过敏性鼻炎患者肺功能测定的临床意义

目的:探讨过敏性鼻炎患者的肺功能变化及临床意义。方法:对38例无支气管哮喘症状的过敏性鼻炎患者进行肺通气功能及气道反应性测定。结果:肺通气功能异常18例(47.4%),其中阻塞性通气功能障碍2例,小气道功能异常16例。肺通气功能异常患者支气管激发试验阳性率高于肺通气功能正常患者(P<0.01)。结论:对无哮喘症状的过敏性鼻炎患者进行肺通气功能测定,并对异常者及时进行气道反应性测定,对过敏性鼻炎合并支气管哮喘的早期发现与治疗具有临床意义。     

辅舒良联合吸入型糖皮质激素及顺尔宁治疗30例儿童哮喘合并过敏性鼻炎临床体会

30例支气管哮喘合并过敏性鼻炎患儿给予辅舒良经鼻吸入治疗。年龄<5岁及轻度哮喘患儿给予辅舒酮吸入治疗;年龄≥5岁及中重度哮喘患儿给予舒利迭吸入治疗。同时所有患儿服用顺尔宁咀嚼片。治疗前后,检测患儿FEV1及进行病情症状及体征记分比较,评价治疗支气管哮喘及过敏性鼻炎的临床疗效。结果支气管哮喘均达到完全控制,且FEV1治疗后比治疗前明显提高(P<0.05),过敏性鼻炎的临床总有效率达93.3%。无明显不良反应。辅舒良联合吸入型激素及顺尔宁能有效控制儿童支气管哮喘及过敏性鼻炎的临床症状,并显著提高肺功能。     

变应原疫苗免疫治疗对过敏性支气管哮喘合并鼻炎患者的效果

目的探讨变应原疫苗免疫治疗对过敏性支气管哮喘合并鼻炎患者的临床效果。方法选取100例过敏性支气管哮喘合并鼻炎患者进行研究,将其随机均分为2组,对照组采用舒利迭联合布地奈德鼻喷剂治疗,观察组采用变应原疫苗免疫治疗,对2组的治疗效果进行比较。结果观察组患者的治疗总有效率显著高于对照组(P 0. 05);治疗后,观察组哮喘控制测试(ACT)评分显著高于对照组,过敏性鼻炎症状评分显著低于对照组(P 0. 05);治疗后,观察组的生存质量总评分显著高于对照组(P 0. 05); 2组不良反应发生率无显著差异(P 0. 05)。结论过敏性支气管哮喘合并鼻炎患者采用变应原疫苗免疫治疗效果理想,可促进患者哮喘及鼻炎症状改善,提升患者生存质量,安全性较高。     

中山市过敏性鼻炎和支气管哮喘儿童致敏原临床调查

目的了解中山市儿童过敏性鼻炎和支气管哮喘的主要致敏变应原,寻找诱发过敏性鼻炎和支气管哮喘的危险因素并探讨其相互关系。方法对400例患有过敏性鼻炎与哮喘的儿童进行问卷调查,同时结合标准化过敏原皮肤点刺试验.结果变应原总的阳性检出率为72%(288/400),阴性检出率为28%(112/400),其中螨的阳性检出率最高,三种螨占阳性率的比分别是:屋尘螨93.8%(270/288),粉尘螨92.0%(265/288),热带螨61.1%(176/288),其次是艾蒿22.9%(66/288)、猫毛18.4%(53/288)及狗毛14.9(43/288)。在危险因素探讨中,70.2%(165/235)的支气管哮喘患儿伴有过敏性鼻炎,37.6%(62/165)的过敏性鼻炎患儿伴有支气管哮喘,32.3%的患儿有家族史,32.3%的患儿家中养宠物,64.8%的患儿暴露于家庭吸烟环境,环境潮湿者占39.0%。结论中山市儿童过敏性鼻炎、支气管哮喘的主要致敏原是尘螨,其次是艾蒿、猫毛、狗毛;过敏史、环境因素、遗传特质是诱发过敏性鼻炎和支气管哮喘的危险因素。     

过敏性鼻炎-哮喘综合征患儿血清25(OH)D与病情控制的相关性

目的 探讨过敏性鼻炎-哮喘综合征患儿血清25-羟基维生素D[25(OH)D]水平与病情严重程度及激素反应性的相关性.方法 选取过敏性鼻炎患儿、哮喘患儿、过敏性鼻炎-哮喘综合征患儿各50例,以体检健康儿童50名作为正常对照组.检测所有对象的血清25(OH)D水平,同时检测肺功能[用力肺活量(FVC)、一秒用力呼气容积(F...     

