布地奈德雾化吸入对支气管哮喘患者Th1、Th2型细胞因子的影响

目的探讨布地奈德雾化吸入治疗对支气管哮喘患者Th1、Th2型细胞因子的影响。方法轻、中度支气管哮喘患者共59例,健康对照者10例,检测肺功能,并采哮喘组治疗前及布地奈德雾化吸入治疗后2周的晨起静脉血,与健康对照者比较,检测血中Th1型细胞因子IFN-γ及及Th2型细胞因子IL-5的水平。结果轻、中度哮喘患者体内IFN-γ水平低于健康对照者(P0.05),IL-5水平高于健康对照者(P0.05),经布地奈德治疗后,IFN-γ水平较前增高,IL-5水平较前下降。结论哮喘患者体内Th1型细胞因子IFN-γ的分泌减少,Th2型细胞因子IL-5的分泌增多,布地奈德吸入治疗可在一定程度上提高IFN-γ的水平,降低IL-5的水平,值得关注。     

白三烯受体拮抗剂对支气管哮喘患者Th1/Th2平衡及肺功能的影响

目的观察白孟鲁司特钠对支气管哮喘患者Th1/Th2平衡及肺功能的影响。方法采用ELISA法分别测定50例支气管哮喘患者(哮喘组,其中30例急性发作期,20例稳定期)孟鲁司特钠片3个月治疗前后、25例正常人(对照组)的血清白细胞介素-4及γ-干扰素水平,以及使用肺功能仪测定两组哮喘患者治疗前后的FEV1%、PEF%水平。结果哮喘患者血清IL-4水平均明显高于正常对照组,哮喘急性发作期血清IL-4水平又明显高于哮喘稳定期水平(P<0.05)。哮喘患者血清γ-干扰素水平均明显低于正常对照组,哮喘急性发作期血清γ-干扰素水平又明显低于哮喘稳定期水平(P<0.05);哮喘组白三烯受体拮抗剂治疗后血清IL-4水平比治疗前显著降低(P<0.05),而血清γ-干扰素水平较治疗前明显升高,肺功能水平较治疗前有明显改善(P<0.05)。结论支气管哮喘Th1/Th2细胞因子处于失衡状态,白三烯受体拮抗剂孟鲁司特钠可明显改善支气管哮喘患者这种Th1/Th2失衡,改善支气管哮喘患者肺功能。     

硫酸镁联合雾化吸入布地奈德对急性支气管哮喘患儿血清IL-12、IL-17的影响

目的 探讨硫酸镁联合雾化吸入布地奈德对急性发作支气管哮喘患儿血清白细胞介素-12(IL-12)、白细胞介素-17(IL-17)的影响.方法 86例急性发作支气管哮喘患儿随机分为两组,观察组43例,对照组43例.观察组采用常规治疗加雾化吸入布地奈德和硫酸镁静点滴,对照组采用常规治疗加强的松.治疗7d后测定患儿治疗前后血清的IL-12和IL-17.结果 观察组总有效率为93％,对照组总有效率为83.7％,观察组总有效率高于对照组(P＜0.05).治疗后两组患儿血清IL-12均明显升高,观察组高于对照组(P＜0.05);治疗后两组患儿血清IL-17均降低,观察组低于对照组(P＜0.05).结论 硫酸镁联合雾化吸入布地奈德可以更明显降低血清IL-12和IL-17,进而改善急性发作支气管哮喘患儿病情.     

哮喘患者血清Th1／Th2类细胞因子水平变化及意义

目的探讨Th1／Th2类细胞因子在哮喘发病中的作用。方法采用ELISA法检测52例急性哮喘患者（急性组）和56例慢性哮喘患者（慢性组）外周血血清Th1类细胞因子（IL-2、γ-IFN）和Th2类细胞因子（IL4、IL-5、IL—10）水平,并选择60例正常健康人群（对照组）作对照比较。结果与慢性组及对照组比较,急性组IL-2和1-IFN水平均明显下降;而IL-4、IL-5、IL-10水平均明显升高（P均〈0．05）;慢性组γ-IFN水平明显低于对照组,IL-5水平明显高于对照组（P均〈0．05）。结论Th1／Th2类细胞因子失平衡状态可能是哮喘发病的重要原因,在哮喘’防治中应重视对失衡的细胞因子进行调节。     

