TH细胞亚群在哮喘发病中的作用及临床意义

支气管哮喘是一种气道的慢性炎症性疾病,嗜酸细胞(EOS),T淋巴细胞等炎症细胞起着关键作用。T细胞亚群及其产物(细胞因子)除了调控B细胞的IgE生成外,还吸引和活化其它效应细胞,在哮喘气道炎症反应和气道高反应性(BHR)的发生和发展中     

截喘汤对哮喘模型小鼠外周血浆IL-5、TNF-α及Eotaxin的影响

目的:研究中药截喘汤对哮喘模型小鼠外周血浆白细胞介素-5(IL-5)、肿瘤坏死因子(TNF-α)及嗜酸细胞活化趋化因子(Eotaxin)的影响,探讨其治疗支气管哮喘的作用机制。方法:将84只小鼠随机均分为7组,即正常对照组、哮喘模型组、地塞米松组、联合用药组及中药低、中、高剂量组,通过中药血清药理学,体内观察不同剂量截喘汤对哮喘模型小鼠外周血IL-5、TNF-α及Eotaxin含量的影响。结果:截喘汤能通过抑制IL-5和TNF-α的合成而阴滞气道变应性炎症(AAI)产生、发展和持续的各个环节,抑制气道高反应性(BHR),并可通过抑制Eotaxin的表达而减少嗜酸性粒细胞(EOS)在肺部的聚集和活化,从而减轻气道EOS浸润性AAI及BHR。结论:截喘汤可为临床用药提供理论依据。     

支气管扩张合并支气管哮喘患者表面激素吸入的安全性及疗效观察

目的探讨支气管扩张合并支气管哮喘患者表面激素吸入的安全性及疗效观察。方法将2016年2月~2017年2月在我院呼吸内科治疗的86例支气管扩张合并支气管哮喘患者随机分为两组,对照组给予常规西医对症治疗,在此基础上观察组给予二丙酸倍氯米松(必可酮)雾化吸入治疗,比较两组患者的临床疗效、肺功能改善情况、血常规变化、气道高反应性变化。结果观察组临床有效率为93.02%,明显高于对照组的74.42%,两组间有统计学差异(P<0.05);观察组治疗后FEV1、PEF、FVC、FEV1/FVC较对照组明显好转,两组间有统计学差异(P<0.05);观察组治疗后白细胞计数、中性粒细胞、淋巴细胞、嗜酸粒细胞均较对照组明显降低,两组间有统计学差异(P<0.05);观察组治疗后气道阻力(Raw)、气道传导率(Gaw)、气道高反应性(BHR)较对照组明显改善,两组间有统计学差异(P<0.05)。结论支气管扩张合并支气管哮喘患者表面激素吸入治疗有良好效果,能显著改善气道炎性反应,增强肺通气功能,降低气道阻力和高反应性,且不良反应少,具有积极的临床意义。     

343例支气管哮喘患者的气道反应性分析

目的了解支气管哮喘患者的气道反应性,为临床诊治提供依据。方法对343例临床诊断为支气管哮喘的患者进行支气管激发试验,对其阳性率、可疑阳性率及阴性率进行统计,并对三者的FEV1下降率进行分析。结果 343例支气管哮喘患者有61%具有气道高反应性(AHR)。三组病例的平均FEV1下降率之间差异具有统计学意义。结论气道反应性测定可作为支气管哮喘诊断、病情、预后评估及治疗方案选择的一个重要条件,但并非唯一。有许多因素可影响支气管激发试验的测定结果,其间尚有许多的工作要做。     

支气管哮喘 慢性支气管炎血清总IgE sIL-2R与气道高反应性改变的对比分析

支气管哮喘(哮喘)和慢性支气管炎(慢支)都是以气道通气障碍和气道高反应性(BHR)为特征的.为探讨两者发病机制中BHR与免疫学变化的不同点,我们对60例哮喘、33例慢支病人进行乙酰甲胆碱(MCH)激发试验,同时检测血清总IgE、可溶性白细胞介素 2受体(sIL-2R)水平,并与30名正常人对照分析,现报告如下.     

