硫酸镁联合川芎嗪治疗喘憋性肺炎48例

目的探讨硫酸镁联合川芎嗪对喘憋性肺炎患儿的治疗效果。方法48例喘憋性肺炎患儿分为对照组(n=21)和治疗组(n=27)。对照组采用吸氧、抗感染、氨茶碱解痉等对症支持疗法;治疗组在常规治疗的基础上加用硫酸镁和川芎嗪代替氨茶碱。结果与对照组比较,硫酸镁联合川芎嗪治疗小儿喘憋性肺炎可以明显改善患儿呼吸困难、喘鸣等症状和体征,促进肺部炎症的吸收,缩短住院时间(P<0.01)。结论硫酸镁和川芎嗪联合应用可以起到协同治疗作用,减少心肺等重要器官衰竭的并发症发生。     

喘乐宁、爱喘乐、普米克联合沐舒坦氧驱动雾化吸入治疗毛细支气管炎的疗效观察

目的 探讨喘乐宁、爱喘乐、普米克联合沐舒坦氧驱动雾化吸入治疗毛细支气管炎的疗效.方法 将毛细支气管炎患儿126例随机分为两组,观察组69例,对照组57例,两组常规治疗方法相同,观察组加予喘乐宁、爱喘乐、普米克联合沐舒坦氧驱动雾化吸入,对照组仅予常规治疗.观察两组治疗效果及解除主要症状和体征的时间.结果 观察组治愈率、缓解喘憋及缩短哮鸣音持续时间均明显优于对照组(P＜0.05).结论 喘乐宁、爱喘乐、普米克联合沐舒坦氧驱动雾化吸入治疗毛细支气管炎显效迅速,疗效显著.     

特布他林、爱喘乐及普米克令舒喷射雾化吸入治疗毛细支气管炎30例

目的探讨特布他林、爱喘乐及普米克令舒三药联合喷射雾化吸入治疗毛细支气管炎的疗法。方法将56例住院毛细支气管炎患儿随机分为两组：对照组26例给予抗感染、吸氧祛痰、静注糖皮质激素等全身用药综合治疗；治疗组30例在上述治疗基础上加用特布他林、爱喘乐及普米克令舒喷射雾化吸入治疗3～5天。结果与对照组比较，治疗组的症状、体征改善优于对照组，病程缩短，且治愈率明显高于对照组（P〈0．01）。结论在常规治疗基础上加用特布他林、爱喘乐及普米克令舒喷射雾化吸入治疗毛细支气管炎能缩短病程，值得临床推广。     

Role of cysteinyl leukotrienes in airway inflammation and responsiveness following RSV infection in BALB/c mice

Cysteinyl leukotrienes (CysLTs) contribute to the development of airway obstruction and inflammation in asthma; however little information is available on the role of these molecules in the pathophysiology of respiratory syncytial virus (RSV) bronchiolitis. This study was designed to evaluate the effects of RSV infection on CysLTs production in a well-established mouse infection model. Furthermore, we assessed the effect of anti-inflammatory agents (a leukotriene receptor antagonist, MK-571, and dexamethasone) on the functional and immune changes induced by RSV infection. Six to 8-wk-old BALB/c mice were infected with human RSV (strain A2). Measurements of airway function were performed using whole body plethysmography. Lung inflammation was assessed by cell counts, measurement of cytokines and CysLTs in bronchoalveolar lavage fluid (BALF) in the absence and presence of treatment with MK-571 or dexamethasone. RSV infection produced a marked increase in CysLTs in the BALF and lung tissue, recruitment of neutrophils and lymphocytes into the airways, increased IFN-gamma levels and airway hyperresponsiveness (AHR). Treatment with MK-571 decreased RSV-induced AHR without affecting the cellular and inflammatory responses to RSV. Dexamethasone decreased AHR and markedly reduced the recruitment of inflammatory cells and production of IFN-gamma. Our findings suggest CysLTs play an important role in the pathogenesis of RSV-induced airway dysfunction. Treatment with MK-571 decreases RSV-induced AHR but does not appear to alter the lung inflammatory responses to RSV. In contrast, dexamethasone decreases RSV-induced AHR but interferes with recruitment of inflammatory cells, resulting in decreased Th1 cytokines (a potentially Th2-prone environment) in this model. These studies support recent reports on the beneficial effects of CysLT receptor antagonist in human trials and provide a model for investigating the role of CysLTs in RSV bronchiolitis.     

