呼吸系统疾病

20000073P一选择在速激肤类致气道高反应性中的作用/于化鹏…//中华内科杂志一飞999,38(4)一228~230 检测哮喘患者激素治疗组27例,非激素治疗组30例及20例正常人的气道反应性。结果:患者气道激发试验阳性率为92.98%,正常人均阴性;非激素治疗组血浆P一选择素和P一物质较激素治疗组及正常人显著升高(P<0.01)。经激素治疗后上述异常均改善“,<0.01)。另外,检测还表明,激素治疗组血浆血管活性肠肤(VIP)高于非激素治疗组(尸<。.()1),P一物质的变化与气道反应性之间呈正相关,VIP与气道反应性呈负相关。认为P一选择素在速激肤类致气道高反应性…     

中药复方 慎柔养真汤 中血管活性肠肽的探讨

目的中药复方慎柔养真汤中是否含有血管活性肠肽（ＶＩＰ），以探索该药治疗消化系统疾病的作用机理．方法用放射免疫分析药盒，对中药复方慎柔养真汤煎剂，２０例正常人和２０例脾阴虚证患者血浆中ＶＩＰ的含量进行检测．结果最大结合率Ｂ０／Ｔ＝５３２９０％；非特异性结合率Ｎ／Ｔ＝１１７０％；拟合曲线方程Ｙ＝０８１９８３＋０４４３１９Ｘ０２８９２７Ｘ２，拟合度Ｒ２＝０９９０；中药中ＶＩＰ＝１０６６ｎｇ／Ｌ±２０ｎｇ／Ｌ，与正常人相比较无显著性差异，但有升高趋势；正常人血浆中ＶＩＰ＝９０１６ｎｇ／Ｌ±１５ｎｇ／Ｌ；脾阴虚患者血浆中ＶＩＰ＝６３２５ｎｇ／Ｌ±１１ｎｇ／Ｌ，与正常人相比较有显著性差异（Ｐ＜００５）．结论中药复方慎柔养真汤煎剂中有ＶＩＰ或ＶＩＰ前体复合物，其ＶＩＰ水平略高于正常人血浆，而脾阴虚患者血浆中ＶＩＰ水平低于正常人．     

慢性干咳伴有气道高反应性即是咳嗽变异性哮喘吗？

目的评价气道反应性测定在咳嗽变异性哮喘（ＣＶＡ）诊断中的价值。方法１２４例慢性干咳患者经气道反应性测定后，分为咳嗽气道高反应阳性组（ＣＢＨ－Ｐ组）３５例，咳嗽气道高反应阴性组（ＣＢＨ－Ｎ组）３３例。观察常规肺功能、抗原皮肤点刺试验阳性率、血嗜酸性粒细胞计数、血ＩｇＥ水平、泼尼松试验阳性率并随访２年后发展成典型哮喘例数。结果３５例ＣＢＨ－Ｐ组一秒钟用力呼气容积占用力肺活量比值（ＦＥＶ１％）为７４±１０（Ｐ＜０．０１），３３例ＣＢＨ－Ｎ组为８３±１０（Ｐ＜０．０５）。抗原皮肤点刺试验阳性率ＣＢＨ－Ｐ组为５１％，ＣＢＨ－Ｎ组为１２％；血嗜酸性粒细胞计数ＣＢＨ－Ｐ组为０．５±０．１×１０９／Ｌ，ＣＢＨ－Ｎ组为０．３±０．１×１０９／Ｌ；泼尼松试验阳性率ＣＢＨ－Ｐ组为８３％，ＣＢＨ－Ｎ组为１５％。随访２年后发展成典型哮喘例数中ＣＢＨ－Ｐ组有１６例发展成典型哮喘。在ＣＢＨ－Ｐ组中发展成典型哮喘与未发展成典型哮喘患者在皮肤抗原点刺试验阳性率、常规肺功能、反应阈值（Ｄｍｉｎ）及致喘阈值（Ｄｃｗ／Ｄｍｉｎ）等方面差异均无显著性。结论气道反应性测定是诊断ＣＶＡ的重要依据，但不是唯一的诊断标准，还应结合其它临床资料综合判断     

