多项联合治疗胃食道返流继发哮喘的临床观察

目的探讨多项联合治疗对胃食道返流继发哮喘的临床疗效。方法随机选择我院胃食道返流继发哮喘患者50例,随机分为:对照组26例,给予常规与奥美拉唑治疗;观察组24例,给予多项联合治疗。比较两组疗效、哮喘症状评分及消失时间等的差异。结果观察组治疗有效率为95.38%,显著高于对照组,差异有统计学意义(P0.05);观察组哮喘症状评分与常见症状消失时间均显著低于对照组(均P0.05);观察组患者的肺功能及血细胞因子指标改善明显优于对照组(P0.05)。结论多项联合治疗胃食道返流继发哮喘症状控制更好,药物具有安全性高。     

胃食道返流对支气管哮喘气道反应性的影响

以食道酸灌注试验模拟胃食道返流（ＧＥＲ），观察了ＧＥＲ对２０例支气管哮喘伴或不伴ＧＥＲ患者气道反应性的影响。经食道酸灌注１５分钟后进行组织胺吸入激发试验。结果显示；食道酸灌注后哮喘伴ＧＥＲ者气道反应性增高了５４．８９％，不伴ＧＥＲ者增高了４０．３９％，二者差异有显著性（Ｐ＜０．０５），而正常对照者气道反应性无明显变化。提示ＧＥＲ可能通过某些机制增高了哮喘患者的气道反应性，从而加剧或诱发哮喘发作。     

胃食管返流与支气管哮喘

胃食管返流是指胃内容物通过食管下端括约肌频繁地逆流到食管内从而引起一系列的临床症候群,而支气管哮喘是由多种原因引起的一种炎症性疾病,两种疾病早已为人们所熟知,但两者的关系多年来并未引起人们足够重视,直到近年,随着有效的抑酸药物和便携式食管24小时pH测试仪的问世,对这方面的研究才取得重大进展,逐渐认识到胃食管返流可能是哮喘的一个激发因素,本文将对目前哮喘和胃食管返流之间联系的机制及诊断与治疗作一综述。     

新生儿胃食道返流的X线诊断(附23例报告)

胃食道返流是由于各种原因引起食道下段括约肌功能不全,使胃内容物返流入食道的一种临床表现。X线钡餐造影检查可明确诊断,并指导临床治疗。新疆自治区人民医院放射科从1999年5月~2000年5月共诊断新生儿胃食道反流23例,现报告如下。1一般资料患者男16例、女12例,汉族18例、维吾     

胃食管返流病的临床治疗

胃食管返流病（Crastroesophageal reflux disease，GERD）的典型症状包括烧心、返酸、腹胀常见于餐后尤饱餐或高脂餐后，在平卧或弯腰后加重，服抗酸剂可缓解。GERD还可有一些不典型的或谓之食管外的症状，研究发现约50％的非心源性胸痛，78％的慢性声音嘶哑，82％的哮喘及部分慢性咳嗽与GERD有关。     

抗返流粘膜切除术治疗难治性胃食管反流病的进展

内镜下抗反流黏膜切除术是一项新兴的、安全有效的内镜下胃食管反流病治疗方法。由于长期口服质子泵抑制剂存在不良反应,而外科手术创伤较大,因此对于症状顽固的质子泵抑制剂难治性胃食管反流病患者,抗反流黏膜切除术是很好的选择。该方法因疗效显著、安全性较好及手术简便,最有希望成为标准化的内镜下胃食管反流病治疗手段。     

支气管肺泡灌洗术联合机械通气治疗重症哮喘患者的疗效观察简

目的 观察支气管肺泡灌洗术联合无创机械通气治疗重症哮喘患者的临床疗效.方法 50例重症哮喘患者随机分为两组,对照组（n=25例）给予无创通气治疗,观察组（n=25例）在对照组治疗基础上加用支气管肺泡灌洗.比较两组患者肺功能及病情缓解时间等情况.结果 观察组治疗总有效率（92.0%）明显高于对照组（80.0%）（P〈0.05）;观察组治疗后肺功能指标（FEV1/L、FVC/L和FEV1/FVC）改善程度明显优于对照组（P〈0.05）;观察组临床症状改善时间及ICU住院天数较对照组缩短（P〈0.05）.结论 支气管肺泡灌洗术联合无创机械通气治疗重症哮喘患者疗效显著,患者肺功能恢复快,症状缓解时间及ICU住院天数短.     