气道反应性测定对咳嗽变异型哮喘诊治的指导意义

<正>气道高反应性(Bronchial hyperresponsiveness,BHR)是指气道对外界特异性或非特异性刺激的过早和(或)过强烈的反应,表现为气道平滑肌的收缩、管腔分泌物增加、管腔变窄、气道阻力增加和气流受限。BHR是支气管哮喘的基本特征之一[1]。咳嗽变异型哮喘(Cough variant asthma,CVA)是支气管哮喘的一种潜在形式,主要表现为慢性咳嗽,没有喘息的症状,肺部听诊无哮鸣音,胸部X线片及一般肺功能检查     

支气管哮喘急性发作期的呼吸指导与护理

支气管哮喘是一种以多种细胞特别是肥大细胞、嗜酸性粒细胞和T淋巴细胞等炎性细胞参与的气道慢性炎症和以气道高反应性(BHR)为特征的疾病[1]。这种炎症使易患者对各种激发因子具有高反应性,并可引起气道缩窄,表现为反复发作的喘息、呼吸困难、胸闷或咳嗽等症状。支气管哮喘是临     

肝酚多镁静点治疗难治性哮喘

支气管哮喘是一种十分复杂的气道炎症性病变引起的气道高反应性(BHR)疾病。表现为气道炎症介质产生、释放和嗜酸性粒细胞为主的炎症细胞浸润．气道粘液的高分泌．管腔粘液阻塞．平滑肌痊挛，管腔牯膜水肿，上皮细胞的损伤、脱落和支气管高反应性为特征的肺部慢性炎症疾病惯用单一治疗方法对轻症支气管哮     

中西医结合治疗治疗成人支气管哮喘的疗效及对肺功能的影响

目的探讨中西医结合治疗治疗成人支气管哮喘的疗效及对肺功能的影响。方法将2015年9月~2016年9月在我院治疗的68例成人支气管哮喘患者根据治疗方法分为两组,对照组给予常规西医对症治疗,治疗组在此基础上给予中药口服,并比较两组患者治疗前后的疗效、肺功能改善情况、血CRP、SAS评分、SDS评分、气道高反应性变化等。结果治疗组临床有效率为94.4%,明显高于对照组的75.0%;治疗组治疗后PEF、FVC、FEV1/FVC较对照组明显好转;治疗组治疗后CRP水平较对照组明显降低;治疗组治疗后SAS评分、SDS评分均较对照组明显降低;治疗组治疗后气道阻力(Raw)、气道传导率(Gaw)、气道高反应性(BHR)较对照组明显改善。各指标两组间差异均有统计学意义(P<0.05)。结论中西医结合治疗支气管哮喘效果良好,能显著改善气道炎性反应,增强患者肺通气功能,抑制哮喘发作,降低气道阻力和高反应性,且利于其焦虑、抑郁情绪的缓解,全身炎症状态得到显著缓解。     

儿童哮喘的治疗进展

哮喘是发生于儿童的极为常见的慢性疾病,其发病率日见上升。近几十年来,哮喘的定义几经变迁,如今的定义为:伴发支气管高反应性(bronchial hyperresponsiveness,BHR)的可逆性气道阻塞,其病理改变为慢性或反复发作的气道炎症。但该定义不适于学龄前儿童。Chanarin等对学龄前儿童哮喘又作了如下定义[1]:(1)在哮喘儿童未见气道持续性炎症迹象;(2)哮喘儿童BHR相对于正常儿童并不常见;(3)对于气道阻塞变化的情况所知甚少。以上发现可能是由于缺乏幼儿有关的气道炎症和BHR数据。现将近年来对儿童哮喘治疗综述如下。     