维生素D对支气管哮喘患者Th1/Th2平衡的调节作用及IL-17的影响

目的 探讨维生素D对支气管哮喘(简称哮喘)患者Th1/Th2平衡的调节及IL-17的影响.方法 将80例稳定期哮喘患者随机分为对照组和治疗组各40例.对照组予以沙美特罗氟替卡松50/250 μg,每日1次,吸入治疗;治疗组在对照组基础上加用阿法骨化醇0.5 μg,每日1次,口服.2组治疗前均行γ干扰素(IFN-γ)、IL-4及IL-17检测,计算IFN-γ/IL-4比值,8周后复查上述指标.结果 治疗前两组IFN-γ和IL-4水平、IFN-γ/IL-4比值及IL-17基本一致(P＞0.05);治疗后IFN-γ/IL-4比值,治疗组明显高于对照组(P＜0.05),治疗组IL-17下降高于对照组(P＜0.05).结论 维生素D对哮喘患者的Th1/Th2平衡有一定的调节作用,可降低哮喘患者IL-17的过度表达.     

吸入糖皮质激素对哮喘患者Th1/Th2细胞因子网络影响

支气管哮喘(哮喘)是一种慢性气道炎症疾病,多种炎性细胞和炎性介质参与其过程。目前认为T辅助淋巴细胞两个功能性亚群Th1／Th2相关细胞因子在哮喘发病中发挥重要作用。我们对哮喘患者白细胞介素-5(IL-5)、白细胞介素-8(IL-8)r-干扰素(IFN-r)水平进行检测,探讨吸入糖皮质激素对哮喘患者Th1／Th2细胞因子的影响。     

银杏内酯对老年哮喘患者外周血Th1/Th2型细胞因子的作用

目的探讨银杏内酯对老年哮喘患者外周血T淋巴细胞Th1/Th2型细胞因子的作用及其治疗哮喘的可能机制。方法采用流式细胞术检测25例健康体检者正常对照组和25例老年支气管哮喘急性发作期患者单个核细胞（PBMC）经银杏内酯干预后Th1型细胞因子（IFN-γ）和Th2型细胞因子（IL-4）水平及Th1/Th2比值变化。结果与正常组比较,哮喘组Th2型细胞因子（IL-4）水平显著增高（P〈0.01）,哮喘组Th1/Th2比值显著减低（P〈0.01）。哮喘组银杏内酯体外干预后Th2型细胞因子（IL-4）水平较干预前显著减低（P〈0.01）,Th1/Th2比值较较干预前显著增高（P〈0.01）。结论银杏内酯具有抑制哮喘Th2细胞亚群优势反应和调节免疫平衡的作用。     

COPD患者Th1/Th2平衡失调临床观察

目的观察慢性阻塞性肺疾病Th淋巴细胞亚群平衡失调特点。方法分别于56例患者疾病急性加重期及稳定期测定反映Th1淋巴细胞功能的IFN-γ及反映Th2淋巴细胞功能的IL-4血清水平,比较急性加重期及稳定期上述炎症因子水平差异,并将其与同年龄健康对照组进行比较。结果与对照组比较,稳定期COPD患者IL-4水平无显著差异（P〉0.05）而IFN-γ显著增高（P〈0.05）。而急性期COPD患者IL-4及IFN-γ水平均较对照组明显增高（p均〈0.05）。与稳定期相比,急性期血浆IL-4水平明显增高（P〈0.05）而IFN-γ水平并无显著性差异（P〉0.05）。结论稳定期COPD患者存在Th1淋巴细胞功能亢进,而急性加重期Th1/Th2平衡有向Th2漂移的特点。     

阿奇霉素治疗支气管哮喘及对外周血T淋巴细胞功能的影响

目的探讨阿奇霉素治疗支气管哮喘的临床疗效及其对外周血辅助性T淋巴细胞功能的影响。方法 80例支气管哮喘患者随机分为观察组和对照组。对照组给予青霉素静注联合布地奈德、沙丁胺醇雾化吸入治疗,观察组给予阿奇霉素静注联合布地奈德、沙丁胺醇雾化吸入治疗,评价临床疗效。结果观察组总有效率显著高于对照组,P<0.01。治疗后,观察组IFN-γ、IL-4水平与治疗前及对照组比较有显著性差异(P<0.01)。结论阿奇霉素治疗支气管哮喘疗效确切,安全可靠。     

老年支气管哮喘患者IL-18、IL-12水平的变化及临床意义

目的 探讨老年支气管哮喘患者外周血白细胞介素18(IL-18)和IL-12的变化及其在哮喘发病机制中的作用.方法 采用ELISA法检测42例老年支气管哮喘患者及26例正常对照组检测血清中IL-18及IL-12水平.结果 支气管哮喘发作期患者的血浆IL-12明显高于正常对照组(P<0.01),IL-18明显高于正常对照组(P<0.01).结论 IL-18、IL-12参与了老年支气管哮喘发作期的发病机制,IL-18、IL-12在Th1/Th2细胞因子网络失衡的发病机制中起重要的调节作用.     