过敏性鼻炎和支气管哮喘的关系

过敏性鼻炎和支气管哮喘常常共同存在于同一患者，过敏性鼻炎常发生在哮喘之前，患者中支气管哮喘的发病率明显高于一般人群。用乙酰胆碱或组织胺作支气管激发试验。发现一部分不伴哮喘的过敏性鼻炎患者气道反应性增高，可能是进一步发展为支气管哮喘的高危人群。治疗过敏性鼻炎可以减轻哮喘的症状，改善肺功能，降低气道反应性。鼻-支气管反射、鼻腔阻塞后呼吸方式的改变、后鼻道的炎性分泌物吸入下呼吸道可能是过敏性鼻炎与支气管哮喘有密切联系的机制。     

郴州地区支气管哮喘与其他过敏性疾病的相关性调查分析

目的 了解郴州地区支气管哮喘的相关过敏因素,及其他过敏性疾病的相关性.方法 对216例支气管哮喘进行过敏原的相关检测,及其他过敏性疾病的相关性进行临床调查.结果 有176例患者变应原检测阳性,其中吸入性过敏原以户尘螨、粉尘螨阳性率最高,为42.05%,食人性过敏原中以鱼蟹虾的阳性率最高,为28.98%,发现62.04%支气管哮喘患者有变应性鼻炎、湿疹、荨麻疹、过敏性结膜炎、药物过敏等过敏性疾病,51.38%支气管哮喘患者有哮喘疾病家族遗传史.结论 郴州地区的支气管哮喘过敏原检测以粉尘、尘螨最多见,哮喘和其他过敏性疾病及家族史有一定相关性.     

某院哮喘合并变应性鼻炎的流行病学调查

目的调查西南医院门诊哮喘合并变应性鼻炎(AR)患者的分布情况,分析二者在临床表现方面的相关性及患者对AR的认知程度和治疗现状。方法选取2013年1~9月西南医院收治的哮喘患者250例进行面对面的问卷调查,了解其哮喘病史、严重程度分级、哮喘控制测试(ACT)评分和鼻炎情况,并建立个人数据档案。结果 250例哮喘患者中,161例(64.4%)合并AR,单纯哮喘组(A组)和哮喘合并AR组(B组)在年龄、性别、病程等方面差异无统计学意义(P0.05)。B组中轻度持续、中度持续、重度持续例数均高于A组,差异有统计学意义(P0.05);ACT评分显示完全控制、一般控制例数均低于A组,差异有统计学意义(P0.05);未控制哮喘高于A组,差异有统计学意义(P0.05)。AR起病早于哮喘占58.3%,两者同时起病占12.7%。32.8%患者曾经检测过敏原,22.6%患者使用药物治疗鼻炎。结论重庆地区哮喘合并AR发生率高,认知程度较低,治疗现状不容乐观。     

过敏性鼻炎哮喘综合征的治疗

过敏性鼻炎哮喘综合征（ CARAS ）是指以过敏性鼻炎和哮喘为主，可能还伴发过敏性结膜炎、过敏性咽炎和湿疹的一组症状[1]。典型的CARAS病情发生发展分为三个阶段：①过敏性鼻炎不伴咳喘，即单纯过敏性鼻炎或过敏性鼻结膜炎阶段；②过敏性鼻炎伴有气道高反应，有刺激性咳嗽但没有发展为哮喘，称为过敏性鼻-支气管炎；③过敏性鼻炎伴有哮喘阶段，称为过敏性鼻炎哮喘综合征。三个阶段的区别可能只是一种疾病的不同严重程度或不同发病阶段而已。从鼻腔吸入的变应原蔓延至支气管是过敏性鼻炎发展到过敏性支气管炎或过敏性鼻炎哮喘综合征的关键。 CARAS的最主要的特征就是兼具过敏性鼻炎和哮喘，部分患者还可能伴发其他过敏性疾病如过敏性结膜炎、过敏性咽炎和湿疹等。其病理学特征是包括上、下呼吸道以肥大细胞反应、嗜酸细胞和T细胞浸润为主，伴有淋巴细胞、巨噬细胞等参与调节的变应性炎症。这种炎症可导致鼻黏膜和支气管的反应性增高，临床上表现为反复发作的打喷嚏、流清鼻涕、鼻塞、突然喘息或阵发性咳嗽。这些症状可自行缓解或经治疗缓解。     