嗜酸性粒细胞在腺样体肥大患儿诊治中的临床价值

目的 探讨嗜酸性粒细胞（EOS）在腺样体肥大患儿组织和外周血中的分布水平及与变应因素的相关性。方法 选择2017年10月—2018年7月于天津市第一中心医院耳鼻咽喉头颈外科行腺样体切除手术的患儿为研究对象。将112例患儿分为单纯腺样体肥大（AH）组62例,腺样体肥大伴变态反应性鼻炎（AH+AR）组50例。高倍镜下观察苏木精-伊红（HE）染色的组织切片中EOS数量,抽取外周血检验EOS百分比,对所有患儿进行血清特异性IgE检测及视觉模拟量表（VAS）评分,分析组织和外周血中EOS水平差异。绘制受试者工作特征（ROC）曲线,评价组织和外周血EOS水平对AH+AR的诊断价值。结果 在腺样体肥大患儿中,AH+AR组EOS明显高于AH组（P＜0.05）,不同过敏原等级EOS水平差异无统计学意义（P＞0.05）。在外周血中,伴重度变态反应性鼻炎组EOS水平明显高于轻度变态反应性鼻炎组（P＜0.05）,重度与中度、中度与轻度组间差异无统计学意义（P＞0.05）;在组织中,变态反应性鼻炎症状愈严重,EOS 水平愈高（均 P＜0.05）。根据 ROC 曲线,分别计算曲线下面积（AUC）：外周血（AUC=0.791,95%CI：0.705~0.878,P＜0.001）,截断点（cut-off 值）为 2.6%,此时敏感度为 70.0%,特异度为 74.2%;组织（AUC=0.843,95%CI：0.765~0.920,P＜0.001）,cut-off值为3/10个视野,此时敏感度为76.0%,特异度为80.6%。结论 血清特异性IgE检测阳性的腺样体肥大患儿中腺样体组织和外周血EOS的水平增高,提示AH患儿的病因中有变应因素存在。组织中EOS水平较外周血对于变应因素的鉴别更具诊断意义。     

AD患儿外周血白细胞介素-17、白细胞介素-8、血清IgE及EOS水平变化及其意义

目的 探讨特应性皮炎(AD)患儿外周血白细胞介素-17(IL-17)、白细胞介素-8(IL-8)、免疫球蛋白E(IgE)及嗜酸性粒细胞计数(EOS)的水平变化及其意义.方法 选取120例AD患儿作为AD组,以同期30名健康儿童作为对照组,检测并比较两组外周血IL-17、IL-8、IgE及EOS的水平,依据皮损严重程度对AD患儿进行分层分析.结果 AD组患儿的外周血中IL-17、IL-8、IgE及EOS水平均显著高于对照组(P＜0.05);AD组患儿的外周血中IL-17、IL-8、IgE、EOS水平及AD严重程度评分各亚组间比较,重度组＞中度组＞轻度组,且差异具有统计学意义(P＜0.05);AD组患儿的外周血中IL-17、IL-8、IgE、EOS水平与AD严重程度评分均呈显著正相关(P＜0.05).结论 AD儿童外周血IL-17、IL-8、IgE及EOS水平均显著的增高,且与病情严重程度密切相关.     

疟疾病例血液参数变化及其诊断价值的研究

目的探讨疟疾病例血液参数变化及其诊断价值,为疟疾诊断提供科学依据。方法采用全自动血球分析仪分别检测20例疟疾患者和20例健康体检者WBC、EOS、RBC、HGB、PLT等血液参数,应用t检验对参数进行统计分析。结果疟疾患者血液参数RBC、HGB和PLT低于健康组,二者差异有统计学意义(P<0.01),而WBC、EOS与健康组差异无统计学意义(P>0.05)。结论血液参数RBC、HGB和PLT变化与疟疾病例有着密切联系,在发热患者的诊断中应引起重视,进而科学、准确诊断疟疾病例。     