环磷酰胺联合羟氯喹治疗难治性肾病综合征临床观察简

目的对比分析环磷酰胺与环磷酰胺联合羟氯喹治疗难治性肾病综合征的疗效与安全性。方法选择2007年1月至2011年12月广西河池市人民医院收治的难治性肾病综合征患者92例作为研究对象,随机分为观察组和对照组各46。对照组46例接受环磷酰胺及泼尼松治疗,观察组46例接受环磷酰胺联合羟氯喹及泼尼松治疗。对比两组患者治疗后相关临床指标的变化情况及不良反应。结果治疗6个月后,两组治疗总有效率及临床疗效（秩和检验）比较差异无统计学意义（P〉0．105）;观察组尿蛋白定量、丙氨酸转氨酶（ALT）低于对照组（P〈．05）;血白蛋白（Alb）高于对照组（P〈0．05）;两组不良反应发生率比较,差异无统计学意义（P〉0．05）。结论环磷酰胺联合羟氯喹治疗难治性肾病综合征可降低患者尿蛋白定量、ALT,升高Alb,不良反应小。     

Effect of asthma compliance enhancement training on asthma control in patients on combination therapy with salmeterol/fluticasone propionate: a randomised controlled trial

Objective: We investigated if a higher proportion of adults with previously uncontrolled asthma can achieve total control when given salmeterol/fluticasone propionate (50/250 µg) bid and compliance enhancement training (CET) compared to those given medication alone. Methods: Open comparison of stable, but uncontrolled, adult asthmatics. After a 12‐week treatment period on salmeterol/fluticasone propionate (period 1), patients who failed to achieve control were randomised to continuing treatment with or without CET for 12 weeks (period 2). The primary end point was the proportion achieving total control of their asthma in 7 of the last 8 consecutive weeks of period 2. Results: A total of 361 subjects (50.4% males, mean age 40.0 ± 14.4 years) in 29 centres were included, of whom 75.9% were randomised into treatment period 2 (n = 140 in the intervention group). The proportion of subjects achieving total asthma control was 8.8% and 7.6%, respectively, in the intervention and control group [not significant (NS)]. Mean morning peak flow, forced expiratory volume in one second (FEV₁), asthma symptom score and quality of life improved significantly over the study period in both treatment groups. Furthermore, proportion of days with use of rescue medication declined from 59.7% ± 34.6% (55.7% ± 35.3%) during screening to 20.3% ± 29.2% (19.4% ± 30.9%) during treatment period 2 (NS). Conclusion: CET failed to increase the likelihood of achieving total control in asthmatics on salmeterol/fluticasone propionate compared to subjects receiving medication only. However, both groups had a significant improvement in asthma control. (Clinical Trials.gov number, NCT00351143) Please cite this paper as: Ulrik CS, Claudius BK, Tamm M, Harving H, Siersted HC, Backer V, Hellquist B, Dahl R, Høgholm A and Jøhnk IK. Effect of asthma compliance enhancement training on asthma control in patients on combination therapy with salmeterol/fluticasone propionate: a randomised controlled trial. The Clinical Respiratory Journal 2009; 3: 161–168.     

Treatable traits,combination inhaler therapy and the future of asthma management

The landscape of asthma has considerably changed in the last decade. Effective medications and inhaler devices have been developed and integrated into the asthma pharmacopoeia, but unfortunately, the proportion of uncontrolled patients remains unacceptably high. This is now recognized to be mainly due to the inappropriate use of medications or inhaler devices, heterogeneity of the disease or other factors contributing to the disease. Currently, inhaled corticosteroids (ICS), with or without long-acting beta agonists (LABA), are the cornerstone of asthma management, and recently international guidelines recognized the importance of combination inhaler therapy (ICS/LABA) even in mild asthma. In future, ultra-long-acting personalized medications and smart inhalers will complement combination inhaler therapy in order to effectively addresses issues such as adherence, inhaler technique and polypharmacy (both of drugs and devices). Asthma is now acknowledged as a multifaceted cluster of disorders and the treatment model has evolved from one-size-fits-all to precision medicine approaches such as treatable traits (TTs, defined as measurable and treatable clinically important factors) which encourages the quality use of medications and identification and management of all underlying behavioural and biological treatable risk factors. TT requires research and validation in a clinical context and the implementation strategies and efficacy in various settings (primary/secondary/tertiary care, low-middle income countries) and populations (mild/moderate/severe asthma) are currently evolving. Combination inhaler therapy and the TTs approach are complementary treatment approaches. This review examines the current status of personalized medicine and combination inhaler therapy, and describes futuristic views for these two strategies.     

