支气管哮喘合并过敏性鼻炎的中西医结合治疗

目的研究中西医结合治疗支气管哮喘合并过敏性鼻炎的临床效果。方法随机抽取2010年1月至2011年6月间收治支气管哮喘合并过敏性鼻炎的患者100例,并随机将其分为治疗组和对照组,每组50例。对照组采用生黄芪15 g,党参12 g,白术、当归、熟地黄、茯苓各10 g,法半夏、陈皮、紫苏子各6 g,柴胡、防风、荆芥、羌活、射干、杏仁、紫菀、款冬花各5 g,麻黄4 g,白芥子、甘草各3 g,将此剂熬制后服用。治疗组是对照组的基础上采用硫酸沙丁胺醇雾化溶液雾化吸入治疗方式进行治疗。并将两组患者的过敏性鼻炎体征评分及肺功能的变化进行统计分析。结果治疗组患者通过治疗后,患者过敏性鼻炎体征评分无显著性差异(P>0.05)。治疗组患者的肺功能改善情况显著优于对照组的改善(P<0.05)。结论中西医结合联合治疗支气管哮喘合并过敏性鼻炎能够充分地改善患者的鼻炎症状,改善肺功能,促进患者的康复。     

舌下含服粉尘螨滴剂治疗过敏性疾病效果观察

目的研究舌下含服粉尘螨滴剂治疗儿童过敏性哮喘和变应性鼻炎的疗效及安全性。方法治疗组40例,舌下含服粉尘螨滴剂进行特异性免疫治疗的同时使用对症药物治疗;对照组50例,仅接受对症药物治疗。治疗前和治疗后3、6个月,比较两组哮喘和鼻炎症状评分。结果治疗后,两组病儿症状评分均较治疗前有所下降,差异有显著性（t=2.10～3.06,P〈0.05）。且治疗组的哮喘和鼻炎症状评分均较对照组低,差异有显著性（t=2.17～7.81,P〈0.05）。脱敏治疗中均未出现严重不良反应。结论使用粉尘螨滴剂治疗儿童过敏性哮喘和变应性鼻炎是安全、有效的,且采用舌下脱敏联合对症药物治疗效果优于单纯使用对症药物治疗。     

变应性鼻炎舌下免疫治疗对患者生活质量的影响

目的探讨变应性鼻炎舌下免疫（sublingual immunotherapy,SLIT）治疗对患者生活质量的影响。方法将79例变应性鼻炎患者随机分为实验组40例与对照组39例,对照组给予抗组胺药物及鼻局部皮质类固醇药物治疗,实验组在此治疗基础上给予SLIT治疗。治疗后比较两组患者症状评分、药物评分及鼻炎生活质量情况。结果实验组在治疗3个月后症状评分和2个月后药物评分均较对照组明显降低;2年后实验组患者鼻炎生活质量明显优于对照组,组间比较,均P〈0.01,差异具有统计学意义。结论变应性鼻炎采用SLIT治疗,可明显减轻患者鼻部症状,减少用药量,改善患者鼻炎生活质量,是一种安全、有效的治疗方法。     

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。     

南京地区支气管哮喘患者合并过敏性鼻炎的现状及其临床表现相关性

背景:过敏性鼻炎和支气管哮喘均为呼吸道炎性疾病,它们常并存于同一患者。目的:了解南京地区支气管哮喘患者中过敏性鼻炎的发生率,并分析过敏性鼻炎与支气管哮喘在临床表现方面的相关性。设计:问卷调查。单位:解放军南京军区南京总医院耳鼻咽喉-头颈外科及呼吸内科。对象:纳入2001-02/2005-04解放军南京军区南京总医院确诊为支气管哮喘的患者134例,男73例,女61例;年龄3～72岁。参照全球哮喘防治创议(Global initiative for asthma,GINA)方案进行哮喘严重程度分级;过敏性鼻炎的诊断标准参照1997-11"海口会议"的修订标准;所有患者均同意参与问卷调查。方法:通过问卷调查,详细了解134例支气管哮喘患者中患支气管哮喘、过敏性鼻炎患者的年龄、症状分型及严重程度、治疗状况、家族史等临床资料。应用统计学描述和两个独立样本的t检验,并计算支气管哮喘合并过敏性鼻炎的发生率,比较支气管哮喘和过敏性鼻炎患者的年龄、发病年龄及病程的差异有无显著性。应用Spearman等级相关分析进行两者严重程度相关性分析。主要观察指标:支气管哮喘患者中过敏性鼻炎的发生率,以及过敏性鼻炎与支气管哮喘在临床表现方面的相关性。结果:支气管哮喘患者134例中82例(61.2%,82/134)并发过敏性鼻炎,其中男45例,女37例。此82例患者中,哮喘严重程度一级(轻度间歇)56例,二级(轻度持续)21例,三级(中度持续)4例,四级(重度持续)1例。其过敏性鼻炎分型,间歇性65例,持续性17例;按严重程度分级,轻度63例,中-重度19例。过敏性鼻炎与支气管哮喘严重程度呈明显正相关(r=0.689,P<0.01)。结论:南京地区支气管哮喘合并过敏性鼻炎的发生率较高;过敏性鼻炎与支气管哮喘严重程度具有高度相关性。     

