哮喘儿童过敏原抗体调查

为了解江苏省苏、锡、常、宁、杨地区哮喘患儿过敏原，用Phadiatop全自动检测仪检测正常儿童、肺炎及哮喘患儿血清过敏原抗体。吸入性过敏原过筛包括D1、H1、EX1、MX2、TX4、WX1、16；食物性过敏原过筛主要是FX5E。结果显示正常、肺炎、哮喘3例组吸入性过敏原阳性率分别为28．13％、19．05％、78．27％。食物性过敏原阳性率分别为9．38％、11．34％、27．17％。哮喘组与正常组、肺炎组间吸入性过敏原、食物性过敏原差异均有显著性（P＜0．005），正常组与肺炎组间差异无显著性。哮喘组D1呈现高水平趋势，且其阳性率随年龄增长而增长，呈正相关。哮喘组部分患儿对蟑螂等过敏，其食物与年龄之间未能显示明显规律性。提示哮喘患儿主要对尘螨、屋尘等吸入性过过敏原过敏，小部分对蟑螂等吸入性和食物性过敏原过敏。     

哮喘儿童体外过敏原抗体280例调查研究

目的了解东莞市哮喘儿童过敏原分布情况。方法（1）问卷调查；（2）用UniCAP100全自动检测仪、荧光免疫检测法、体外检测哮喘组及肺炎组（对照组）患儿血清过敏原抗体。吸人性过敏原筛查包括：螨及屋尘螨、粉尘螨等。食人性过敏原筛查（FX5E）：主要为牛奶、鸡蛋、虾、螃蟹、鱼等。结果吸人性过敏原筛查：肺炎组受检296例患儿中，阳性为75例（25．33％）；哮喘组受检280例患儿中，阳性为230例（82．14％）。食人性过敏原筛查：肺炎组受检296例患儿中，阳性为45例（15．20％）；哮喘组受检280例中，阳性为142例（50．71％）。哮喘组与肺炎组间吸人性过敏原、食人性过敏原差异均有统计学意义（P〈0．05）。哮喘组对尘螨呈高敏感趋势，而且阳性率随年龄增长而增长，呈正相关关系。哮喘组对食人性过敏原较为敏感者，主要是对海鲜类过敏，其次为常见蔬果过敏。结论本组受检哮喘儿童吸人性过敏原中，主要过敏原为尘螨。而且阳性率及过敏反应程度随年龄的增长而增长，呈正相关关系。部分哮喘儿童对海鲜类食物过敏，其次是对常见蔬果类过敏。     

哮喘患儿吸入糖皮质激素对骨代谢影响

目的　探讨哮喘患儿吸入糖皮质激素 (IGs)对骨代谢影响。方法　对 5 0例 5～ 12岁连续吸入IGs 2年哮喘患儿 ,于吸入前 ,0 .5、1、1.5、2年分次进行血清钙、磷、骨源性碱性磷酸酶 (BALP)、骨钙素 (OC)水平监测 ,并进行身高生长速度测定。其中观察I组 2 7例 ,平均吸入丙酸倍氯米松 2 5 0 μg/d ;观察Ⅱ组 2 3例 ,平均吸入丙酸氟替卡松 15 0 μg/d ;正常对照组 2 2例。 结果　观察Ⅰ、Ⅱ组、对照组间分次检测的血钙、磷、BALP、OC水平均无显著差异 (P均 >0 .0 5 ) ;且各组间q检验无显著差异 (P均 >0 .0 5 )。观察Ⅰ、Ⅱ组身高生长速度分别于对照组比较 ,均无显著差异 (P均 >0 .0 5 )。结论　每日小剂量较长时间IGs对儿童骨生长发育无明显影响。     

上海嘉定地区支气管哮喘儿童常见过敏原分析

目的 探讨上海嘉定地区儿童哮喘的致敏原以及哮喘患儿年龄与过敏原的相关性.方法 351例哮喘儿童按年龄分组,用15种标准化的吸入性过敏原和食物性过敏原点刺液对所有患儿进行皮肤点刺试验,观察阳性率及不同年龄组过敏原情况.结果 (1)哮喘患儿吸入性过敏原阳性率为71.2%,其排序依次为粉尘螨(49.6%)、屋尘螨(49.0%...     