普米克令舒、博利康尼雾化吸入治疗轻中度支气管哮喘的临床研究

目的探讨联合雾化吸入普米克令舒、博利康尼对轻中度支气管哮喘的治疗作用。方法51例支气管哮喘患者随机分为对照组（25例）和治疗组（26例）。两组均予吸氧、抗感染、静脉氨茶碱及对症等治疗。治疗组加用普米克令舒及博利康尼氧气雾化吸入。两组均于治疗前及治疗7天后测定肺功能及动脉血气。结果两组肺功能及PaO2较治疗前均有明显改善（P〈0．01或P〈0．05）。结论联合雾化吸入普米克令舒和博利康尼治疗轻、中度支气管哮喘安全有效，并有协同作用。     

The Role of Budesonide in Adults and Children with Mild-to-Moderate Persistent Asthma

Asthma, a chronic and potentially life-threatening disease of the airways, affects patients of all ages. Inhaled corticosteroids (ICS) are the recommended first-line therapy for patients with persistent asthma. To review the clinical efficacy and tolerability data available on budesonide in the treatment of mild-to-moderate persistent asthma, a MEDLINE database search was performed for 1996-2003 using the following key words: budesonide, inhaled corticosteroid, efficacy, safety, systemic. When administered once or twice daily, budesonide effectively controls asthma in children, adolescents, and adults with mild-to-moderate asthma. Budesonide can be delivered effectively via a dry powder inhaler (Pulmicort Turbuhaler®) in patients aged ≥ 6 years or as an inhalation suspension (Pulmicort Respules®) in children as young as 12 months. With over 20 years' clinical exposure, budesonide has been demonstrated to be well tolerated in the treatment of chronic asthma in patients as young as 12 months. Specifically, at doses required to treat mild or moderate persistent asthma, budesonide does not affect hypothalamic-pituitary-adrenal axis function, bone mineral density, cataract formation, or final adult height. As Pulmicort Turbuhaler®, budesonide is the only ICS to achieve a Food and Drug Administration pregnancy category B rating. Early intervention with budesonide is recommended in asthma management: maximum benefit from therapy is reported in patients treated within 2 years of disease recognition. Budesonide is effective and well tolerated in the control of mild-to-moderate persistent asthma in patients aged 12 months and older. There is no evidence for variation in efficacy in population subgroups.     

The role of budesonide in adults and children with mild-to-moderate persistent asthma.

Asthma, a chronic and potentially life-threatening disease of the airways, affects patients of all ages. Inhaled corticosteroids (ICS) are the recommended first-line therapy for patients with persistent asthma. To review the clinical efficacy and tolerability data available on budesonide in the treatment of mild-to-moderate persistent asthma, a MEDLINE database search was performed for 1996-2003 using the following key words: budesonide, inhaled corticosteroid, efficacy, safety, systemic. When administered once or twice daily, budesonide effectively controls asthma in children, adolescents, and adults with mild-to-moderate asthma. Budesonide can be delivered effectively via a dry powder inhaler (Pulmicort Turbuhaler) in patients aged > or = 6 years or as an inhalation suspension (Pulmicort Respules) in children as young as 12 months. With over 20 years' clinical exposure, budesonide has been demonstrated to be well tolerated in the treatment of chronic asthma in patients as young as 12 months. Specifically, at doses required to treat mild or moderate persistent asthma, budesonide does not affect hypothalamic-pituitary-adrenal axis function, bone mineral density, cataract formation, or final adult height. As Pulmicort Turbuhaler, budesonide is the only ICS to achieve a Food and Drug Administration pregnancy category B rating. Early intervention with budesonide is recommended in asthma management: maximum benefit from therapy is reported in patients treated within 2 years of disease recognition. Budesonide is effective and well tolerated in the control of mild-to-moderate persistent asthma in patients aged 12 months and older. There is no evidence for variation in efficacy in population subgroups.     