Long-term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a quantitative review

One of the major questions regarding long-term side effects of bronchiolitis by respiratory syncytial virus (RSV) is whether or not it induces asthma in later life. In this quantitative review, the data of 10 controlled studies are analysed. METHODS: Follow-up studies of RSV bronchiolitis published between January 1978 and December 1998 were identified through a MEDLINE search. Studies were selected if (i) postnatal age at the time of the initial illness was below 12 mo, (ii) all children were hospitalized for RSV bronchiolitis, (iii) the diagnosis RSV was virologically confirmed in all cases, and (iv) a control group was used. RESULTS: Six studies met all selection criteria. Up to 5 y of follow-up after RSV bronchiolitis in infancy, 40% of children reported wheezing as compared to only 11% in the control group (p <0.001). Between 5 and 10 y of follow-up 22% of the bronchiolitis group reported wheezing against 10% of the control group (p = 0.19). The incidence of recurrent wheezing as defined by three or more wheezing episodes also decreased with increasing years of follow-up: at 5 or more years of follow-up the difference between the RSV group and the control group was no longer significant. Furthermore, the presence of either a personal and/or a family history of either atopy and/or asthma did not differ between the two groups. CONCLUSIONS: Wheezing is common after RSV bronchiolitis in infancy. It may persist for > or = 5 y of follow-up. However, no significant difference between the RSV bronchiolitis and the control group was observed regarding recurrent wheezing by 5 y of follow-up. No significant difference between the RSV bronchiolitis and the control group were found regarding a personal history of atopy, a family history of atopy and/or asthma. Therefore it seems unlikely that RSV bronchiolitis is a cause of atopic asthma in later life.     

毛细支气管炎患儿血清病毒抗体检测及意义

目的：了解2005年10月～2006年3月我院毛细支气管炎患儿的主要病毒致病原。方法：对190例毛细支气管炎患儿进行了合胞病毒、腺病毒、流感病毒和副流感病毒抗体检测。结果：131例患儿病毒榆测抗体阳性。流感病毒抗体阳性68例（51．91%），呼吸道合胞瘸毒抗体27例（20．610％），副流感病毒抗体26例（19．85％），腺病毒抗体10例（7．63％）．病毒抗体阳性类型不同的毛细支气管炎患儿在年龄和病情方面的差异无显著性，P〉0．05。结论：流感病毒是毛细支气管炎的主要致病原。     

Eosinophil cationic protein in nasopharyngeal secretions and serum of infants infected with respiratory syncytial virus

Eosinophil cationic protein (ECP) was assayed in nasopharyngeal secretion (NPS) and serum from 42 infants, hospitalized with acute lower respiratory infection, in El Salvador and the results analyzed in relation to etiology of the infection. ECP concentrations were high in NPS, at an average 50 times higher than those found in serum. Exceedingly high levels of ECP (> 1000 μg/L) were found more frequently in wheezing than in non-wheezing children (30% vs 7%) and, accordingly, were more commonly found in children hospitalized with bronchiolitis than in those with pneumonia. Excessive levels were significantly more common in girls than in boys. Of the 42 cases, 28 were found to be caused by respiratory syncytial virus (RSV) subgroup A, and 3 by RSV-B, by means of detection of RSV antigen in nasopharyngeal cells. ECP serum levels were moderately elevated during the acute phase of the respiratory infection and increased slightly but significantly, in cases with RSV antigen-positive bronchiolitis, but not in those with pneumonia. The ECP levels in NPS from patients in Sweden who, by antigen detection in NPS cells, were diagnosed as either RSV or para-influenza 3 infection or none of these, were similar. These results indicate that elevation of ECP in NPS is associated with acute lower respiratory infection in general, but particularly pronounced in cases of bronchiolitis. Elevation of ECP is not an exclusive consequence of RSV infection, but may occur to an equal extent in infections caused by other agents. Girls generally seem to be less prone than boys to developing airway obstruction and may, therefore, acquire severe bronchiolitis only when large amounts of inflammatory mediators, such as ECP, accumulate in the airways.     