哮喘儿童吸入糖皮质激素治疗回顾性分析

对哮喘患儿进行长期、持续、规范化治疗是提高哮喘综合管理水平的关键。我科哮喘学组自1996年1月起 ,遵循《全球哮喘防治创议》(GlobalInitiativeforAsthma,GINA)[1]及1993年、1998年中华医学会儿科呼吸学组制定的哮喘防治指南 [2 ,3],进行以糖皮质激素 (glucosecorticosteroid,GCS)吸入为主的治疗措施 ,现总结如下。对象与方法一、对象1996年1月～2000年12月接受糖皮质激素吸入治疗的支气管哮喘患儿326例 ,男178例 ,女148例 ,男女之比为1∶2。首次就诊时的年龄范围为2个月～16岁 ,其中2个月～3岁91例(占27.9 % ) ,～6岁137例 (占42.0 %…     

长期吸入糖皮质激素对支气管哮喘患儿身高的影响

支气管哮喘(哮喘)是儿童期最常见的慢性疾病,吸入糖皮质激素(ICS)仍是目前哮喘治疗中最有效的方法。但由于本身存在的不良反应,使其在临床应用中受到一定的影响。通过对近年国内外相关文献进行综述,认为短期吸入中小剂量糖皮质激素(GC)对哮喘儿童的身高无显著性影响。对长期吸入者身高的影响与ICS的种类、剂量、疗程、吸入器、吸入技术、不同年龄以及个体对激素的敏感程度等有关,可采取一定的措施预防ICS对身高的影响。     

哮喘患儿长期吸入糖皮质激素对身高的影响

支气管哮喘(哮喘)是儿童最常见的慢性呼吸道疾病。吸入型糖皮质激素( inhaled corticoste-roid,ICS)是目前治疗哮喘最有效的药物,但近来亦有报道长期使用仍会产生一些不利影响。汇总近年来相关文献资料,ICS长期治疗可能会轻度地减缓身高的增长速度,但这种抑制只出现在哮喘治疗早期,并且不影响或仅轻度影响最终身高。 ICS对身高的影响,亦与其使用的种类、剂量和吸入方法相关。     

昆明市哮喘儿童过敏原皮肤试验、血清IgE检测分析

支气管哮喘是由嗜酸性粒细胞、肥大细胞和T淋巴细胞等多种炎性细胞参与的气道慢性炎症,主要与外界环境中的过敏原有关。我们于1997年8月至1999年1月选择过敏原皮肤点刺试验对哮喘儿童作过敏原检测分析,对其中部分儿童作血清总IgE(tIgE)、尘螨特异性IgE(sIgE)测定,并与健康儿童作对照,旨在了解昆明市儿童哮喘最常见的过敏原,为预防和治疗哮喘提供依据。     

支气管哮喘患儿吸入糖皮质激素治疗前后细胞因子及免疫功能变化

目的　探讨支气管哮喘患儿吸入糖皮质激素前后细胞因子、T细胞亚群等指标的变化。方法　采用双抗体夹心ELISA法检测 2 8例哮喘患儿吸入糖皮质激素前、吸入 1个月、吸入 1年后血清白细胞介素 6 (IL 6 )、IL 8、肿瘤坏死因子α(TNF α)水平 ,同时检测外周血T细胞及其亚群、B细胞变化。结果　哮喘患儿吸入前血清IL 6、IL 8、TNF α均显著高于正常对照组 (P <0 .0 1)。吸入 1个月、1年时 ,3种细胞因子水平渐降低 ,但仍高于正常水平。哮喘患儿外周血CD3+ 、CD4 + 、CD8+ 细胞均显著低于正常对照组 ,而CD4 + /CD8+ 、B细胞下降 ,但仍未降至正常水平。结论　哮喘患儿存在多种细胞因子失调及T细胞亚群、B细胞失衡。IL 6、IL 8、TNF α可能参与哮喘的炎症反应。吸入糖皮质激素可显著降低体内炎症细胞因子水平 ,促进T细胞亚群恢复平衡     