Association between nonspecific bronchial hyperreactivity and superoxide anion production by polymorphonuclear leukocytes in chronic airflow obstruction

Inflammatory reactions are believed to be important in nonspecific bronchial hyperreactivity (BHR). To investigate the potential role for oxidant-mediated modulation of BHR, we investigated oxidative metabolism of polymorphonuclear leukocytes (PMN) from the peripheral blood in 28 nonallergic patients with chronic airflow obstruction (CAO). No difference in O2- generation was found between 14 smokers and 14 ex-smokers with CAO. A significant correlation was found between the degree of BHR and O2- generation of PMN after stimulation with 20 ng/ml phorbol myristate acetate, both in smokers (r = 0.59, p less than 0.01) and in ex-smokers (r = 0.79, p less than 0.01). The results suggest that oxygen radicals in a direct or indirect way may modulate BHR. Thus, in nonallergic patients with CAO, BHR and inflammation may be linked in a similar way as in allergic patients with asthma.     

射干对支气管哮喘治疗作用及对嗜酸性粒细胞脱颗粒的影响

观察射干治疗支气管哮喘的临床疗效及其主要成分射干苷对嗜酸性粒细胞(EOS)脱颗粒的影响。将支气管哮喘患者随机分为射干治疗组和常规治疗组。常规治疗组用氨茶碱片,每次0.1g,每日3次,同时加服酮替酚;射干治疗组除常规治疗外给予射干煎剂口服,每次30mL,每日3次,疗程均为4周。观测患者肺功能、外周血EOS计数和主要碱性蛋白(MBP)及EOS阳离子蛋白(ECP)含量。采集哮喘患者外周血,裂解红细胞后用Percoll液密度梯度离心分离收集EOS,初步培养后加入射干苷,以ELISA法检测射干苷对EOS释放MBP和ECP的影响。射干对支气管哮喘有明显疗效,可改善肺功能,减少ECP;射干苷明显减少EOS释放MBP和ECP。该作用可能与其主要成分射干苷可抑制EOS脱颗粒有关。     

Genetic variation of the beta(2)-adrenoceptor: its functional and clinical importance in bronchial asthma

Asthma is a polygenic disease for which no clear genotype-phenotype relationships have emerged. In contrast, although not associated with the diagnosis of asthma per se, variant forms of the beta(2)-adrenoceptor (beta2-AR) gene (ADRB2) display functional effects that may be clinically relevant. Single nucleotide polymorphisms (SNPs) of ADBR2 are common and result in amino acid substitutions at positions 16, 27, and 164 of the receptor as well as position 19 of its 5' upstream peptide. These SNPs influence receptor function in vitro, although evidence regarding exact relationships is conflicting. This has raised the possibility that phenotypes such as bronchial hyper-responsiveness (BHR) and responses to (beta2)-agonist drugs may be genetically determined. To date, no unequivocal relationships between SNPs and phenotype have been identified. In some studies the Gly(16) allele has been associated with increased BHR and asthma severity. In others, the Arg(16) allele has been shown to determine acute bronchodilator response and adverse events during long term beta(2)-agonist therapy. The latter may provide the basis for clinical application of this new knowledge. More recently, a small number of frequently occurring, functionally relevant ADRB2 haplotype pairs have been confirmed. These combinations of alleles may be more important in determining genotype/phenotype relationships than individual SNPs, and may explain why earlier investigations have yielded contrasting results. Future studies will be required to clarify the pharmacodynamic effects of ADRB2haplotypes both in vitro and in vivo.     

