气道反应性测定在咳嗽变异性哮喘鉴别诊断中的作用

目的探讨气道反应性在咳嗽变异性哮喘鉴别诊断中的作用。方法按照慢性咳嗽解剖学诊断程序进行诊断,对肺功能正常仍不能确诊患者行支气管激发试验。结果21例咳嗽变异性哮喘、23例感染后咳嗽、3例嗜酸粒细胞性支气管炎患者气道高反应性的发生率分别为100%、26.1%和0,3组疾病气道高反应性的发病率差异有显著性,咳嗽变异性哮喘组明显高于感染后咳嗽及嗜酸粒细胞性支气管炎组;咳嗽变异性哮喘及感染后咳嗽的平均一秒钟用力呼气容积下降20%时的乙酰甲胆碱含量分别为0.74和1.86g/L,2组疾病气道反应性差异有显著性,咳嗽变异性哮喘组明显高于感染后咳嗽组。结论气道反应性测定在咳嗽变异性哮喘的鉴别诊断中具有重要意义。     

咳嗽变异性哮喘

喘息、胸闷和咳嗽是典型的支气管哮喘常有的症状 ,因此也称为哮喘的三联症。而咳嗽变异性哮喘 (ｃｏｕｇｈｖａｒｉａｎｔａｓｔｈｍａ ,简称ＣＶＡ) ,又称咳嗽型哮喘(ｃｏｕｇｈｔｙｐｅａｓｔｈｍａ) ,是指以慢性咳嗽为主要或惟一临床表现的一种特殊类型哮喘。大约在 30年前 ,Ｓｔａｎｅｓｃｕ和Ｇｌａｕｓｅｒ等就注意到了这一现象。流行病学资料显示 ,大约 5 %～ 6%的支气管哮喘患者出现典型的哮喘症状之前数年 ,可仅表现为顽固性咳嗽。咳嗽多发生在夜间或凌晨 ,常为刺激性咳嗽 ,体检时无哮鸣音 ,往往被误诊为咽炎或支气管炎。研究发现 …     

儿童咳嗽变异性哮喘36例

儿童咳嗽变异性哮喘(CVA)，又叫过敏性咳嗽，是以咳嗽为主要表现的支气管哮喘，临床上无典型哮喘的喘息症状、呼吸困难及肺部体征，常按慢性支气管炎、反复呼吸道感染、肺结核等，给予抗感染、止咳等治疗，治疗效果不佳而长期误诊并增加经济负担。现将36例CVA患儿的诊治情况总结如下。     

咳嗽变异性哮喘

喘息、胸闷和咳嗽是典型的支气管哮喘常有的症状，因此也称为哮喘的三联症。咳嗽变异性哮喘，又称咳嗽型哮喘，是指以慢性咳嗽为主要或唯一临床表现的一种特殊类型哮喘。流行病学资料显示，大约5％-6％的支气管哮喘患者出现典型的哮喘症状之前数年，可仅表现为顽固性咳嗽。此类咳嗽常为刺激性咳嗽，体检时无哮鸣音，往往被误诊为咽炎或支气管炎。     

成人咳嗽变异性哮喘23例

目的探讨咳嗽变异性哮喘（CAV）的临床特征及治疗情况,提高对该病的认识和诊断水平。方法总结23例CAV患者的临床资料,对其发病特点、误诊及治疗情况进行回顾性分析。结果本组23例患者误诊7例,误诊率为30.4%。所有患者确诊为咳嗽变异性哮喘后,停用抗生素、止咳药,给予吸入β2-受体激动剂气雾剂、糖皮质激素气雾剂,口服氨茶碱、酮替酚或强的松后症状消失。结论提高对咳嗽变异性哮喘的认识,早确诊,且一旦诊断成立即按哮喘的治疗原则施治,对降低哮喘的发生率非常重要。     

咳嗽变异性哮喘诊治误区

咳嗽变异性哮喘,属哮喘的范畴,临床表现为反复发作的刺激性咳嗽,如不高度警惕本病的存在,很容易误诊、漏诊。笔总结我院门诊３５例咳嗽变异性哮喘诊治情况。分析其诊治中存在的误区。     