表面皮质激素吸入治疗儿童哮喘剂量的探讨

目的探讨我国哮喘儿童吸入皮质激素的疗效及安全性。方法研究５０例间歇发作型及轻度持续发作型哮喘儿童吸入不同剂量（２００～１２００μｇ／ｄ）皮质激素（二丙酸倍氯松,ＢＤＰ）的肺功能、气道高反应性及下丘脑－垂体－肾上腺轴（ＨＰＡＡ）功能的变化。将５０例哮喘患儿随机分为５组（每组１０例）,分别吸入安慰剂及ＢＤＰ２００,４００,８００,１２００μｇ／ｄ。结果经过３个月的治疗,各治疗组的第１秒用力呼气容积（ＦＥＶ１）,最高呼气流速（ＰＥＦ）及ＰＤ２０－ＦＥＶ１均显著升高,而对照组则无明显变化。治疗前后各组患儿的血浆ＡＣＴＨ及血清皮质醇基础值均无明显变化,血浆皮质醇对ＡＣＴＨ刺激的反应值在对照组及ＢＤＰ２００μｇ组无明显变化,而在ＢＤＰ≥４００μｇ／ｄ时则明显下降。结论２００μｇ／ｄ的ＢＤＰ能有效地改善哮喘儿童的肺功能,降低气道高反应性,但当剂量≥４００μｇ／ｄ时,则可能引起血皮质醇对ＡＣＴＨ刺激的反应性抑制。临床上使用ＢＤＰ吸入疗法治疗间歇发作型及轻度持续发作型儿童哮喘时,尽可能将剂量控制在每日４００μｇ以下     

海南儿童哮喘常见吸入性变应原的调查

目的 了解海南地区儿童哮喘常见吸入性变应原,探讨有效实施变应原避免的措施,为成功开展特异性免疫治疗提供依据.方法 对2 361例哮喘儿童进行13种常见过敏原皮肤点刺试验,对其中450例患儿进行10种过敏原体外特异性IgE检测.结果 2 361例哮喘患儿皮肤点刺阳性率为86.0%,其中,屋尘螨及粉尘螨阳性率分别为91.2%及89.3%,热带螨为86.3%,且阳性级别高.对三种螨呈三级以上皮肤点刺阳性反应的患者分别占65.7%、65.4%和58.2%.动物皮毛中,狗毛阳性率为22.4%,猫毛14.4%;德国小蠊及美洲大蠊分别为28.7%及21.9%,但其阳性级别通常很低.450例体外过敏原检测阳性率为72.4%,其中仍以螨虫阳性率最高,屋尘螨66.2%,粉尘螨59.6%.结论 屋尘螨、粉尘螨和热带螨是海南地区最重要的过敏原,其阳性率和阳性级别均比国内其他地区高.狗毛、猫毛、蟑螂等过敏原在海南也占一定比例.     

Increased glycosaminoglycans in the urine of asthmatic children on inhaled corticosteroids

Increased extracellular matrix (ECM) deposition in the airway wall contributes to the airway remodeling in asthmatics. Glycosaminoglycans (GAGs) are polysaccharides attached to a protein core in order to form proteoglycans, a component of the ECM. In this study, we investigated the possible influence of long-term treatment with inhaled corticosteroids (ICS) on urinary GAGs levels of asthmatic children. Seventy asthmatic children (41 boys), aged 6.8-12.5 yr, participated in the study. About 44 were treated with inhaled budesonide via turbuhaler for 2-35 months (median 12 months) and 26 were on relief medications. About 30 healthy controls were also studied. GAGs were precipitated from early morning urine samples, collected, isolated and quantified using uronic acid-carbazole reaction and expressed as uronic acid (UA) in microg/g/Cr(u)/m2. Urinary GAGs values did not differ significantly between controls and asthmatics but significant differences were found between children on ICS and asthmatics on relief medications (p < 0.001). There was a positive correlation between the daily dose of inhaled budesonide and the urinary GAGs values (r = 0.32, p = 0.037) whereas a threshold distinguishing 'low' vs. 'high' doses of ICS was found to be at 300 microg/m2 per day with a significant difference in urinary GAGs secretion (p = 0.006). Our data show that urinary GAGs secretion is reduced in asthmatic children that used only relief medication but it is increased in those on long-term treatment with ICS. A dose dependent effect of ICS was also detected.     

Lymphocyte subsets, sIL2-R and sICAM-1 in blood during allergen challenge tests in asthmatic children

In order to study cell activation in peripheral blood on bronchial allergen provocation up to 24 h, we investigated 32 asthmatic children, sensitive to house-dust mites. Six healthy young adult volunteers served as controls. Lymphocyte subsets (CD3, CD19, CD4, CDS) and activation markers (CD25-T, HLADR-T, CD23) in peripheral blood as well as soluble IL2-R and soluble ICAM-1 in scrum were evaluated. In terms of clinical reaction, 23 children exhibited a DAR, 6 an EAR, 6 a LAR and 3 children did not show a bronchoconstrictor response to allergen challenge with house-dust mite extract (NAR). In comparison to controls, asthmatic children showed a significantly higher expression of CD23 on B-lymphocytcs (p < 0.05). Other subsets were in the same range in both groups. After provocation there was a significant increase of CD4/CD8-ratio only in asthmatic children. Serum levels of sIL2-R were significantly higher in asthmatic children compared to controls at baseline as well as at 12 and 24 h after provocation, without variation during observation period, No differences were noted for SICAM-1. Our results confirm the hypothesis that lymphocytes, as important cells in regulation of allergic immune response, are recruited into peripheral blood under allergen challenge conditions in sensitized asthmatic children.     

