支气管哮喘脱敏治疗66例

近年,我院对支气管哮喘患者进行了吸入性变应原(致敏原)皮试检测,根据皮试结果对外源性支气管哮喘患者采用相应致敏原给予脱敏治疗,收到较好效果。现将其资料完整的66例报告如下。1临床资料66例患者年龄2~60岁,2~8岁5例,17~45岁47例,46~60岁14例。病程在1年内者3例,1~5年26例,5~10年20例,10年以上17例。诊断符合1992年广州全国哮喘会议修订的哮喘诊断标准[1]。脱敏治疗疗程6~18个月。2方法与结果2.1脱敏治疗方法根据变应原皮试结果选择相应的起始浓度(见表1),上臂皮下注射,每周两次,从0·1ml开始递增剂量,每一个浓度级注射10次,至1·0ml为一…     

615例变态反应性哮喘病因分析

我们对山东地区来本院就诊的2030例患者进行了吸入性及食物性特异性变应原皮试。其中支气管哮喘患者共716例,吸入性变应原皮试阳性者为615例,占哮喘受检者的85.89%。皮试结果:尘螨皮试阳性率为76.10%,屋尘为68.94%,多价霉菌(Ⅰ、Ⅱ)为48.94%。对1～4种花粉(早春花粉、晚春花粉、夏秋花粉、蒿属花粉)过敏者为     

变应原脱敏治疗支气管哮喘疗效评价

目的 评价9种变应原对支气管哮喘患脱敏治疗的疗效与复发率。方法 选用9种变应原经皮试阳性的哮喘患行脱敏治疗。结果 本组坚持脱敏治疗一年以上的病例561例。总有效率81．64％（458／561）。临床控制率8．56％（48／561）。脱敏治疗小于2年，停药后复发率高达79．39％（208／262），脱敏治疗大于2年和3年停药后复发率分别为47．09％（81／172）和22．33％（23／103）．三组间比较差异显（P＜0．001）。结论：脱敏对过敏原明确的哮喘患临床疗效显，复发率和治疗时间呈相关。     

武汉地区支气管哮喘患者常见吸入变应原调查

60％～80％的支气管哮喘发病与过敏因素有关，由于地理环境和气候的不同，变应原的分布具有鲜明的地区性和季节性的特点。本研究随机调查了2003年武汉地区204例支气管哮喘患者常见的吸入性变应原，并对其中的128例尘螨阳性患者进行了血清特异性IgE(sIgE)检测，以探讨本地区支气管哮喘患者的主要变应原。     

摩拉生物共振诊断治疗仪配合治疗支气管哮喘32例疗效观察

目的使用摩拉生物共振诊断治疗仪对26例支气管哮喘患者针对变应原进行脱敏治疗。方法将患者自身电磁波及过敏原检测结果输入仪器,经设备分析后将病理波形镜象回输,对26例支气管哮喘患者进行脱敏配合药物治疗并与单纯药物治疗组26例对照。结果生物共振诊断治疗仪脱敏配合治疗哮喘控制率65.38%,对照组控制率34.62%,优于对照组。结论生物共振诊断治疗仪配合治疗支气管哮喘疗效较佳,无任何不良反应,患者依从性好。     

唐山地区支气管哮喘患者吸入变应原调查分析

目的调查唐山地区主要吸入性变应原。方法选用20种变应原抗原对唐山地区160例过敏性支气管哮喘患者进行皮肤针刺试验。并将样本中44例4～18岁患者设为儿童组,116例19～80岁患者设为成人组。比较两组在变应原阳性率分布上的差异。结果变应原皮肤试验阳性率前8位的变应原分别为粉尘螨(DF)、屋尘螨(DP)、葎草、夏秋花粉Ⅰ、春季花粉Ⅰ、枝孢芽枝、多价真菌Ⅰ、春季花粉Ⅱ。儿童组中吸入变应原以单种过敏者为主,成人吸入变应原2～3种同时过敏者为多,两者之间χ2=4.04,P0.01。结论尘螨、葎草和夏秋花粉Ⅰ是唐山地区过敏性支气管哮喘患者最重要的变应原。     