嗜酸粒细胞性支气管炎与咳嗽变异性哮喘患者的气道炎症特征的研究

目的研究嗜酸粒细胞性支气管炎以及咳嗽变异性哮喘病人气道炎性细胞因子与炎性介质的主要特性。方法嗜酸粒细胞性支气管炎(EB)组16例患者、咳嗽变异性哮喘(CVA)组16例患者、哮喘组15例患者以及对照组15例正常体检者,检测这4组人员诱导痰中的嗜酸粒细胞即嗜酸粒细胞(EOS)比例;流式检测白细胞介素-5(IL-5)和γ-干扰素(IFN-γ)刺激的EOS表面CD69蛋白的表达;酶联免疫吸附(ELISA)法检测各组患者诱导痰上清液中前列腺素E2(PGE2)、白三烯C4(LTC4)的蛋白表达量。结果 EB组、CVA组、哮喘组患者诱导痰中EOS表面CD69蛋白的表达量差异无统计学意义,与对照组相比差异有统计学意义(均P<0.05)。EB组、CVA组、哮喘组患者诱导痰中PGE2浓度比较差异有统计学意义(均P<0.05);与对照组相比,CVA组患者、EB患者以及哮喘组患者的诱导痰中LTC4浓度显著增高(均P<0.05),EB组患者的LTC4的蛋白表达量和CVA组患者以及哮喘组患者的差异进行比较,同样具有统计学意义(均P<0.05)。CVA组患者以及哮喘组患者诱导痰中LTC4/PGE2的比值与EB组患者相比显著增高(均P<0.05)。结论 EB组患者的诱导痰中PGE2的表达水平增高,CVA组患者的LTC4/PGE2比值与EB组患者相比也是明显升高,推测这两个因素是EB缺乏气道反应性的潜在炎症基础。     

咳嗽变异性哮喘过敏原检测分析

目的探讨咳嗽变异性哮喘(CVA)与过敏原之间的相互关系,为CVA的临床诊治提供依据。方法应用Mediwiss公司出品的AllergyScreen过敏原检测系统对58例CVA患者、51名非CAV型慢性咳嗽患者进行过敏原体外免疫测试,并计算各种过敏的所占阳性比例。结果 1种以上过敏原阳性率,CVA组为81.03%(47/58),非CAV组为19.61%(10/51),两组相比,差异有高度统计学意义(P<0.01);而其中4种过敏原的阳性检出率两组之间的差异均有统计学意义(P<0.05)。结论 CVA与过敏因素关系密切;可用过敏原体外检测辅助诊断咳嗽病因。     

咳嗽变异性哮喘30例报告

咳嗽变异性哮喘是以咳嗽为主要表现的支气管哮喘，国内较少报道，临床上无哮喘音常长期按慢性支气管炎、上呼吸道感染、肺结核等给予抗感染和止咳祛疾治疗无好转而长期误诊。现把我们收治的具有完整资料并符合1992年10月全国儿科哮喘协作组在南京制订的咳嗽变异性哮喘诊断标准［1］的30例报告如下。1临床资料1．1一般资料：本组30例，男20例，女10例，开始咳嗽年龄：～3岁8例，～6岁10例，～9岁12例。发病季节：春季10例，夏季8例，秋季4例，冬季8例。病程6个月～2年16例，～4年8例，～6年6例。6例有过敏性鼻炎史，6例有哮喘病家族史，5例有…     

Notch配体在哮喘气道重塑小鼠中的表达及布地奈德的干预作用

目的探讨哮喘小鼠气道重塑发病过程中Notch配体Jagged1及Jagged2在肺组织的表达变化及布地奈德的干预作用。方法清洁级C57BL/6雄性小鼠30只随机分为对照组、哮喘气道重塑组、布地奈德干预组,每组各10只。建立哮喘气道重塑模型,利用酶联免疫吸附测定、免疫组化、Western blot等方法,检测炎症因子、气道重构和Jagged1及Jagged2表达变化,并分析它们的相关性。结果哮喘气道重塑组小鼠肺组织的炎症因子IL-4/5/13、Jagged1及Jagged2表达明显增加（P < 0.01或0.001）;布地奈德干预后,气道炎症、气道粘液分泌及胶原沉积明显缓解（P < 0.01）,Jagged1及Jagged2表达明显降低（P < 0.05或0.01）;Jagged1及Jagged2表达水平与炎症因子、气道重构呈正相关（P < 0.001）。结论Notch配体Jagged1及Jagged2表达增加可能参与了哮喘小鼠气道炎症反应及气道重塑。布地奈德能抑制哮喘气道炎症反应及气道重塑可能与降低Jagged1及Jagged2的表达有关。     

气雾型布地奈德联合孟鲁司特钠对咳嗽变异性哮喘患儿白三烯、炎性因子水平的影响

目的 探讨气雾型布地奈德联合孟鲁司特钠治疗咳嗽变异性哮喘(CVA)患儿的临床效果.方法 选取2019年1月至2020年3月收治的82例CVA患儿为研究对象,遵循随机数字表法的原则将其分为对照组(40例)和试验组(42例).两组患儿均给予常规吸氧、抗感染等对症治疗.在此基础上,对照组给予布地奈德治疗,试验组在对照组基础上...     