Determinants of bronchial hyperresponsiveness in subjects with rhinitis

Subjects with rhinitis but without asthma may have coexisting bronchial hyperresponsiveness, although the reasons for this are uncertain. To evaluate the factors that determine BHR in rhinitis we examined 410 patients with symptomatic rhinitis with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)>or=80% of the predicted value. In all subjects a skin prick test (SPT) was performed, a determination of total serum IgE and an eosinophils count in the blood. Of the 410 subjects we found that 161 (39.3%) exhibited a methacholine PD20 of 800 mg or less (Group A), whereas 249 (60.7%) had a methacholine PD20 more of 800 mg (Group B). Despite the matched mean values for FEV1 and FVC, compared with Group B, Group A had a lower predicted forced expiratory flow between 25% and 75%(FEF25%-75%) (86.7 +/- 12.0 vs. 93.7 +/- 7.3, P < 0.0001). A great portion of the subjects of the Group Ain respect to subjects of the Group B were exposed to passive smoke (37.8% vs. 22.0%, P = 0.0008), reported having mothers with asthma (34.1% vs. 6.0%, P < 0.0001), presented a positive skin prick test (93.7% vs. 67.0%, P < 0.0001), had higher levels of total serum IgE (geometric mean of Log10 2.46 +/- 0.27 kU/L vs. 2.06 +/- 0.38 kU/L, P < 0.0001) and higher blood eosinophil counts (geometric mean of Log10 2.67 +/- 0.07 x 10(-3) mL vs. 2.57 +/- 0.09 x 10(-3) mL, P < 0.0001), and reported increased nasal obstruction (2.0 (95% CI 1.8 to 2.2) vs. 0.6 (95% CI 0.5 to 0.7), P < 0.0001). Logistic regression demonstrates that nasal obstruction (OR 2.19, 95% CI 1.72 to 2.80) and the presence of positive SPT (OR 6.15, 95% CI 2.42 to 15.61) were the most available predictors to discriminate between subjects with BHR and subjects without BHR. In addition, BHR was positively related to blood eosinophil counts (OR= 2.80, 95% CI 1.54 to 5.07), FEF25%-75% values (OR= 2.72, 95% CI 1.23 to 5.99) and familiarity (mother) for asthma (OR = 2.45, 95% CI 1.10 to 5.46). Whereas passive smoke and total serum IgE were not positively related to BHR. Increased nasal obstruction and the presence of positive SPT were the most available predictors to discriminate between subjects with and without BHR. Finally, BHR was positively related to blood eosinophil counts, FEF25%-75% values and to familiarity (mother) for asthma.     

Inhibition of acute feeding responses to systemic 2-deoxyglucose or insulin in rats pretreated with the GABA-transaminase blocker ethanolamine-O-sulfate (EOS)

Acute feeding responses to 2-deoxyglucose (750 mg/kg) or insulin (12 U/kg) were examined 24 hr after intracisternal injection of the GABA-transaminase inhibitor ethanolamine-O-sulfate (EOS, 400 μg) in female rats. EOS pretreatment completely abolished acute feeding responses to both challenges. These findings complement recent research showing that central EOS can reverse chronic overeating in several experimental preparations. The present results are consistent with previous indications that EOS treatment may induce a metabolic shift away from brain glucose utilization, thus making glucoprivation irrelevant as a metabolic challenge. An alternative possibility is that EOS-induced increases of brain GABA may offset specific neural mechanisms through which these glucoprivic agents normally induce feeding.     

哮喘患者血清嗜酸细胞及其活化产物血清浓度变化及意义

目的：探讨哮喘发病中哮酸细胞及其激活产物的作用及临床价值。方法：采用荧光免疫法和直接计为九法测定血清嗜酸细胞阳离子蛋白（ＥＣＰ）和外周血嗜酸细胞计数（ＥＯＳ）。结果：哮喘组糖皮质激素吸入治疗前后血清ＥＣＰ水平均高于对照组,有明显高于治疗后。治疗后ＥＣＰ水平的下降与通气功能的改善呈正相关。外周血ＥＯＳ与ＥＣＰ水平的变化 无相关性。结论：嗜酸细胞的激活是哮归病的重要环节,血清ＥＣＰ水平是反映气道炎症的