546例支气管哮喘患者过敏原检测分析

目的探讨支气管哮喘患者的过敏原分布情况及防护措施。方法对2007—2009年546例支气管哮喘患者进行22种过敏原皮内试验。结果546例支气管哮喘患者中,吸入性过敏原阳性498例,阳性率91。2％;食入性过敏原阳性502例,阳性率91．9％。吸入性过敏原排在前五位分别是室内尘土75．5％、粉尘螨68．1％、春季花粉I52．4％、桑蚕丝41．0％、多价昆虫39．2％;食入性过敏原主要有：海虾64．5％、海鱼56．4％。结论过敏原是支气管哮喘的诱发因素之一,避免接触过敏原或环境干预降低过敏原的浓度,将减少或避免支气管哮喘的发作次数和减轻症状。     

哮喘儿童体外过敏原检测及临床意义

目的:研究体外过敏原检测法在各年龄组哮喘儿童病因诊断中的临床意义。方法:应用UniCAP100系统的荧光酶联免疫方法,对106例临床确诊的哮喘患儿及86例无特异性疾病的对照组患儿进行吸入性变应原筛查(Phadiatop)和食物性变应原筛查(fx5),比较2组筛查的结果。哮喘组Phadiatop阳性者,选测尘螨、霉菌、猫及狗毛皮屑,树木和草花粉血清特异性IgE(SIgE)。fx5阳性,选测鸡蛋和牛奶SIgE。结果:变应原过筛总阳性率为67.92%,其中Phadiatop阳性率高于fx5,Phadiatop和fx5 2种检测的灵敏度为67.9%,特异度为88.4%。Phadiatop阳性率随年龄增加而增加,fx5则减少(P=0.001)。哮喘儿童变应原阳性率在不同性别、有无家族及有无本人特应性之间差异均无统计学意义(P>0.05)。结论:哮喘儿童2/3变应原阳性,婴幼儿期以食物性过敏原为主,吸入性过敏原随年龄而增加。吸入性变应原是哮喘儿童的主要病因。     

特异性皮试、气道反应性测定在区别EBA和IBA中的价值

支气管哮喘分外源性支气管哮喘(EBA)与内源性支气管哮喘(IBA)两类。因两者的病因、发病机制、治疗方法和预后各不相同,故区别两者对治疗非常重要。我们对163例支气管哮喘病人进行了特异性皮肤试验(即吸入性变应原皮试),并对反应阳性和反应阴性的病人进行了临床资料、血清总IgE测定和气道反应性测定的比较,以观察     

西安地区支气管哮喘患者特异性IgE检测结果分析

目的 了解西安地区支气管哮喘(简称哮喘)患者外源性过敏原特异性IgE(sIgE)和总IgE在不同年龄的特点,探讨哮喘的致病因素,为环境控制和免疫治疗提供依据.方法 收集2016年10月至2017年1月西安交通大学第二附属医院呼吸内科及儿科门诊临床诊断为哮喘患者140例,按年龄分为成人组和少儿组,使用免疫印迹法过敏原sIgE抗体检测试剂盒,测定哮喘患者血清中的sIgE和总IgE浓度,并比较两组间变应原分布及差异.结果 140例哮喘患者中,总IgE阳性率少儿组、成人组分别为53.4%和60.9%,两组差异无统计学意义.在吸入性过敏原中,少儿组吸入性过敏原sIgE阳性率以屋尘、猫毛/狗毛皮屑为主,阳性率分别为44.78%和27.59%;成人组吸入性过敏原sIgE阳性率以户尘螨、屋尘为主,阳性率分别占63.41%和48.78%.在食物性过敏原中,少儿组中鱼贝蟹、小麦、牛羊肉阳性率分别为18.97%、13.79%和12.07%;而成人组中,食物性过敏原sIgE阳性率以鱼贝蟹、鸡蛋、腰果/花生最高,分别为30.49%、30.49%和26.83%.分别对两组变应原比较,在吸入性过敏原中,成人组和少儿组树组合阳性率分别为31.71%和8.62%,户尘螨阳性率分别为63.41%和10.34%,两组间差异有统计学意义(P<0.05).在食物性过敏原中,成人组和少儿组鸡蛋阳性率分别为30.49%和10.34%,腰果/花生阳性率分别为26.83%和6.89%,两组间差异有统计学意义(P<0.05).结论 成人组及少儿组总IgE和sIgE检出阳性率差异无统计学意义,但常见吸入性和食物性变应原检测的过敏原并不完全相同,为不同年龄组间哮喘患者的临床诊治提供科学的依据.     