Relationship of circulating chemerin and omentin levels with Th17 and Th9 cell immune responses in patients with asthma

Objective: Adipokines are correlated with immune responses in asthma, but data on the roles of chemerin and omentin in asthma are limited. This study explored the relationship of chemerin and omentin levels with Th17 and Th9 cells in asthma. Methods: Seventy-six asthmatics were divided into intermittent-to-mild persistent (n = 28), moderate persistent (n = 26) and severe persistent (n = 22) and were enrolled in the study. Additionally, 20 healthy subjects were enrolled as controls. Clinical characteristics of the subjects, the Asthma Control Test, lung function, fractional exhaled nitric oxide score, and plasma chemerin and omentin levels were evaluated, and the percentages of Th17 and Th9 cells were determined by flow cytometry. Results: The percentages of Th17 and Th9 cells were higher in the moderate-to-severe persistent asthmatics than in the intermittent-to-mild persistent asthmatics or healthy controls (p < 0.05). The severe persistent asthma group had a higher chemerin level but lower omentin levels than the control group (p < 0.05). Chemerin levels were positively correlated with Th17 and Th9 cell percentages, while omentin levels were negatively correlated with Th17 and Th9 cell percentages (p < 0.01). Conclusions: The regulatory functions of adipokines on immune responses may be associated with pathogenesis and processes of asthma.     

Budesonide inhalation suspension reduces the need for emergency intervention in pediatric asthma: a named-patient case series.

This report describes 15 children aged 10-35 months frequently hospitalized with uncontrolled asthma who were monitored for a mean of 26.9 months to assess the efficacy of budesonide inhalation suspension (AstraZeneca LP, Wilmington, DE) in reducing emergency interventions. Budesonide inhalation suspension was previously shown to relieve asthma symptoms, improve pulmonary function, and reduce rescue medication use in children as young as 6 months with mild to severe persistent asthma. We now show that > or = 1 year of treatment with budesonide inhalation suspension at doses between 0.25 and 1.5 mg/d decreased the burden of asthma. The mean number of hospitalizations caused by asthma or respiratory illness decreased from 1.8 +/- 1.37 in the period before initiation of treatment with budesonide inhalation suspension to 0.33 +/- 0.62 during treatment. Likewise, the mean number of oral prednisone courses decreased from 8.1 +/- 13.7 to 1.8 +/- 2.1, and the mean number of acute respiratory illnesses requiring additional therapy decreased from 2.7 +/- 2.3 before treatment with budesonide inhalation suspension to 0.87 +/- 0.74 during treatment. Numbers of emergency department visits decreased or remained the same after initiation of budesonide inhalation suspension treatment in all but two children. There was no effect on growth rate in this group of children with moderate to severe asthma. In this case series, budesonide inhalation suspension represents a safe, effective treatment option to prevent recurrent emergency intervention for patients < 3 years of age with poorly controlled asthma.     

Addition of montelukast versus double dose of inhaled budesonide in moderate persistent asthma

BACKGROUND: Although current guidelines suggest the use of inhaled corticosteroids as the first line therapy in persistent asthma, the concerns about high-dose corticosteroids may limit their usage. We aimed to investigate the efficacy of inhaled budesonide plus oral montelukast versus a double dose of inhaled budesonide. METHODOLOGY: Thirty patients with moderate asthma took part in the study. Following a 2-week run in period, the patients were randomized into two groups to receive 400 microg/day of inhaled budesonide plus 10 mg/day of montelukast (BUD + M group) or 800 microg/day of inhaled budesonide (high BUD group). The patients were evaluated at 2-week intervals (during a total treatment period of 6 weeks) for symptom scores, asthma exacerbations, lung function, use of short-acting beta2 agonist, blood eosinophil counts and adverse events. RESULTS: At the end of the study, morning and daytime symptom scores were significantly reduced within the groups. Although there was a significant decrease in the frequency of short-acting beta2 agonist use in the BUD + M group, the decrease in the high BUD group was not significant. During the study period, no patient in either group experienced an asthma exacerbation. Blood eosinophil levels significantly declined in both the BUD + M (0.87 +/- 0.31%) and high BUD groups (0.67 +/- 0.29%) as compared with baseline levels (BUD + M = 2.60 +/- 0.65%, high BUD group = 2.60 +/- 0.47%; P < 0.05). CONCLUSION: Our results suggest that the addition of montelukast to low-dose inhaled budesonide is as effective as a double dose of inhaled budesonide in asthma control.     

特布他林雾化剂联合布地奈德混悬液治疗咳嗽变异性哮喘研究

目的探讨特布他林雾化剂联合布地奈德混悬液治疗咳嗽变异性哮喘的临床疗效。方法将符合标准的132例咳嗽变异性哮喘患儿随机分成特布他林组(41例)、布地奈德组(38例)和联合用药组(53例),分别予以特布他林雾化剂、布地奈德混悬液、特布他林雾化剂和布地奈德混悬液联合治疗,比较三组的临床疗效。结果治疗1个疗程后,联合用药组的咳嗽缓解时间、咳嗽消失时间均短于单纯用药组,联合用药组的通气功能改善更好,且显效率和总有效率明显优于单纯用药组,复发率明显低于单纯用药组(P<0.05),单纯用药组的组间比较差异无统计学意义(P>0.05)。结论特布他林雾化剂联合布地奈德混悬液治疗咳嗽变异性哮喘的临床疗效确切,值得临床推广应用。     