支气管哮喘患者血浆胃泌素测定及其意义

为了探讨胃泌素（Ｇａｓ）和支气管哮喘发病的关系，测定了２３例急性发作期和１９例缓解期哮喘患者的血浆Ｇａｓ含量，并与１８例正常人作对照研究．同时还测定１４解期组气道反应性、肺功能和动脉血气分析。结果表明，哮喘急性发作期组［（５０．９１±８．７９）ｎｇ．Ｌ）及缓解期组［（５７．６５±１０．９０）ｎｇ／Ｌ］Ｇａｓ均显著低于正常人组（（８６．２０±１８．３７）ｎｇ／Ｌ），并且哮喘缓解期组Ｇａｓ降低与最大呼气流速（ＰＥＦＲ）和ＨＩＳ－ＰＣ２０）之间存在相关关系．提示Ｇａｓ含量减少与哮喘发作和气道反应性增高有关．     

双盲对照吸入倍氯米松一年对气道高反应性与哮喘的防治作用

目的探讨长期吸入糖皮质激素对哮喘患者的治疗作用和对无症状的气道高反应性（ＢＨＲ）者发生哮喘的预防作用。方法以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２～１８岁，吸入倍氯米松干粉剂（ＢＤＰ，６００μｇ／ｄ）或安慰剂１年对气道反应性及哮喘症状的作用。结果试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显著下降（分别为０．３８５±０．４２４、１．１８７±０．６０３μｍｏｌ组胺，Ｐ＜０．０２），只有３０％哮喘者仍有喘息，而对照组则有８６％仍有喘息（Ｐ＝０．０７６）；无症状ＢＨＲ学生的ｌｇＰＤ２０－ＦＥＶ１在ＢＤＰ组及对照组间差异无显著性，但ＢＤＰ组不出现喘息症状，而对照组则有３例出现喘息（１５％）；ＢＨＲ者吸入ＢＤＰ组的累积症状计分显著低于对照组（分别为１．５０±２．５４分、５．５８±６．２２分，Ｐ＜０．０１）。结论ＢＤＰ能降低哮喘患者的ＢＨＲ及减轻其症状，且可能有预防无症状ＢＨＲ者发生哮喘的作用     

二尖瓣狭窄患者气道高反应性与糖皮质激素吸入的治疗 …

目的 了解气道反应性增高和二尖瓣狭窄患者咳嗽及气短症状间的关系,以及糖皮质激素吸入的治疗作用。方法 测定２３例二尖瓣狭窄患者的气道反应性,对１５例（６５％）气道反应性增高者,随机分为丙酸倍氯米松治疗组（８例）和安慰剂组（７例）,治疗６周后复查。治疗前后测定患者咳嗽及气短症状评分。对８名气道反应性正常者亦吸入丙酸倍氯米松作为对照组。结果 丙酸倍氯米松吸入组治疗６周后,其气道反应性显著降低（Ｐ〈０．０     

不稳定性心绞痛患者血浆vWF、GMP-140检测的临床意义

目的：探讨内皮及血小板活化功能在不稳定性心绞痛中的作用。方法采用ＥＬＩＳＡ双抗体夹心法测定不稳定性心绞痛１７例、稳定性心绞痛２５例,正常人２２例血浆ｖＷＦ（ｖｏｎＷｉｌｌｅｂｒａｎｄ因子,血管性假血友病因子）、ＧＭＰ－１４０（α颗粒膜蛋白－１４０）水平。结果不稳定性心绞痛组急必阶段血浆ｖＷＦ、ＧＭＰ－１４０显著高于稳定性心绞痛组和正常人组（Ｐ〈０．０１）,后两者之间无显著差异。不稳定性心绞痛组病情     