支气管哮喘过敏原血清特异性免疫球蛋白E及总免疫球蛋白E、嗜酸性粒细胞阳离子蛋白的测定及分析

目的探讨血清总免疫球蛋白E(TIg E)、嗜酸性粒细胞阳离子蛋白(ECP)水平在过敏性哮喘诊断中的意义,为哮喘患者防治方案的个体化、具体化提供客观依据。方法:采用自动化快速检测系统(CAP)对90例哮喘患者进行6种吸入性、12种食入性混合过敏原特异性Ig E(SIg E)及TIg E、ECP检测。结果 (1)90例哮喘患者中过敏原总阳性率为68.89%,其中吸入性过敏原阳性率为58.89%,食入性过敏原阳性率为38.89%;(2)吸入混合过敏原中以Wx3(蒿属、车前草、藜属、一枝黄花、荨麻)及Hx2(屋尘、尘螨、粉瞒、蟑螂)占多数,食物以Fx3(小麦、燕麦、玉米、芝麻、荞麦)、Fx5(蛋白、牛奶、鳕鱼、花生、黄豆)占多数;(3)TIg E阳性率为64.44%,大多数哮喘患者以1~3种混合过敏原为主,过敏原种数、ECP水平与TIg E显著相关。过敏原种数与ECP无显著相关性。SIg E阳性组的血清TIg E明显高于SIg E阴性组,P0.01。SIg E阳性组的血清ECP与SIg E阴性组相比无明显差异,P0.05。结论蒿属、藜属类植物为就诊于我院哮喘患者导致支气管哮喘发作最主要的变应原,混合型过敏原为初步筛选患者主要的过敏种类,若筛查阳性可进一步进行单项过敏原测定。TIg E可以用来提示过敏的概率,并帮助医师决定是否对一组常见吸入性过敏原试验阴性的患者作进一步检查。ECP检测不能判断患者的过敏状态。过敏原检测在哮喘疾病的预防和治疗中起着重要作用,检测变应原对特异性免疫治疗具有重要的指导意义。     

Clinically masked increases in bronchial inflammation in guideline-treated persistent asthma

BACKGROUND: Current guidelines generally recommend a combination of inhaled corticosteroids and a Beta2-agonist for persistent asthma. The adjustment of anti-inflammatory therapy in persistent asthma is advised to be guided mainly by the presence of symptoms. OBJECTIVE: To investigate whether clinically masked increases in bronchial inflammation occur in guideline-treated, persistent asthma following allergen exposure. METHODS: After a 4-week steroid-run-in period (fluticasone 250 microg twice daily) 48 allergic patients with persistent asthma underwent a bronchial challenge with a single dose of allergen, after inhalation of salbutamol (400 microg, nebulized dose). FEV1 and sputum markers of bronchial inflammation were measured before and after allergen challenge. Furthermore, additional rescue-salbutamol usage was recorded following allergen challenge. RESULTS: After allergen challenge there was a significant increase in sputum eosinophil numbers (geometric mean number x 10(4)/g [95% CI]: 0.5 [0.3; 1.0] before, and 2.4 [1.3; 4.2] after challenge, p=0.01). The mean change in FEV1 between 4 and 8h after challenge relative to baseline was -0.04% [95% CI-2.3; 2.2], p>0.9. None of the patients took additional rescue salbutamol over 8 h after allergen challenge. CONCLUSIONS: Clinically masked increases in bronchial inflammation occur in guideline-treated, persistent asthma following allergen exposure. This finding underscores the need for additional guides for the adjustment of anti-inflammatory therapy in persistent asthma.     

细辛脑雾化吸入佐治老年支气管哮喘急性发作期的临床疗效

目的探讨细辛脑雾化吸人佐治老年支气管哮喘急性发作期的临床疗效。方法选择住院治疗的支气管哮喘急性发作期老年患者70例,其中男性43例,女性27例,年龄60～78岁,平均（69．2±4．8）岁。随机分为常规治疗组（对照组）和细辛脑佐治组（试验组）,每组各35例。常规治疗组患者接受常规治疗;细辛脑佐治组患者在常规治疗基础上加用细辛脑注射液雾化吸人,共7d。对两组患者的疗效、临床症状与体征消失时间、肺功能变化[（第一秒用力呼气容积／用力呼气量预计值的百分比（FEV,％）,第一秒用力呼气容积／用力肺活量百分比（FEV1／FVC％）,最大呼气峰值流速实测值占预计值的百分比（PEF％）]等进行比较及统计学分析。结果细辛脑佐治组的有效率明显高于常规治疗组（P〈0．05）,喘息、咳嗽、胸闷、肺部哮鸣音等症状、体征消失时间明显少于常规治疗组（均P〈0,01、P〈0．05）。与两组治疗前比较,两组治疗后FEV1％、FEV1／FVC％和PEF％均显著升高（P〈0．01）;与常规治疗组治疗后比较,细辛脑佐治组治疗后的FEV1％、FEV1／FVC％和PEF预计值皆明显升高,差异有统计学意义（P〈0．01）。结论细辛脑对老年支气管哮喘有很好的辅助疗效。     