Respiratory syncytial virus infection and immunoprophylaxis for selected high-risk children in Central Australia

BACKGROUND: There are limited data on the epidemiology and viral aetiology of bronchiolitis in Central Australia and respiratory syncytial virus (RSV) immunoprophylaxis in an Australian population. OBJECTIVE: To (i) determine the incidence and the viral aetiology of bronchiolitis hospitalisations and (ii) report on the usage of RSV immunoprophylaxis in selected high-risk infants and children in Central Australia. METHODOLOGY: A retrospective review was performed of all hospital separations for bronchiolitis for a three-year period, 1998-2000. Respiratory viruses in the nasopharyngeal aspirates were identified from the cases in the year 2000. A combined retrospective chart review and prospective follow up study was undertaken of all the infants and children who received RSV immunoprophylaxis at the Alice Springs Hospital, Central Australia. RESULTS: Incidence of bronchiolitis hospitalisation in infants for 1998, 1999 and 2000 were 176, 200 and 180 per 1000, respectively. Nine high-risk children had RSV immunoprophylaxis on a total of 46 occasions and there were two mild RSV-related illnesses in them. None had severe lower respiratory tract illness. CONCLUSION: The incidence of bronchiolitis in Central Australia is extremely high. The usage of RSV immunoprophylaxis may be justified in selected high-risk children living in high endemic areas.     

The effect of bronchiolitis obliterans syndrome on health related quality of life

Bronchiolitis obliterans syndrome (BOS) is the most important factor limiting long-term survival after lung transplantation, and has a substantial impact on patients' daily life in terms of disability and morbidity. Aim of our study was to examine the effects of BOS on health related quality of life (HRQL) in lung transplantation patients. Data on HRQL from 29 patients who developed BOS at least 18 months earlier were studied longitudinally. HRQL measures were: the Nottingham Health Profile (NHP), the State Trait Anxiety Inventory (STAI), the Self-rating Depression Scale (ZUNG), and the Index of Well Being (IWB). Furthermore questions concerning activities of daily life and dyspnea were asked. The majority of the patients were male, and the most common diagnosis was emphysema. After the onset of BOS, significantly more restrictions were reported on the dimensions energy and mobility of the NHP. These restrictions appeared to increase over time. After the onset of BOS, STAI scores remained more or less stable and close to the value of the general population. ZUNG scores were significantly higher after the onset of BOS, and patients experienced a lower level of well being than the general population. The percentage of patients that reported to be able to perform activities of daily life without effort declined dramatically after the onset of BOS. Furthermore, the percentage of patients complaining of dyspnea increased after the onset of BOS. In conclusion, our study showed that HRQL was negatively affected by the onset of BOS. However, in spite of these less favorable long-term results, even patients who develop BOS may at least temporarily benefit from a lung transplantation.     

Production of interferon gamma in respiratory syncytial virus infection of humans is not associated with interleukins 12 and 18

In order to understand early events in the immune response to respiratory syncytial virus (RSV) infection, we studied the presence of various chemokines and cytokines in respiratory secretions of human infants with RSV infection. Interferon gamma (IFNgamma) was present in 30/39 (76.9%) subjects tested, but the IFNgamma-inducing cytokines interleukin (IL)12 and IL18 were detectable in 6/40 (15%) and 11/38 (28.9%) subjects, respectively. Quantities of IL12 and IL18 did not correlate with those of IFNgamma. IL18, but neither IFNgamma nor IL12 was found in significantly greater concentrations in subjects with mild, nonhypoxic forms of bronchiolitis than in those with upper respiratory illness alone or hypoxic bronchiolitis. The findings suggest that IFNgamma may be induced independently of the activities of IL12 and IL18 during RSV infection. Immune responses characterized by relatively greater release of IL18 may be associated with milder forms of bronchiolitis.