腺苷、白细胞介素-l、茶碱对哮喘患者外周血单个核细胞产生白细胞介素-8的影响

哮喘患者血浆及肺组织中腺苷水平升高,吸入腺苷可引起哮喘患者气道反应性增高,腺苷受体反义寡核苷酸能降低哮喘兔气道阻力,改善气道顺应性,提示腺苷是哮喘气道炎症中的一种重要炎性介质。本研究通过观察腺苷、白细胞介素（ＩＬ）－ｌ、茶碱对哮喘患者外周血单个核细胞（ＰＢＭＣｓ）产生ＩＬ－８的影响,探讨腺苷在哮喘中的作用。 一、对象与方法 １．对象：（１）正常组：１２例,男、女各６例,年龄（４０．５ ±１３．ｌ）岁。均健康正常人,无吸烟及过敏性疾病史。（２）哮喘组：哮喘缓解期患者１７例,男７例,女１０例,平均年龄…     

双盲对照吸入倍氯以一年对道高反应性与哮喘的防治作用

目的 探讨长期吸入糖皮质激素对哮喘患的治疗作用和无症状的气道高反应性（ＢＨＲ）发生哮喘的预防作用。方法 以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２－１８岁，吸入倍氯米松粉剂（ＢＤＰ，６００μｇ／ｄ）安慰剂１年对气道反应性及哮喘症关诉作用。结果 试试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显下降（分别为０．３８５±０．４     

肝硬化时血浆胃肠激素与胃肠动力障碍的关系

目的了解肝硬化时胃肠激素与胃肠动力障碍的关系。方法对８３例肝硬化患者进行二周以上西沙比利治疗前后的血浆胃动素（ＭＴＬ）、生长抑素（ＳＳ）、血管活性肠肽（ＶＩＰ）水平测定比较,以及２０例正常人的血浆胃动素,生长抑素、血管活性肠肽的观察进行比较。结果肝硬化组ＭＴＬ、ＶＩＰ较正常组异常升高,但治疗后血浆ＭＴＬ、ＶＩＰ、ＳＳ水平较治疗前无明显变化,不与临床症状改善密切相关。结论肝硬化患者存在明显胃肠动力障碍,胃肠激素紊乱是其重要原因之一,但还有其他因素共同作用,肝功能损害程度是决定因素,西沙比利用于治疗肝硬化时消化不良症状有效,但保肝、利胆等治疗更为重要。     

支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点及意义

目的探讨支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点,以便为临床诊断提供依据。方法采用日本产ＡＳＴＯＧＡＰＨＴＣＫ６０００ＣＶ气道反应测定仪,以乙酰甲胆碱为气道激发剂,观察６０例支气管哮喘、５８例咳嗽变异性哮喘及３７例急性支气管炎患者气道反应性变化。结果支气管哮喘和咳嗽变异性哮喘病人气道激发试验均为阳性,哮喘病人的气道反应阈值（Ｄｍｉｎ）低于咳嗽变异性哮喘病人（Ｐ＜００５）。急性支气管炎病人中,气道激发试验３３例阴性,占８９％,４例阳性,占１１％。４例阳性急性支气管炎患者的气道反应性曲线与哮喘组及咳嗽变异性哮喘组明显不同,其Ｄｍｉｎ也显著高于哮喘组（Ｐ＜００１）及咳嗽变异性哮喘组（Ｐ＜００５）。结论气道反应性测定对于不同类型哮喘及急性支气管炎的鉴别和指导治疗具有很好的临床应用价值。     

Non-invasive evaluation of lower airway inflammation in hyper-responsive elite cross-country skiers and asthmatics