成人支气管哮喘患者吸入糖皮质激素治疗的依从状况及其影响因素

目的探讨成人支气管哮喘患者应用糖皮质激素治疗的治疗依从性,并分析与其相关的影响因素。方法选取2014年3月至2015年6月我院收治的成人支气管哮喘患者160例,应用哮喘用药依从性量表对患者吸入糖皮质激素治疗依从性进行测评,并应用Logistic回归分析对于吸入糖皮质激素治疗相关的影响因素进行分析。结果 160例患者中,吸入糖皮质激素治疗依从性好的患者有60例,依从率为37.5%,治疗依从性较差的患者有100例;经影响吸入皮质激素治疗依从性的单因素分析显示,患者病情严重程度及吸入技术掌握程度及哮喘知识掌握程度与患者吸入糖皮质激素治疗依从性存在相关性,差异有统计学意义(P0.05);经Logistic多因素分析显示,哮喘知识的掌握程度、疾病严重程度及吸入技术掌握程度是影响支气管哮喘患者吸入糖皮质激素治疗依从性的影响因素。结论成人支气管哮喘患者应用糖皮质激素吸入治疗的依从性不高,应加强患者吸入技术及哮喘知识的宣教,以提高治疗依从性。     

519例支气管哮喘患者血清特异性IgE抗体结果分析

目的了解甘肃地区支气管哮喘患者的主要过敏原,分析过敏原阳性患者的年龄差异,为哮喘病人的诊治及预防提供参考依据。方法采用免疫印迹法对2017年3月至2020年3月就诊于甘肃省人民医院哮喘中心的519例支气管哮喘患者的血清特异性IgE进行检测,并对所有结果进行统计学分析。结果519例患者中,血清特异性IgE阳性者331例(63.77%),阳性结果前八位的分别为艾蒿(30.63%)、猫毛(17.92%)、豚草(11.75%)、黄豆(9.83%)、屋尘(9.44%)、柳树/杨树/榆树(8.86%)、屋尘螨/粉尘螨(8.48%)、葎草(7.90%)。不同年龄组间过敏原存在差异。多数患者对两种以上过敏原呈阳性反应。结论艾蒿是甘肃地区支气管哮喘患者最常见的过敏原。猫毛的致敏率在我省目前仅次于艾蒿;黄豆、鸡蛋白、牛奶为主要食入性过敏原;多数患者存在多种过敏原同时致敏。     

布地奈德雾化吸入佐治老年支气管哮喘的临床疗效研究

目的探讨老年支气管哮喘的治疗方法。方法选择90例老年支气管哮喘急性发作期患者随机分为布地奈德佐治组（试验组）和常规治疗组（对照组）,每组各45例。对照组患者接受常规治疗;试验组患者在常规治疗基础上加用布地奈德雾化吸人,共2W。分别检测两组患者的疗效、临床症状与体征消失时间、第一秒用力呼气容积／用力呼气量预计值的百分比（FEV1％）、第一秒用力呼气容积／用力肺活量百分比（FEV1／FVC％）、最大呼气峰值流速实测值占预计值的百分比（PEF％）,并进行比较与统计学分析。结果布地奈德佐治组的总有效率显著高于常规治疗组（84．44％VS．73．33％,P〈0．05）,咳嗽、喘息、胸闷、肺哮鸣音等症状、体征消失时间明显少于常规治疗组（均P〈0．01、P〈0．05）。各组治疗前后比较,治疗后FEV1％、FEV1／FVC％和PEF％均显著升高（P〈0．01）;与常规治疗组治疗后比较,布地奈德佐治组治疗后的FEV1％、FEV1／FVC％和PEF预计值均明显升高,差异有统计学意义（P〈0．01）。结论布地奈德对老年支气管哮喘有很好的辅助疗效。     

Die protektive Wirkung von Dinatrium cromoglicicum im inhalativen Antigen-Provokationstest bei Bäckerasthma