HRCT测量支气管哮喘的气道壁厚度与其病情严重度及肺功能的相关性研究

目的高分辨率CT(HRCT)测量不同程度的支气管哮喘患者支气管管壁厚度,并评估与病情严重度和肺功能损害的相关性。方法用HRCT扫描支气管哮喘患者35例,其中轻度13例、中度12例、重度10例。正常对照组20例。测量支气管壁横截面的气道壁的外径D和内径L,通过公式计算出支气管管壁厚度与外径比值(T/D)、气道壁面积占气道总截面积百分比(WA%)。计算观察指标与病情严重度及肺功能的相关性。结果支气管哮喘患者与正常组的T/D、WA%之间均有显著差异(P<0.01)。重度、中度支气管哮喘患者较轻度患者的T/D、WA%明显增加(P<0.01)。T/D、WA%与病情严重度呈正相关(P<0.01),WA%与FEV1呈负相关性(P<0.01)。结论重度、中度支气管哮喘患者较轻度及正常对照组的支气管壁明显增厚,且增厚程度与病情严重度及气道阻塞有关。     

变应性鼻炎患者血清OPN、NF-κB与sIgE水平的相关性

目的 探讨血清骨桥蛋白(OPN)、核转录因子-κB(NF-κB)水平与变应性鼻炎患者特异性免疫球蛋白E(sIgE)的相关性.方法 选取2017年6月至2019年7月到该院就诊的85例变应性鼻炎患者作为变应性鼻炎组;将患者按严重程度分组:轻度31例、中-重度组54例;按变应性鼻炎类型分组:间歇性组44例、持续性组41例....     

The Fc gammaRIIa polymorphism in Turkish children with asthma bronchial and allergic rhinitis

OBJECTIVE: The aim of the present study was to evaluate the Fc gammaRIIa polymorphism in Turkish children with atopic asthma and allergic rhinitis. DESIGN AND METHODS: In this study, 372 atopic children (192 asthma bronchial, 180 allergic rhinitis) between ages of 5 and 16 years old (11.3+/-2.9) who were followed at Aegean University Paediatric Allergy and Pulmonology Outpatient Clinics and 234 healthy subjects as the control group were included. The evaluation of subjects included routine biochemical blood analysis and allergic workup based on the following laboratory determinants. The Fc gammaRIIa polymorphism was determined using the polymerase chain reaction method. RESULTS: Distribution of R131R genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 2.64 95%CI: 1.22-5.79, p=0.006; for allergic rhinitis OR: 2.58 95%CI: 1.18-5.71, p=0.009). Frequency of 131R allele was significantly different among patient groups compared to controls (for asthmatic children OR: 1.66 95%CI: 1.22-2.26, p=0.0007; for allergic rhinitis OR: 1.93 95%CI: 1.42-2.63, p=0.00001). CONCLUSION: This study shows that Fc gammaRIIa gene 131R allele represents an important genetic risk factor for bronchial asthma and allergic rhinitis susceptibility.     

Acute phase reactants in allergic airway disease

Acute phase reactants have been implicated for their involvement as proinflammatory molecules in various inflammatory diseases. However, little is known regarding their role in the allergic airway disease. The aim of the present study was to examine the blood concentrations of three acute-phase proteins, namely C-reactive protein (CRP), serum amyloid A (SAA) and fibrinogen in patients with allergic rhinitis and asthma. Three study groups include: non-smoker allergic rhinitis (n = 50), non-smoker asthma (n = 20), and non-allergic, non-smoker healthy control subjects (n = 20). Patients who have had recent upper or lower respiratory tract infection and trauma, any rheumatological illnesses, malignancy or obesity were excluded. Blood samples were obtained from all the patients and control subjects and were analyzed for serum CRP, SAA and plasma fibrinogen. The mean CRP and fibrinogen values in the rhinitis and asthma groups were not significantly different when compared to the control group. However, the mean SAA levels of both groups were found to be significantly higher than those of the control group (p = 0.002 for rhinitis, p = 0.02 for asthma). There was no significant correlation between the FEV(1) values and the levels of the serum markers. This study demonstrates that acute phase reactant SAA rises in patients with allergic rhinitis and patients with asthma. We therefore suggest that SAA may have a role in the inflammatory airway disease.     