Asthma-like symptoms and bronchial hyper-responsiveness (BHR) to methacholine are prevalent in competitive cross-country skiers. Whether these symptoms (ski asthma) in these athletes are caused by asthma remains uncertain. Bronchial responsiveness to adenosine 5'-monophosphate (AMP) and nitric oxide (NO) concentration in exhaled air, both indirect markers of asthmatic airway inflammation, were investigated in two non-smoking study populations of skiers and asthmatics. Of 18 skiers with ski asthma, 15 non-steroid and 14 steroid-treated asthmatics, BHR to AMP was present in five (28%), six (40%) and 10 (71%) subjects respectively. Although the groups were not significantly different in responsiveness to methacholine, responsiveness to AMP increased in order of magnitude from ski asthma < non-steroid-treated < steroid-treated asthma. Exhaled NO in 44 (nine with ski asthma) skiers was not significantly different from 82 healthy non-atopic controls [median [interquartile range (IQR)] 6.5 (4.1-9.9) vs. 5.2 (4.2-6.5) ppb]. Exhaled NO in 29 subjects with mild intermittent asthma was three-fold greater [median (IQR) 19.2 (5.1-25.6) ppb, P < 0.01] than in skiers. Exhaled NO was two- and four-fold greater in atopic than non-atopic subjects in the skier (P < 0.001) and asthmatic (P < 0.01) groups, respectively, and was correlated to methacholine responsiveness in atopic asthmatics (n = 22, rho = 0.55, P < 0.01). Exhaled NO was not elevated in ski asthma and may be more useful as a marker of atopic status than inflammation in the lower airway in skiers. Few skiers were hyper-responsive to AMP, indicating that pre-activated mucosal mast cells are not a predominant feature in ski asthma.     

Effect of inhaled steroid therapy on exhaled nitric oxide and bronchial responsiveness in children with asthma.

Inhaled steroid therapy is reported to reduce the level of exhaled nitric oxide (eNO), but the effects of inhaled corticosteroids (ICS) on bronchial hyperresponsiveness (BHR) have been controversial. The aim of this study was to determine the effects of ICS on the relationship between eNO and BHR. Twenty-six children with asthma were recruited, including 14 children who were receiving ICS (ICS group) and 12 who were not (ICS-naive group). The fractional exhaled nitric oxide concentration (FE(NO)) was examined by the recommended online method. To evaluate BHR, an acetylcholine challenge test was performed. In the ICS-naive group, FE(NO) was significantly correlated with PC20 (p < 0.05, r = -0.70), but not in the ICS group. In conclusion, FE(NO) was significantly correlated with BHR in the ICS-naive group, but this relationship was not present in the ICS group. Our results suggest that the use of ICS should be taken into consideration when evaluating the relation between BHR and airway inflammation.     

中性粒细胞与白细胞介素8在哮喘发病中的作用

目的探讨中性粒细胞与白细胞介素8（IL-8）在支气管哮喘(简称哮喘)发病中的作用。方法对轻度哮喘患者行气道激发试验,对哮喘患者中性粒细胞超氧阴离子（O(*)/(2)）产生、血浆及诱导痰IL-8、丙二醛(MDA)水平进行测定分析。结果中、重度哮喘患者每106个周围血中性粒细胞O(*)/(2)产生水平为［（20.9±5.1）nmol/L］,与轻度哮喘患者［(15.2±4.2)nmol/L］比较,差异有显著性（P<0.01）,轻度哮喘组与正常人［(11.3±2.4)nmol/L］比较,差异有显著性(P<0.05);周围血中性粒细胞O(*)/(2)产生与气道反应性指标一秒钟用力呼气容积下降20%时所需的累积量(PD20FEV1)呈显著负相关(r=-0.693,P<0.05);急性发作期哮喘患者血浆及诱导痰IL-8水平［(585±75)ng/L、(791±103)ng/L］、MDA水平［(6.3±1.6)mmol/L、(21.8±6.3)mmol/L］,与缓解期哮喘患者血浆及诱导痰IL-8水平［(227±54)ng/L］、［(322±95)ng/L］、MDA水平［(5.4±1.0)mmol/L］、［(15.1±5.6)mmol/L］比较,差异有显著性（P<0.01）;缓解期哮喘患者与正常人血浆及诱导痰IL-8水平［(188±46)ng/L］、［(224±51)ng/L］及MDA水平［(4.1±0.4)mmol/L］、［(9.5±4.2)mmol/L］比较,差异有显著性（P<0.05）,诱导痰MDA水平与PD20FEV1呈显著负相关(r=-0.708,P<0.01);诱导痰IL-8水平与诱导痰中性粒细胞百分数呈显著正相关（r=0.838,P<0.01）。结论中性粒细胞产生的氧自由基可能参与哮喘气道炎症及气道高反应的形成。     