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。     

抗焦虑抑郁治疗对冠心病患者生活质量的影响

目的观察抗焦虑抑郁治疗对冠心病患者生活质量的影响。方法对冠心病患者进行症状自评量表(SCL-90)测评阳性患者50名,随机分成两组,第1组26人,第2组24人;量表测评阴性的患者14人为第3组。三组患者均用左旋肉碱治疗6个月,第1组同时加用氢溴酸西酞普兰。治疗前后进行生活质量的评定包括SCL-90、心血管患者生活质量量表(QOL)及心功能指标(FS、SV、CO、EF、E/A)。结果(1)治疗后各组患者的生活质量(QOL)均有显著好转,第1组治疗前(35.4±6.61)vs治疗后(19.93±2.64),P<0.01;第二组治疗前(37.20±6.83)vs治疗后(25.68±6.49),P<0.01;第三组治疗前(32.31±5.23)vs治疗后(21.38±4.43),P<0.01。第1组QOL(P<0.05)的好转更明显。(2)三组之间的SCL-90比较示抑郁、焦虑、敌对评分和总均分以第1组中下降最显著。(3)第1组的心脏收缩和舒张功能都显著提高,第3组仅收缩功能显著提高,第2组无改变。结论抗焦虑抑郁治疗增加常规药物疗效,提高冠心病患者的生活质量。     

无创双水平正压通气对慢性阻塞性肺疾病患者生存质量的影响

目的 探讨使用无创双水平正压通气对慢性阻塞性肺疾病患者生存质量的影响。方法 52例慢性阻塞性肺疾病患者随机分成无创双水平正压通气治疗组(n = 26)和对照组(n = 26)。对照组给予常规氧疗,同时进行呼吸功能锻炼。无创双水平正压通气治疗组给予BiPAP呼吸机辅助通气,每日使用3-4次,每次使用2小时,两组均同时使用支气管扩张剂等药物和营养治疗,4周为一疗程。利用生存质量(QOL)评分标准分别在治疗前、治疗后2 周、治疗后4周对两组患者生存质量评估。结果 无创通气治疗组治疗后其QOL总均分(TMS)、日常生活能力(F1S) 、社会活动情况(F2S) 、抑郁心理状态(F3S) 、焦虑心理症状(F4S) 评分较治疗前降低,P <0.05 ,有显著意义。而对照组差异无显著意义(P>0.05)。结论 使用无创双水平正压通气可以减轻慢性阻塞性肺疾病患者的气流阻塞,改善患者的呼吸功能,减轻症状,增加活动范围,从而提高生存质量。     

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....     

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.     

放松训练对哮喘患儿临床症状和肺功能的影响

目的　探讨放松训练对学龄哮喘患儿临床症状和肺功能的影响。方法　将 6 0例诊断为哮喘 ,并符合入组条件的学龄哮喘患儿随机分为实验组 30例 ,对照组 30例。两组在应用相同药物治疗的基础上 ,实验组每晚睡前实施放松训练 ,持续4w。实验前后评估两组患儿的焦虑、抑郁分值和肺功能 ,实验期间评估哮喘控制参数。结果　实验组焦虑和抑郁评分在实验结束时显著降低 (P <0 .0 1) ,哮喘控制参数和肺功能指标与实验前比较或与对照组比较有显著性差异 (P <0 .0 1)。结论　放松训练可以减轻学龄哮喘患儿的不良情绪 ,改善临床症状和肺功能 ,是一种简便有效的哮喘辅助治疗方法     

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。     

白三烯受体拮抗剂普鲁司特治疗支气管哮喘

目的 :评价国产普鲁司特胶囊治疗支气管哮喘的临床疗效及其安全性。方法 :观察 112例支气管哮喘患者用药前、后哮喘自觉症状、肺功能指标、实验室指标及不良反应。结果 :患者治疗后第 1、2、3、4周的平均晨间PEF值、平均夜间PEF值较治疗前均有显著性改变 (P <0 .0 0 1)。治疗后第 2、4周FEV1值均较治疗前有显著性改善 (P <0 .0 0 0 1)。治疗 4周后 ,平均日间、夜间哮喘症状评分均减少明显 ,日间、夜间无症状天数的百分数增加明显。全天无症状天数的百分数增加、日间、夜间患者使用喘乐宁气雾剂喷数减少 ;治疗期间全天未用喘乐宁气雾剂天数的百分数增加。共 9例患者发生药物不良反应 ,发生率为 8.0 4% ;不良反应主要为胃肠道反应 ,反应均较轻微 ,不影响研究用药的完成。结论 :国产普鲁司特胶囊能改善支气管哮喘患者的肺功能、减轻哮喘症状 ,不良反应轻微 ,具有良好的临床疗效及安全性。     