咳嗽变异型哮喘与胃食管反流的关系

目的许多研究发现支气管哮喘与胃食管反流有关，通过本文研究明确咳嗽变异型哮喘与胃食管反流的关系，并指导其治疗。方法将咳嗽变异型哮喘患者200例进行筛选，伴有胃食管反流108例，根据治疗方法分为对照组52例，实验组56例。结果两组比较，实验组缓解率大于对照组，差异具有显著性（P〈0．05）。结论大约54％的咳嗽变异型哮喘伴有胃食管反流。抑酸及增加胃动力可以明显缩短缓解时间。     

支气管哮喘合并胃食管反流病相关危险因素分析

目的探讨支气管哮喘合并胃食管反流病（GERD）的相关危险因素,为预防及治疗提供理论依据。 方法回顾性收集自2013年1月至2018年8月在新疆维吾尔自治区人民医院呼吸科就诊的支气管哮喘合并GERD患者187例及单纯支气管哮喘者192例临床资料,统计方法比较两组临床特点,分析哮喘合并GERD相关危险因素。 结果两组患者年龄、性别、过敏史、高血压病史、冠心病病史、糖尿病病史、饮酒史等差异无统计学意义（P＞0.05）;两组患者吸烟史、体重指数（BMI）、哮喘家族史、第一秒末用力呼气量（FEV1）、FEV1/用力肺活量（FVC）、最大呼气流量（PEF）内急性发作次数等有差异性,并差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示,高BMI、吸烟、PEF、既往12月内急性发作次数是哮喘合并GERD的独立危险因素（P＜0.05）。 结论高BMI、吸烟、PEF、既往12月内急性发作次数是哮喘合并GERD的危险因素,改善肺功能、积极减重、戒烟,有望预防和减少GERD的发生。     

中西医结合治疗中度支气管哮喘慢性持续期临床观察

目的观察中西医结合治疗中度支气管哮喘慢性持续期的疗效。方法通过3个月的临床研究,对治疗组（中西医结合治疗组）与对照组（舒利迭组）两组有效率及症状体征积分进行比较,治疗前后外周血嗜酸性粒细胞（EOS）计数及肺功能（FEV1、FEV1、PEF）进行比较。结果治疗组总有效率明显高于对照组（P〈0.05）。治疗组症状体征积分,EOS计数下降明显大于对照组（P〈0.05）。治疗组肺功能PEF治疗后明显大于治疗前和对照组治疗后,有显著性差异（P〈0.05）,结论中西药合用治疗中度支气管哮喘慢性持续期能较快地消除症状和体征,明显改善肺通气功能,减少吸入激素用量,具有肯定疗效。     

Benefits of fixed-dose combination therapy with inhaled corticosteroids and long-acting bronchodilators as initial maintenance therapy in the management of asthma

Background and objective:   Revised Australian guidelines for asthma management were released by the National Asthma Council (NAC) in 2006. One area where clinical opinion and trial data have changed recently concerns the place of fixed-dose combination (FDC) therapy with inhaled corticosteroid (ICS) and long-acting β₂-agonists as initial maintenance therapy.
Methods:   A systematic review of the literature commissioned by the NAC and undertaken by the University of Tasmania addressed several questions, including whether there was evidence for the use of FDC therapy as first-line asthma treatment in steroid-naïve patients.
Results:   Nineteen relevant studies were identified, from which 20 comparisons contributed to the analyses. The definition of steroid-naïve ranged from no ICS therapy over the preceding 1 month to no ICS therapy ever. FDC therapy was effective in subjects who were steroid-naïve and was more effective than an equivalent dose of ICS, irrespective of the definition of steroid-naïvety. Compared with ICS alone, FDC therapy increased mean FEV₁ by 140 mL, mean morning PEF by 21 L/min and mean evening PEF by 20 L/min. There was a mean increase of 9.8% in symptom-free days, associated with a greater reduction in rescue medication use of −0.12 puff/24 h. FDC therapy was not superior to ICS alone for prevention of withdrawals or exacerbations requiring systemic corticosteroids. Adverse events were similar for FDC therapy and ICS, whether ICS were administered at the same or an increased dose.
Conclusions:   FDC therapy is effective as first-line treatment in steroid-naïve subjects and is superior to ICS alone for most outcomes, irrespective of the period of time since last exposure to ICS.     

Association of gastroesophageal reflux disease with asthma control

Gastroesophageal reflux disease (GERD) may make asthma difficult to control and may be a potential risk factor for frequent asthma exacerbations, but the mechanisms of the relationship between GERD and not well‐controlled asthma remain unclear. The aim of this study was to explore the association of GERD with asthma control in adults. Patients with asthma were consecutively recruited, and Asthma Control Test (ACT) and Reflux Diagnostic Questionnaire scores were determined. The patients were categorized into not well‐controlled asthma and well‐controlled asthma groups according to the ACT score. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between GERD and not well‐controlled asthma. Seven hundred and sixty‐eight patients with asthma were enrolled. The mean ACT score was 18.2 ± 3.6, and there were 161 (21.0%) patients with not well‐controlled asthma. The Reflux Diagnostic Questionnaire score was 10.5 ± 4.7, and 212 (27.6%) patients were complicated by GERD. Multivariate logistic regression analyses revealed the independent association of GERD with not well‐controlled asthma (odds ratio, 3.12; 95% confidence interval, 1.53–4.88) after other established contributors to asthma control were adjusted. In conclusion, there is an association of GERD with not well‐controlled asthma, independent of other potential contributors to asthma control.     