CpG DNA: immunomodulation and remodelling of the asthmatic airway

Asthma is a disorder of increasing severity and prevalence. Present understanding of the pathogenesis of asthma emphasises its inflammatory nature. Unbridled inflammation appears to induce irreversible changes, collectively known as airway remodelling. CpG oligonucleotides are a class of compounds that have been developed from studies of prokaryotic DNA. Bacterial DNA, for example, contains sequence motifs based on the dinucleotides cytosine-guanine (CpG); these motifs are suppressed in mammalian DNA and induce (as part of the innate immune system) inflammation, characterised by the induction of T helper type 1 and regulatory responses. The pattern of inflammation promoted by CpG DNA tends to suppress the cytokine and cellular responses characteristic of asthma and atopic disorders. This has led to the investigation and development of CpG DNA as a novel therapeutic approach for the treatment and prevention of these disorders. In addition to suppressing acute and persistent airway inflammation, CpG DNA also reduces the development of subepithelial collagen deposition, goblet cell hyperplasia/metaplasia, and other aspects of airway remodelling. In this paper, the effects of CpG DNA on asthma inflammation and remodelling are reviewed.     

Cough-variant asthma in children and adults: case reports and review

Two cases of cough-variant asthma are presented, one in an adult and one in a child. We discuss the diagnosis, treatment, and course of this common, yet often unrecognized entity. The keys to diagnosis are a typical history, clinical suspicion, and subsequent response to bronchodilator therapy. Treatment of cough-variant asthma is no different from that of classic asthma.     

氯胺酮雾化吸入对哮喘大鼠气道反应性和炎症的影响

目的观察氯胺酮雾化吸入对哮喘模型大鼠气道反应性和炎症的影响。方法将40只Brown Norway大鼠随机分成对照组(C组)、哮喘模型组(A组)、氯胺酮1组(K1组)、氯胺酮2组(K2组)、氯胺酮3组(K3组),每组8只。A组用卵蛋白辅以百日咳杆菌菌苗及氢氧化铝为佐剂注射致敏,2周后雾化吸入卵蛋白激发;K1,K2,K3组大鼠以同样方法致敏,在激发前分别雾化吸入12.5、25、50 mg/mL的氯胺酮;C组注射和雾化吸入PBS。应用动物体描箱法测定大鼠的气道反应性,计数支气管肺泡灌洗液(BALF)中细胞总数并分类,检测BALF中IL-13浓度(ELISA法)。结果在乙酰胆碱(ACH)浓度为50、100、200μg/kg时,K1、K2、K3组呼气阻力(expiratory resistance,Re)的明显小于A组(P<0.05),与哮喘组比较,治疗组BALF中白细胞总数、嗜酸细胞的数目、BALF中IL-13水平明显下降(P<0.05)。结论氯胺酮雾化吸入治疗可明显减轻哮喘模型大鼠气道反应性和气道炎症。     

Serum prolidase activity and oxidative status in patients with bronchial asthma

Asthma is a disease where there is an accumulation of collagen in the reticular basal membrane of the airway leading to chronic inflammation. The enzyme prolidase plays an important role in the breakdown of collagen and the breakdown of intracellular protein especially in the final stage when peptides and dipeptides contain a high level of proline. To evaluate the relationship between prolidase activity and oxidative status in asthma patients. Comparison was made between 42 patients diagnosed with bronchial asthma and 32 healthy children of similar age and gender. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total antioxidant capacity (TAC) and total oxidant status (TOS) measurement. The prolidase activity of the asthma patient group was statistically significant compared with the control group (P≤0.001). TAC and TOS levels in the asthma patient group were higher than the control group (P≤0.001, P≤0.002, respectively). No correlation was found between the prolidase and oxidative levels of the two groups. A positive correlation was determined between the prolidase activity and TAC in the asthma patient group (P≤0.001, r=0.501). The prolidase enzyme activity, which plays a role in the collagen turnover, was low in the asthma patients; therefore, their collagen metabolism had undergone a change and this indicates that there may be an effect on the accumulation of collagen in the reticular basal membrane. Moreover, the high level of TOS indicates that these patients were exposed to severe oxidative stress with an increased TAC response. J. Clin. Lab. Anal. 23:132–138, 2009. © 2009 Wiley‐Liss, Inc.     