Significance of antibacterial therapy of Chlamydophila pneumoniae infection in patients with bronchial asthma

AIM: To study effects of eradication of Chlamydophila pneumoniae CP) infection in bronchial asthma (BA) on BA course and changes in quality of life (QOL) in BA patients. MATERIAL AND METHODS: 194 BA patients in clinical remission participated in the trial. Microbiological diagnosis of asymptomatic CP infection was made serologically (ELISA, indirect enzyme immunoassay) using polymerase chain reaction. Clinical and biochemical tests, assessment of pulmonary ventilation function, QOL by AQLQ during 6-week antimicrobial therapy were made in 56 patients. RESULTS: Patients with stable BA had high frequency of serological signs of clinically asymptomatic CP infection (52%) deteriorating BA symptoms and QOL. Antibacterial therapy of latent CP infection with azitromycin significantly improved BA course and QOL of BA patients. CONCLUSION: When laboratory tests detect CP infection in patients with long-term course of BA, especially in smoking males with moderate and severe BA it is clinically valid to prescribe addition of azitromycin to basic antiinflammatory treatment of BA.     

Association of asthma therapy and Churg-Strauss syndrome: an analysis of postmarketing surveillance data

BACKGROUND: Churg-Strauss syndrome (CSS), also known as allergic granulomatous angiitis (AGA), is a rare vasculitis that occurs in patients with bronchial asthma. The nature of the association of CSS with various asthma therapies is unclear. OBJECTIVE: This study investigated the associations of different multidrug asthma therapy regimens and the reporting of AGA (the preferred code for CSS in the coding dictionary for the Adverse Event Reporting System [AERS]) by applying an iterative method of disproportionally analysis to th AERS database maintained by the US Food and Drug Administration. METHODS: The public-release version of the AERS database was used to identify reports of AGA in patients receiving asthma therapy. Reporting of AGA was examined using iterative disproportionality methods in patients receiving > or =1 of the following drug classes: inhaled corticosteroid (ICS), leukotriene receptor antagonist (LTRA), short-acting beta(2)-agonist (SABA), or long-acting beta(2)-agonist (LABA). The Bayesian data-mining algorithm known as the multi-item gamma poisson shrinker was used to determine the relative reporting rates by calculation of the empirical Bayes geometric mean (EBGM) and its 90% CI (EB05 = lower limit and EB95 = upper limit) for each drug. Subset analyses were performed for each drug with different medication combinations to differentiate the relative reporting of AGA for each. RESULTS: A strong association was found between LTRA use and AGA (EBGM = 104.0, EB05 = 95.0, EB95 = 113.8) that persisted with all combinations of therapy studied. AGA was also associated with the ICS, SABA and LABA classes (EBGM values of 27.8, 14.6 and 40.4, respectively). However, the latter associations were mostly dependent on the presence of concurrent LTRA and, to a lesser extemt, oral corticosteroid therapy and became negligible (ie, EB05 < 2) for patients who were not receiving these concurrent treatments. CONCLUSIONS: Differences based on relative reporting were observed in the patterns of association of AGA with LTRA, ICS, and beta(2)-agonist therapies. A strong association between LTRA use and AGA was present regardless of the use of other asthma drugs.     

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.     

耳穴磁疗联合鼻穴按摩综合护理防治变应性鼻炎疗效评价

目的：探讨耳穴磁疗联合鼻穴按摩综合护理对变应性鼻炎的防治效果。方法选取2014年6月至2015年2月本院耳鼻咽喉科、针灸科门诊收治的60例患者为研究对象,随机分为对照组(口服抗阻胺药或加用糖皮质激素类鼻喷剂)和治疗组(耳穴磁疗+鼻穴按摩+中医辨证施护)。发作期观察比较两组患者治疗前后鼻炎症状、体征及中医兼症改善情况,缓解期观察比较两组患者鼻炎复发的次数。结果两组患者治疗后鼻炎症状、体征及中医兼证情况均有所改善,治疗组总有效率略高于对照组( P<0.05);治疗后半年内鼻炎复发次数较对照组明显减少,差异具有统计学意义( P<0.01)。结论耳穴磁疗联合鼻穴按摩综合护理防治变应性鼻炎是有效的。     