潮气呼吸法支气管舒张试验在5岁以下儿童哮喘诊断中的价值

目的 利用潮气呼吸法对小年龄哮喘患儿进行支气管舒张试验,探讨支气管舒张试验在5岁以下患儿哮喘诊断中的价值.方法 将2006年1月-2007年5月就诊的哮喘患儿246例,根据不同年龄段分为4组,Ⅰ组0～1岁,Ⅱ组～3岁,Ⅲ组～5岁,Ⅳ组～6岁.以0.5%沙丁胺醇作为支气管舒张约物,用潮气呼吸肺功能分析各组吸药前后肺功能指标变化.结果 Ⅰ、Ⅱ、Ⅲ组吸药前后达峰时间比(tPTEF/tE)、达峰容积比(VPEF/VE)差异均无统计学意义(t=0.065～0.179,P＞0.05);Ⅳ组吸药前后tPTEF/tE和VPEF/VE差异均有统计学意义(t=-4.295、5.029,P＜0.05).tPTEF/tE和VPEF/VE吸药前后差值与年龄呈正相关(P＜0.05).随年龄增大,差值逐渐增高.tPTEF/tE改善率和VPEF/VE改善率组问比较差异有统计学意义(P＜0.05).结论 潮气呼吸法支气管舒张试验在5岁以下哮喘患儿诊断中无明确临床价值,对于＞5岁哮喘患儿诊断与成人哮喘相同具有诊断意义.     

Individual time-courses of ECP and EPX during allergen provocation tests in asthmatic children

To study the time-course of eosinophil cationic protein (ECP) and eosinophil protein X (EPX) during bronchial allergen provocation, we investigated 32 asthmatic children sensitive to house-dust mites as well as 6 non-atopic young adult controls. In all subjects, allergen challenges were performed with house dust mite extracts of Dermatophagoides pteronys-sinus or Dermatophagoides farinae. Blood samples were taken at regular intervals during the 24-h observation period. The individual time-courses of ECP and EPX revealed different characteristic groups of patterns: (1) an isolated early serum peak of both mediators during or within the first 60 min after provocation (2) an early plus a late peak (3) an isolated late peak 12 h after provocation (4) an isolated late peak 24 h after provocation, and (5) no significant variation during the 24-h observation period. The early peak could be due to short-term changes in eosinophil activation, while late peaks may reflect eosinophil proliferation, recruitment, subsequent priming and enhancing of the propensity to release their proteins. ECP and EPX showed a corresponding parallel time-course in nearly all challenges, with EPX-concentration exceeding that of ECP. There was no correlation between ECP/EPX serum concentrations and clinical parameters such as lung function data. From our results we conclude that the striking groups of time-courses of ECP/EPX serum concentration indicate different uniform patterns of eosinophil activation during allergen challenge - but do not predict clinical outcome of provocation. The role of the eosinophil in early asthmatic reactions remains to be established in further studies.     

Unilateral right-sided internal jugular phlebectasia in asthmatic children

The most common cause of a neck mass that increases in size on straining is laryngocele. Internal jugular phlebectasia, which is of unknown cause, may present similarly. We present three cases of internal jugular phlebectasia, all of whom were asthmatic children. This association of asthma and internal jugular phlebectasia has not been reported previously.     

Assessment of use of spacer devices for inhaled drug delivery to asthmatic children

In the treatment of bronchial asthma, inhaled therapy with both bronchodilators and corticosteroids represents the basis for acute and long-term management. Drug therapy in asthma is predominantly by pressurized metered dose inhalers. The impact of treatment on the disease morbidity and mortality depends to a large extent on appropriate delivery of drug to the lungs by means of a spacer device. We performed an audit on spacer use in 200 children and showed that 99% owned a spacer, 2% owned but did not use their spacer, 11% were using a spacer which was not ideal for their age, 17% had a poor technique, and 24% were not following the recommendations given on previous visits to wash the spacer only with a soapy solution. Although physicians frequently associate poor control of asthma with inadequate doses of drugs, many factors must be considered before increasing the dose of inhaled medications to children. We should all ensure that the drugs we prescribe are delivered in the best possible manner, thus improving control of asthma, reducing side effects and offering a more cost-effective therapy.