孟鲁司特联合补肾温肺方治疗支气管哮喘合并变应性鼻炎的临床分析

[摘要]目的 观察孟鲁司特联合补肾温肺方对支气管哮喘合并变应性鼻炎的疗效，并探讨其发病机制。方法 将本科40例患者随机分为对照组和观察组，对照组服用孟鲁司特，观察组在此基础上加服中药方剂补肾温肺方。结果 观察组治疗后支气管哮喘和变应性鼻炎的有效率分别为90.0%、85.0%，明显优于对照组的60.0%和55.0%（P<0.05）；IgE、FEV、PEF、哮喘症状、鼻炎症状和生活质量等指标明显得到改善，且均优于对照组（P<0.05）。结论 支气管哮喘患者往往合并变应性鼻炎，应及早发现，采用孟鲁司特联合补肾温肺方进行综合治疗，可取得较好疗效。     

特异性免疫治疗小儿支气管哮喘合并变应性鼻炎的远期疗效分析

目的探讨特异性免疫治疗对小儿支气管哮喘合并变应性鼻炎的远期疗效,以期为临床中治疗变应性疾病提供依据。方法选择患有支气管哮喘合并变应性鼻炎患儿48例,采用皮下注射标准化屋尘螨法治疗,从低剂量开始逐渐加量至维持剂量,总疗程3年。比较治疗前与治疗结束时及治疗结束时与随访不同时段的哮喘控制程度、哮喘症状评分、肺功能及鼻部症状评分。分析特异性免疫治疗是否具有确切的远期疗效。结果治疗前与治疗结束时各指标相比,治疗结束时哮喘控制程度(t=3.28)、哮喘症状评分(t=4.04)、肺功能(t=0.08)及鼻部症状评分(t=1.58)较治疗前明显好转,差异具有统计学意义(P0.05)。治疗结束后半年、1年、2年、3年各指标与治疗结束时相比,变化不大,差异无统计学意义(P0.05)。结论特异性免疫治疗小儿支气管哮喘合并变应性鼻炎具有远期疗效,可以降低复发率,提高患儿的生活质量。     

Ventilatory and gas exchange functions of the lungs in occupational and other pulmonary diseases

AIM: To study lung ventilation and gas exchange in interstitional and obstructive diseases of dust-induced and non-occupational origin for correction of pulmonary diseases. MATERIAL AND METHODS: Diffuse lung capacity (Erich Jaeger unit) and biomechanical properties of the ventilation system (total plethysmography on the bodyplethysmograph made by Erich Jaeger) were investigated in 132 patients including 87 with occupational dust-induced pulmonary diseases (pneumoconiosis, dust bronchitis, exogenic allergic alveolitis, bronchial asthma) and 45 patients with non-occupational diseases: sarcoidosis (n = 28), exogenic allergic alveolitis (n = 10) and bronchial asthma (n = 7). RESULTS: The changes were of the same type but different severity. Diffuse capacity was subnormal in all the groups, most of all in patients with exogenic allergic alveolitis and sarcoidosis of stage 2-4. In patients with occupational diseases DLCO was reduced, residual volume, total lung capacity were elevated, they had hypoxemia. CONCLUSION: The changes in patients with dust-induced diseases of the lungs may be interpreted primarily as disorders of distribution, imbalance between ventilation and perfusion. Diffusion disorders in patients with alveolitis and sarcoidosis correlated with changes in alveolar-capillary membrane.     

孟鲁司特联用布地奈德吸入防治儿童哮喘合并变应性鼻炎

目的：观察在吸入糖皮质激素（布地奈德）的基础上联合应用白三烯受体拮抗剂（孟鲁司特）对儿童哮喘伴变应性鼻炎的防治作用。方法：74例轻、中度支气管哮喘伴变应性鼻炎患儿随机分为治疗组和对照组各37例，进行3个月的治疗，观察组吸入布地奈德每天400μg，一个月后减至每天200μg，治疗组在此基础上加用孟鲁司特每天5mg。记录患儿的哮喘症状评分、变应性鼻炎症状评分、按需吸入β2受体激动剂的次数及测定气道反应性。结果：治疗后两组患儿的哮喘症状评分、变应性鼻炎症状评分及气道高反应性均明显改善。治疗组治疗后夜间哮喘症状评分及变应性鼻炎症状评分为0分及（0.30±0.36）分，对照组治疗后夜间哮喘症状评分及变应性鼻炎症状评分为（0.41±0.36）分及（1.29±0.54）分，两组比较差异有显著意义（P〈0.01）；按需吸入β2受体激动剂的次数治疗组为（1.84±0.04）喷，对照组为（2.97±0.03）喷，两组比较差异有显著性（P〈0.05）。结论：在吸入糖皮质激素的基础上联合应用白三烯受体拮抗剂可显著提高对儿童哮喘伴变应性鼻炎的疗效。     

Treatment of allergic diseases with monoclonal anti-IgE antibody]

IgE-mediated mast cell and basophil activation initiates immediate and late-phase allergic responses, and plays a pivotal role in the pathogenesis of allergic diseases such as bronchial asthma and allergic rhinitis. Thus, the blocking of the binding of IgE to the high affinity receptors for IgE (Fc epsilon RI) on mast cells and basophils may prevent dual responses, and improve allergic symptoms. A recombinant humanized monoclonal antibody (rhuMAb-E25) forms complexes with free IgE, blocks its binding to mast cells and basophils, and inhibits allergen-induced mediator release from both cells and attenuates immediate and late-phase reactions to inhaled allergens. In clinical trials, the therapy with rhuMAb-E25 was effective in patients with atopic asthma and allergic rhinitis and well tolerated. This antibody seems to be promising as a treatment for atopic asthma and allergic rhinitis.     