Efficacy, tolerability, and effect on asthma-related quality of life of formoterol bid via multidose dry powder inhaler and albuterol QID via metered dose inhaler in patients with persistent asthma: a multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group study

BACKGROUND: Inhaled beta(2)-agonists are widely used in asthma treatment. The design limitations of pressurized metered dose inhalers (pMDIs) have prompted the development of dry powder inhalers (DPIs) for the delivery of asthma medications. OBJECTIVE: The goal of this study was to evaluate the efficacy, tolerability, and effect on asthma-related quality of life (QOL) of a long-acting beta(2)-adrenoreceptor agonist, formoterol, delivered via multidose DPI, compared with albuterol delivered via pMDI or placebo in adolescents and adults with persistent asthma. METHODS: This multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group study was conducted in outpatient clinics at 18 US centers. Adolescents and adults with persistent asthma received formoterol 10 pg BID via multidose DPI, albuterol 180 microg QID via pMDI, or placebo for 12 weeks. The primary efficacy variable was the 12-hour AUC of forced expiratory volume in 1 second (FEV(1)) after 12 weeks treatment. Secondary efficacy variables included asthma-related QOL, asthma symptom scores, rescue medication use, and other pulmonary function measures. RESULTS: A total of 239 patients (147 females, 92 males; age range, 13-85 years) with persistent asthma were enrolled (formoterol, n = 80; albuterol, n = 79; placebo, n = 80). Formoterol delivered via the multidose DPI resulted in clinically relevant and statistically significant increases in 12-hour AUC of FEV(1) after 12 weeks of treatment compared with albuterol pMDI and placebo (P < 0.019 and P < 0.001, respectively). Asthma-related QOL (total score) was significantly improved with formoterol treatment compared with placebo (P < 0.015). Nocturnal asthma symptom scores significantly improved with formoterol compared with albuterol and placebo (P < 0.001 and P < 0.003, respectively) and rescue medication use was significantly less with formoterol compared with albuterol and placebo (P < 0.004 and P < 0.002, respectively). Treatment with formoterol was well tolerated. CONCLUSIONS: In this study of adolescents and adults with persistent asthma, 12 weeks of treatment with formoterol 10 microg BID delivered via a multidose DPI provided significantly greater 24-hour bronchodilation compared with albuterol and placebo and resulted in significant improvements in asthma-related QOL compared with placebo. Formoterol was well tolerated in these patients.     

舌下含服粉尘螨滴剂对不同年龄段过敏性鼻炎患者的临床疗效评估

目的:比较不同年龄段过敏性鼻炎患者使用粉尘螨滴剂舌下含服的临床疗效。方法:选取南京医科大学附属南京医院(南京市第一医院)耳鼻喉科2017年6月至2019年3月收治的264例过敏性鼻炎患者作为研究对象,依照就诊年龄,将患者分为5组:A组(5~7岁,24例)、B组(8~13岁,79例)、C组(14~17岁,40例)、D组(18~39岁,84例)、E组(≥40岁,37例),均给予舌下含服粉尘螨滴剂,分别比较治疗前后各组的症状评分、药物评分、视觉模拟评分(visual analogue scale,VAS)及疗效评价。同时,将所有患者分为疗程少于1年组(T1)及疗程超过1年组(T2),对2组患者治疗前后症状评分、药物评分、VAS评分及疗效评价进行对比。结果:不同年龄段患者治疗后的症状评分、VAS评分及药物评分均较治疗前有改善,差异具有统计学意义(P<0.05),但各组间症状改善程度的差异无统计学意义;T2组症状改善程度的症状评分差值[(5.06±2.54)vs(3.90±3.41),P=0.002],VAS评分差值[(3.65±2.23)vs(2.46±2.55),P<0.001]及显效率(66.1%vs 37.9%,P<0.001)均较T1组高。结论:舌下含服粉尘螨滴剂对各年龄段过敏性鼻炎患者均有疗效,且疗效相近;舌下含服粉尘螨滴剂治疗过敏性鼻炎,疗程超过1年的患者疗效较疗程少于1年的患者疗效更好。     

变应原脱敏治疗对过敏性哮喘患儿的疗效观察

目的探讨变应原制剂辅助治疗对哮喘患儿的疗效影响。方法选择过敏性哮喘患儿85例，分为对照组40例和脱敏组45例。两组均进行止喘、解痉等常规治疗。脱敏组在此基础上进行变应原制剂辅助脱敏治疗。3个月后，评定比较治疗效果，判定临床疗效。结果治疗6个月后，脱敏组哮喘发作次数减少、症状减轻，与对照组比较，差异有统计学意义（P〈0．05）。结论变应原脱敏疗法对过敏性哮喘患儿有显著疗效。