人参五味子汤和小青龙汤二步序贯治疗对哮喘小鼠肺泡灌洗液INF-γ、IL-4水平及气道炎症的影响

目的探讨人参五味子汤和小青龙汤二步序贯治疗对哮喘小鼠肺泡灌洗液INF-γ IL-4水平及气道炎症的影响。方法健康雌性昆明系小鼠40只,随机分为正常对照组、哮喘组、布地奈德组、二步序贯组各10只,分别给予不同干预治疗。观察各组小鼠体征变化;采用普通光镜观察小鼠肺组织病理变化;采用ELISA测定肺泡灌洗液INF-γ、IL-4水平。结果①正常对照组无喘息症状,哮喘组喘息症状明显加重;②哮喘组肺部组织的炎性表现较其它各组明显加重;③哮喘组、布地奈德组、二步序贯组肺泡灌洗液中IL4水平均高于正常对照组（P均〈0．05）,哮喘组、布地奈德组INF-γ水平低于正常对照组（P均〈0．05）。结论人参五味子汤和小青龙汤二步序贯治疗可通过调节Th1／Th2失衡有效地改善气道炎症,治疗效果与吸入布地奈德相似。     

Once-daily inhaled budesonide for the treatment of asthma: clinical evidence and pharmacokinetic explanation.

BACKGROUND: Budesonide, a widely used inhaled corticosteroid (ICS) with a favorable therapeutic ratio, is available via a dry powder inhaler (Pulmicort Turbuhaler) and as a suspension for nebulization (Pulmicort Respules). METHODS: MEDLINE and an AstraZeneca database were searched to identify relevant controlled clinical trials published between 1986 and 2002 using the key words budesonide OR inhaled corticosteroid, AND once daily. RESULTS: Thirty-four controlled clinical studies involving once-daily administration of budesonide to asthmatic patients were identified. Excluding long-term studies, this review presents data from 23 controlled studies for 4466 adults or adolescents and 1532 children with asthma and demonstrates efficacy of budesonide in both corticosteroid-na?ve patients and patients previously treated with ICS. Once-daily administration of budesonide achieves clinical efficacy comparable with that of twice-daily regimens in patients with mild-to-moderate asthma and is equally effective when given in the morning or evening. Once-daily administration simplifies treatment regimens and may improve patient compliance. The tolerability profiles of budesonide once-daily via Turbuhaler or as budesonide inhalation suspension are good and comparable with those for twice-daily dosing. CONCLUSIONS: Once-daily budesonide is effective and well tolerated as initial treatment for adults and children with mild asthma and as maintenance therapy in patients with more severe asthma once asthma control has been achieved.     

Budesonide and formoterol in a single inhaler improves asthma control compared with increasing the dose of corticosteroid in adults with mild-to-moderate asthma

BACKGROUND: We evaluated the efficacy and safety of low-dose budesonide/formoterol, 80 micro g/4.5 micro g, bid in a single inhaler (Symbicort Turbuhaler; AstraZeneca; Lund, Sweden) compared with an increased dose of budesonide, 200 micro g bid, in adult patients with mild-to-moderate asthma not fully controlled on low doses of inhaled corticosteroid alone. METHODS: All patients received budesonide, 100 micro g bid, during a 2-week run-in period. At the end of the run-in phase, 467 patients with a mean FEV(1) of 82% predicted received 12 weeks of treatment with budesonide/formoterol in a single inhaler or budesonide alone in a higher dose. Patients kept daily records of their morning and evening peak expiratory flow (PEF), nighttime and daytime symptom scores, and use of reliever medication. RESULTS: The increase in mean morning PEF-the primary efficacy measure-was significantly higher for budesonide/formoterol compared with budesonide alone (16.5 L/min vs 7.3 L/min, p = 0.002). Similarly, evening PEF was significantly greater in the budesonide/formoterol group (p < 0.001). In addition, the percentage of symptom-free days and asthma-control days (p = 0.007 and p = 0.002, respectively) were significantly improved in the budesonide/formoterol group. Budesonide/formoterol decreased the relative risk of an asthma exacerbation by 26% (p = 0.02) compared with budesonide alone. Adverse events were comparable between the two treatment groups. CONCLUSION: This study shows that in adult patients whose mild-to-moderate asthma is not fully controlled on low doses of inhaled corticosteroids, single-inhaler therapy with budesonide and formoterol provides greater improvements in asthma control than increasing the maintenance dose of inhaled corticosteroid.