多中心临床观察雷贝拉唑联合多潘立酮治疗胃食管反流病的症状缓解情况

目的 观察雷贝拉唑联合多潘立酮治疗胃食管反流病(GERD)的临床疗效.方法 采用多中心、随机、开放、观察性研究方法,将收集的130例GERD门诊患者随机分为观察组(雷贝拉唑联合多潘立酮)64例和对照组(单用雷贝拉唑)66例,以胃食管反流病诊断问卷(GERD Q量表)和一般资料调查方式进行症状评分,症状评分根据烧心、反流、上腹痛等发生的频率和程度.随访4周,比较治疗后2周末和4周末两组患者症状的改善情况.结果 治疗前观察组和对照组GERD Q评分值基线一致,治疗2周末,两组GERD症状GERD Q评分值均有明显下降,分别为8.45±2.53和9.17±2.42;治疗4周末疗效更明显,分别为6.03±1.54和6.70±1.78;治疗前后差异有统计学意义(t=16.113,t=14.149;P值均＜0.01).观察组在治疗2周和4周末GERD Q分值较对照组下降更快,差异有统计学意义(t=-1.658,P=0.050;t=-2.292,P=0.012).观察组和对照组治疗2周后GERD症状分值均明显下降(t=2.006,P=0.047),4周后反流症状分值有明显下降,差异有统计学意义(t=2.287,P=o.022).治疗2周末观察组烧心和反流症状总有效率为79.0％和73.0％,对照组为67.7％和69.7％,观察组优于对照组;但治疗4周末观察组和对照组总有效率相似.结论雷贝拉唑联合多潘立酮能更快缓解GERD烧心和反流症状.     

胃食管反流与支气管哮喘之间的关系及抑酸药物对其的作用

目的探讨胃食管反流与支气管哮喘之间的关系及制酸药物对胃食管反流（GER）的作用分析。 方法随机选取新疆维吾尔自治区人民医院2016年9月至2017年9月接诊的122例哮喘患者的临床资料。根据有无发生胃食管反流将本组患者分为观察组（49例）和对照组（73例）。观察组49例患者为胃食管反流合并支气管哮喘,将观察组49例患者进行随机细分,25例患者利用制酸药物（质子泵抑制剂兰索拉唑）进行治疗,24例患者选择安慰剂进行治疗。对照组73例哮喘患者未合并胃食管反流。对2组患者临床资料进行分析。对比2组患者肺功能指标等相关资料,以此探讨胃食管反流与支气管哮喘的相互关系。评价制酸药物对胃食管反流的影响。 结果观察组45例患者肺功能各项指标明显差于对照组73例患者,差异有统计学意义（P<0.05）。制酸治疗组与安慰剂治疗组比较,差异有统计学意义（P<0.05）。 结论支气管哮喘患者容易因各种因素发生胃食管反流,胃食管反流也容易诱发支气管哮喘,并且在发生胃食管反流后会加重哮喘患者病情会,是难治性哮喘的重要诱因。临床治疗胃食管反流患者应利用抑酸药物进行相应的抗反流治疗,效果显著,可显著改善肺功能。     

Fixed and adjustable dose asthma action plans based on combination therapy: a pilot study

OBJECTIVE: The use of combination inhaled corticosteroid/long-acting beta-agonist therapy within the framework of a self-management plan has yet to be investigated. Methodology: In this randomized open-label study, 69 adult asthmatic patients taking >or= 1,000 microg per day of beclomethasone dipropionate (BDP) or equivalent were treated for 3 months with Symbicort Turbuhaler (200 microg budesonide/6 microg formoterol). Patients were assigned to one of two self-management plans, based on either a fixed or adjustable dose regimen. The primary outcome variable was episode-free days. RESULTS: Both regimens resulted in good asthma control, at least comparable to that obtained with previous high dose inhaled corticosteroid therapy. There were no significant differences in clinical outcome measures between the regimens. The mean (+/- SD) usage of Symbicort was similar for the fixed and adjustable dose regimens (3.8 +/- 0.68 vs 3.6 +/- 1.54 puffs per day, respectively). CONCLUSION: We conclude that Symbicort is effective when administered as either a fixed or adjustable dose regimen as part of a self-management plan.