The effect of Cromolyne (DSCG) on 15 bakers with occupational asthma was studied using a bronchial allergen test; the asthma was caused by sensitization to wheat or rye flour. Nine patients suffered from a pure extrinsic bronchial asthma (Group I), while 6 patients showed additional manifestations of bronchial obstructions, including bronchitis and/or emphysema (Group II). Following control tests with isoprenaline, phenol saline (diluent), and acetylcholine, an allergen inhalation test was performed with wheat or rye flour (Test A). A similar test was then carried out after inhalation of 20 mg DSCG (Test B). Finally, the initial allergen inhalation test without DSCG was repeated (Test C). Between each test there was an interval of 48 hrs. The inhibitory effect of DSCG was significant in all 15 patients. The decrease in FEV_1,0 after allergen inhalation without DSCG was 38.1%±16.0% (Test A). The administration of DSCG reduced the decrease in FEV_1,0 to 11.7%±12.5% (Test B) (p<0.0005). However, the effect of DSCG was markedly different in both groups. The inhibition of the bronchial obstruction was significant (p<0.0005) in Group I (uncomplicated allergic bronchial asthma). In Group II (allergic bronchial asthma with complications) no significant effect could be demonstrated (p>0.05). We conclude that the effect of DSCG depends on the degree of complication in allergic bronchial asthma. The practical implications are discussed.     

Bronchial responsiveness is not increased by bronchoalveolar and bronchial lavage performed after allergen challenge

Nonspecific bronchial responsiveness was studied in 23 allergic patients with a history of rhinitis and/or bronchial asthma who underwent fiberoptic bronchoscopy with bronchoalveolar and bronchial lavage (BAL-BL) 4h (Group A) or 24 h (Group B) after an allergen inhalation challenge. In all patients, the dose of methacholine causing an FEV1 fall of 15% (PD15) was determined at baseline, 24 h before allergen challenge. Methacholine bronchial challenge was repeated 1 h before BAL-BL in patients of both groups and again 12 to 14 h after BAL-BL in Group A and 24 h after BAL-BL in Group B. In patients of Group A, the values of methacholine PD15 after BAL-BL were not significantly different from those determined before BAL-BL. This was also the case in patients in whom bronchial responsiveness was increased after allergen challenge. In patients of Group B, methacholine PD15 was significantly decreased after allergen challenge, and this decrease was correlated with the occurrence and the severity of the late asthmatic reaction. Even in patients who showed dual asthmatic reactions and an increased responsiveness after allergen challenge, methacholine PD15 was not further decreased after BAL-BL. These data support the safety of a procedure combining bronchial allergen challenge with BAL-BL, which can be used for studies on the pathophysiology of bronchial asthma.     

两种治疗联合对危重型哮喘的临床疗效分析

目的分析支气管肺泡灌洗术联合利多卡因雾化吸入对危重型哮喘的临床疗效。方法抽取我院确诊为危重型哮喘的患者72例作为临床研究对象,将其分为两组,对照组予利多卡因雾化吸入治疗,观察组予支气管肺泡灌洗术联合利多卡因雾化吸入治疗,测定并进行分析患者治疗后的作用与手术安全性。结果组间治疗后记录心率、气道压力、动脉血PH的变化比较,P<0.05,具有统计学意义。对照组经过治疗后总有效率仅为55.56%而观察组经过治疗总有效率高达88.89%,P<0.05,具有统计学意义。结论支气管肺泡灌洗术联合利多卡因雾化吸入通过缓解支气管痉挛及减轻支气管阻塞治疗危重型哮喘,能够明显减轻哮喘症状改善患者的生命质量,值得临床研究并大量应用。     

Airway provocation test with ragweed pollenosis and late-phase reaction

Ragweed pollen extract inhalation airway provocation test (APT) were studied in 55 patients with ragweed pollenosis. Single dosage of 9000 PNU ragweed extract was applied and positive response was defined as more than 35% fall in SGrs at the dose of PT35-Grs. Among 55 patients, positive APT was found in 27 case (49%), dual late-pase responses in 11 patients, single late-phase response only was found 2 patients in complicated asthma group. Late-phase response were well related to the increased specific IgE, and strong positive skin test response (wheal greater than 11 mm). The results suggested ragweed pollen was one of the important allergen causing bronchial asthma. There was airway hyperresponsiveness to ragweed pollen in some patients (20%) with ragweed pollenosis without asthmatic symptoms.