Med, 2009, 360(10): 985-993.
17. 沈華浩, 張旻, 黃克武. 支氣管哮喘防治指南(2024年版)[J]. 中華結核和呼吸雜志, 2025, 48(3): 208-248.
18. Djukanovi? R, Wilson SJ, Kraft M, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma[J]. Am J Respir Crit Care Med, 2004, 170(6): 583-593.
19. Hanania NA, Wenzel S, Rosén K, et al. Exploring the effects of omalizumab in allergic asthma: an analysis of biomarkers in the EXTRA study[J]. Am J Respir Crit Care Med, 2013, 187(8): 804-811.
20. Humbert M, Taillé C, Mala L, et al. Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study[J]. Eur Respir J, 2018, 51(5): 1702523.
21. Casale TB, Luskin AT, Busse W, et al. Omalizumab effectiveness by biomarker status in patients with asthma: evidence from PROSPERO, a prospective real-world study[J]. J Allergy Clin Immunol Pract, 2019, 7(1): 156-164,e1.
22. Menzies-Gow A, Flood-Page P, Sehmi R, et al. Anti-IL-5 (mepolizumab) therapy induces bone marrow eosinophil maturational arrest and decreases eosinophil progenitors in the bronchial mucosa of atopic asthmatics[J]. J Allergy Clin Immunol, 2003, 111(4): 714-719.
23. Kolbeck R, Kozhich A, Koike M, et al. MEDI-563, a humanized anti-IL-5 receptor alpha mAb with enhanced antibody-dependent cell-mediated cytotoxicity function[J]. J Allergy Clin Immunol, 2010, 125(6): 1344-1353,e2.
24. Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma[J]. N Engl J Med, 2014, 371(13): 1198-1207.
25. Park HS, Lee SH, Lee SY, et al. Efficacy and safety of benralizumab for Korean patients with severe, uncontrolled eosinophilic asthma[J]. Allergy Asthma Immunol Res, 2019, 11(4): 508-518.
26. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial[J]. Lancet, 2016, 388(10056): 2128-2141.
27. Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma[J]. N Engl J Med, 2017, 376(25): 2448-2458.
28. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β(2)-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial[J]. Lancet, 2016, 388(10056): 2115-2127.
29. Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial[J]. Lancet, 2012, 380(9842): 651-659.
30. McDowell PJ, Diver S, Yang F, et al. The inflammatory profile of exacerbations in patients with severe refractory eosinophilic asthma receiving mepolizumab (the MEX study): a prospective observational study[J]. Lancet Respir Med, 2021, 9(10): 1174-1184.
31. Yao P, Yang L, Liu D, et al. Distribution of blood eosinophil counts in the Chinese general population[J]. Eur Respir J, 2026, 68(3): 2501570.
32. Liang Z, Zhao H, Lv Y, et al. Moderate accuracy of peripheral eosinophil count for predicting eosinophilic phenotype in steroid-na?ve non-atopic adult asthmatics[J]. Intern Med, 2012, 51(7): 717-722.
33. Westerhof GA, Korevaar DA, Amelink M, et al. Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes[J]. Eur Respir J, 2015, 46(3): 688-696.
34. Wagener AH, de Nijs SB, Lutter R, et al. External validation of blood eosinophils, FE(NO) and serum periostin as surrogates for sputum eosinophils in asthma[J]. Thorax, 2015, 70(2): 115-120.
35. Yi F, Fang Z, Liang H, et al. Diagnostic accuracy of blood eosinophils in comparison to other common biomarkers for identifying sputum eosinophilia in patients with chronic cough[J]. World Allergy Organ J, 2023, 16(9): 100819.
36. Global Initiative for Asthma. Difficult-to-treat and severe asthma in adolescent and adult patients: diagnosis and management. A short GINA guide for health professionals[R]. Fontana, Wisconsin, USA: Global Initiative for Asthma, 2025.
37. Heaney LG, Perez de Llano L, Al-Ahmad M, et al. Eosinophilic and noneosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort[J]. Chest, 2021, 160(3): 814-830.
38. Roufosse F, Weller PF. Practical approach to the patient with hypereosinophilia[J]. J Allergy Clin Immunol, 2010, 126(1): 39-44.
39. 陳嚴, 應頌敏, 張超. 哮喘中嗜酸性粒細胞異質性研究進展[J]. 生理學報, 2024, 76(4): 643-652.
40. Van Hulst G, Bureau F, Desmet CJ. Eosinophils as drivers of severe eosinophilic asthma: endotypes or plasticity?[J]. Int J Mol Sci, 2021, 22(18): 10150.
41. Mesnil C, Raulier S, Paulissen G, et al. Lung-resident eosinophils represent a distinct regulatory eosinophil subset[J]. J Clin Invest, 2016, 126(9): 3279-3295.
42. Weller PF, Spencer LA. Functions of tissue-resident eosinophils[J]. Nat Rev Immunol, 2017, 17(12): 746-760.
43. Fricker M, Harrington J, Hiles SA, et al. Mepolizumab depletes inflammatory but preserves homeostatic eosinophils in severe asthma[J]. Allergy, 2024, 79(11): 3118-3128.
44. Caminati M, Buhl R, Corren J, et al. Tezepelumab in patients with allergic and eosinophilic asthma[J]. Allergy, 2024, 79(5): 1134-1145.
45. FitzGerald JM, Bleecker ER, Menzies-Gow A, et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies[J]. Lancet Respir Med, 2018, 6(1): 51-64.
46. Castro M, Corren J, Pavord ID, et al. Dupilumab Efficacy and safety in moderate-to-severe uncontrolled asthma[J]. N Engl J Med, 2018, 378(26): 2486-2496.
47. Rabe KF, Nair P, Brusselle G, et al. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma[J]. N Engl J Med, 2018, 378(26): 2475-2485.
48. Denton E, Price DB, Tran TN, et al. Cluster analysis of inflammatory biomarker expression in the international severe asthma registry[J]. J Allergy Clin Immunol Pract, 2021, 9(7): 2680-2688,e7.
49. Jackson DJ, Korn S, Mathur SK, et al. Safety of eosinophil-depleting therapy for severe, eosinophilic asthma: focus on benralizumab[J]. Drug Saf, 2020, 43(5): 409-425.

Chinese Journal of Respiratory and Critical Care Medicine

Latest Articles從血常規到精準靶向：嗜酸粒細胞在哮喘診療中的價值

Abstract Full text Figures/Tables Video References Cited by

Format

Content