Role of immunotherapy in the treatment of allergic asthma

Allergen-specific immunotherapy (SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although the efficacy of SIT has been shown in terms of reducing symptoms, medication consumption and ameliorating quality of life in both allergic rhinitis and asthma, there has long been some controversies about effectiveness of SIT in the treatment of allergic asthma. The type of allergen, the dose and protocol of immunotherapy, patient selection criteria, the severity and control of asthma, all are significant contributors to the power of efficacy in allergic asthma. The initiation of SIT in allergic asthma should be considered in case of coexisting of other allergic diseases such as allergic rhinitis, unacceptable adverse effects of medications, patient’s preference to avoid long-term pharmacotherapy. Steroid sparing effect of SIT in allergic asthma is also an important benefit particularly in patients who have to use these drugs in high doses for a long-time. Symptomatic asthma is a risk factor for systemic reactions and asthma should be controlled at the time of administration of SIT. Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) have been found to be effective in patients with allergic asthma. Although the safety profile of SLIT seems to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT may appear better and earlier than SLIT in children with allergic asthma.     

锦州地区男性吸烟、体质量指数与临床良性前列腺增生的危险性研究

背景:良性前列腺增生是一种老年男性常见的疾病,尽管发病的危险因素仍不清楚,但是诸多生活方式因素对此病具有一定的影响作用。目的:观察锦州地区男性吸烟、体质量指数与临床良性前列腺增生危险性之间的关系。设计:病例对照观察。单位:华中科技大学同济医学院流行病与统计学系;辽宁医学院预防医学教研室。对象:选择2004-05/2006-05在辽宁医学院附属第一及第三医院、锦州中心医院和锦州市第二人民医院泌尿外科收治的343例良性前列腺增生行外科手术患者为病例组,年龄50￣82岁。纳入标准:①年龄>50岁,I-PSS症状分>7。②排尿后直肠指检前列腺Ⅰ度以上(横径>3cm)。③B超检查示前列腺体积≥30g。④最大尿流率<15mL/s;选择同期入住于上述医院,因患各种与良性前列腺增生、前列腺癌以及前列腺炎危险因素无关疾病的361例患者为对照组,年龄50￣82岁,平均65岁。所有患者均对调查内容知情并同意。方法:采用标准调查表对病例组和对照组患者进行调查,定义一生总吸烟量≥20包为吸烟者,反之为不吸烟者。根据吸烟量分成不吸烟、吸烟量1￣19支/d、吸烟量20￣29支/d和吸烟量≥30支/d,并按吸烟的时间分为不吸烟、1￣19年、20￣29年和≥30年。通过询问法,获得受试对象体质量指数,分为体质量指数<18.4、正常(体质量指数18.5￣23.9)、超重(体质量指数24.0￣27.9)和肥胖(体质量指数≥28);调查患者文化程度分为文化程度<7年,7￣11年和≥12年,患者的职业分为工人、农民、知识分子及其他。将调查结果输入计算机、建立数据库,应用多元Logistic模型分析患者吸烟量、吸烟时间、体质量指数、文化程度、职业与临床良性前列腺增生的比值比(OR)和95%可信限(CI)。主要观察指标:患者吸烟量、吸烟时间、体质量指数、文化程度、职业与临床良性前列腺增生的关系。结果:纳入病例组患者343例,对照组361例均进入结果分析。①吸烟量≥30支/d患者与不吸烟者相比,发生临床良性前列腺增生的危险性增加(OR=1.32,95%CI为0.92￣2.58,P<0.01)。②超重及肥胖吸烟者发生临床良性前列腺增生的危险性较不吸烟者显著增高(OR=1.68,2.35,95%CI分别为1.32￣3.67,1.83￣4.16,P<0.01)。③体力劳动者(农民)与发生良性前列腺增生的危险性呈负相关(P<0.05)。脑力劳动者(知识分子)发生临床良性前列腺增生的危险性高于对照组(χ2=6.62,P<0.01)。结论:吸烟≥30支/d的男性与临床良性前列腺增生呈正相关,超重(体质量指数24.0￣27.9)和肥胖(体质量指数≥28.0)的男性吸烟发生临床良性前列腺增生的危险性显著地升高。