Budesonide/formoterol decreases expression of vascular endothelial growth factor (VEGF) and VEGF receptor 1 within airway remodelling in asthma

INTRODUCTION: Angiogenesis and microvascular remodelling may play a vital role in the chronic inflammatory process within asthma. One of the most important factors involved in angiogenesis is vascular endothelial growth factor (VEGF). In this study we hypothesised that an increased expression of VEGF may be involved in airway remodelling in asthma patients. To this end, we compared the histology and expression levels of VEGF and one of its receptors (VEGFR1) in bronchial tissues of patients with asthma compared with control patients. We also investigated the effect of treatment with budesonide/formoterol (Symbicort(R); AstraZeneca, Lund, Sweden) in the relationship between VEGF and airway remodelling. METHODS: Bronchial tissues were obtained from patients attending the West China Hospital from April to November 2006. Thirteen patients were diagnosed with moderate asthma and 10 others were treated as control. Histological and immunohistochemical comparisons between asthmatic and control patients were made at baseline, and (for asthmatic subjects) following 6 months of treatment with budesonide/formoterol. RESULTS: Compared with control patients, asthmatic patients had significantly decreased respiratory parameters, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV(1)) (% predictive). Furthermore, patients with asthma had submucosal gland hyperplasia, increased smooth muscle mass, increased subepithelial fibrosis and neovascularisation. Asthmatic patients also exhibited increased expression of VEGF and VEGFR1 within epithelial cells. The increased expression of VEGF and its receptor correlated well with airway remodelling, airflow obstruction and airway hyper-responsiveness. After treatment with budesonide/formoterol for 6 months, the expression of VEGF and VEGFR1 was decreased, with correlatory decreased airway remodelling in patients with asthma. CONCLUSION: The increased expression of VEGF and VEGFR(1) in asthmatic patients is accompanied by an increased number and size of blood vessels in asthmatic airways, as well as airway remodelling. Budesonide/formoterol therapy for 6 months can decrease the expression of VEGF and VEGFR(1) alongside airway remodelling in asthma. The inhibition of VEGF and its receptor may be a good therapeutic strategy for asthma.     

内皮素-1与支气管哮喘小气道的关系

目的探讨内皮素-1与支气管哮喘小气道功能的关系。方法采用特异性放射免疫技术测定支气管哮喘急性期患者（A组）25例,缓解期患者（B组）23例和健康对照组（C组）24例的血浆内皮素-1含量,同时测定肺功能：第1s用力呼气容积,用力呼气50%肺活量时瞬间流量,5Hz时电抗值,周边阻力指标,并进行对比分析。结果A组内皮素-1含量显著高于B组和C组（t=14.233,14.705,P〈0.01）,B组和C组比较无显著性差异（t=0.501,P〉0.05）;A组内皮素-1含量与第1s用力呼气容积,用力呼气50%肺活量时瞬间流量呈显著负相关（P〈0.01）,与5Hz时电抗值,周边阻力呈正相关。结论内皮素-1的合成和释放与支气管哮喘患者急性发作的病理生理变化有显著相关性,影响小气道功能。     

钠钾泵Scr复合体通过调控自噬影响幼年哮喘大鼠气道重塑的机制研究

目的 制备哮喘幼年大鼠模型,观察钠钾泵Scr复合体对哮喘幼年大鼠炎性因子及自噬的影响,探讨钠钾泵Scr复合体调控自噬改善幼年哮喘大鼠气道炎症、气道重塑的机制.方法 幼年SD大鼠100只随机分为空白对照组、模型组及钠钾泵Scr复合体低、中、高剂量组各20只.模型组及钠钾泵Scr复合体低、中、高剂量组制备哮喘模型.造模成功...     

嗜酸性粒细胞及中性粒细胞型哮喘患者炎症特点与小气道功能变化分析

目的:分析嗜酸性粒细胞及中性粒细胞两种表型哮喘患者炎症特点及小气道功能变化,为哮喘个体化治疗提供依据。方法:采用横断面研究方法,将2017年7月1日至2019年6月30日在上海市第六人民医院金山分院呼吸科就诊,经诱导痰细胞学检查证实的46例嗜酸性粒细胞型哮喘及42例中性粒细胞型哮喘患者纳入研究对象,按哮喘类别分为嗜酸性...