哮喘气道炎症粘附机制的实验研究

目的评价细胞间粘附分子１（ＩＣＡＭ１）、Ｐ选择素在哮喘气道炎症粘附机制中的作用,进一步阐明哮喘的发病机理。方法用酶联免疫吸附试验、肺组织免疫组化检查和呼吸生理学方法系统观察正常组和哮喘组豚鼠各项指标。结果（１）哮喘组豚鼠肺潮气量、动态肺顺应性（Ｃｄｙｎ）和肺气道阻力与对照组比较差异有显著性（Ｐ＜０．０１及Ｐ＜０．０５）。（２）哮喘组豚鼠血浆和肺泡灌洗液（ＢＡＬＦ）可溶性ＩＣＡＭ１（ｓＩＣＡＭ１）、可溶性Ｐ选择素、血清和ＢＡＬＦ嗜酸粒细胞阳离子蛋白（ＥＣＰ）与对照组比较,差异有显著性（Ｐ＜０．０１）;ＢＡＬＦ中白细胞介素８（ＩＬ８）与对照组比较差异也有显著性（Ｐ＜０．０１）。（３）哮喘组豚鼠肺组织（气道上皮和血管内皮）ＩＣＡＭ１和ＩＬ８表达与对照组比较,差异有显著性（Ｐ＜０．０１）。结论ＩＣＡＭ１、Ｐ选择素、ＩＬ８、ＥＣＰ参与介导了哮喘气道炎症的粘附过程     

Eosinophils play a major role in the severity of exercise-induced bronchoconstriction in children with asthma

Exercise-induced bronchoconstriction (EIB) was associated with eosinophilic airway inflammation, bronchial hyperresponsiveness (BHR), atopy and airway obstruction. To understand the pathogenesis of EIB, we determine whether eosinophil is more related to the mechanism of EIB than atopy, BHR and airway obstruction. This study comprised 268 asthmatic children who underwent lung function test, methacholine challenge test, exercise challenge test, and blood tests for total IgE levels and total eosinophil counts (TEC). Urine eosinophil protein X (EPX) levels after exercise were measured by using ELISA method. EIB was observed in 195 of 268 asthmatics (72.8%). Asthmatics with EIB showed significantly increased TEC (P < 0.01) and decreased log PC(20) as compared with asthmatics without EIB. Maximal percent fall in FEV(1) after exercise was significantly correlated with TEC, log IgE, FEF(25-75%), log PC(20) (P < 0.001, respectively) and FEV(1) (P = 0.013). When the same study was carried out in nonatopic asthmatics, those with EIB showed significantly increased TEC (P = 0.01) compared with those without EIB; however, log PC(20), FEV(1), and FEF(25-75%) showed no significant differences between the two groups of nonatopic asthmatics. In addition, there was a significant correlation between the severity of EIB and TEC in nonatopic asthmatics. Urine EPX/Cr levels after exercise were correlated with the severity of EIB (r = 0.238, P = 0.014). Blood eosinophils and urine EPX/Cr after exercise correlate significantly with the maximal percent fall in FEV(1) after exercise, therefore EIB may reflect a state of eosinophilic inflammation in the airway of asthmatic children.     

Bronchial hyperresponsiveness in subjects with gastroesophageal reflux

BACKGROUND: The relationship between gastroesophageal reflux (GER) and asthma has been widely studied in the last years. GER may interfere with airway reactivity and aggravate or even induce asthma. OBJECTIVE: To assess the prevalence of bronchial hyperresponsiveness (BHR) in patients with GER disease with a view to judging the potential influence of GER on BHR. METHODS: 30 patients with GER disease and no clinical evidence of asthma and 30 normal subjects underwent a methacholine bronchial challenge. The methacholine concentration that caused a 20% fall in the FEV(1) (PC20) was used to assess bronchial responsiveness. RESULTS: In the GER group 11 subjects of the 30 studied showed a PC20 methacholine equal to or less than 8 mg/ml while in the control group only 2 subjects had a PC20 methacholine equal to or less than 8 mg/ml (p < 0.01; ANOVA test). CONCLUSIONS: Subjects with GER had a greater increase in airway reactivity when inhaling methacholine compared to disease-free normal subjects.     

Relationship between Exhaled Nitric Oxide Measured by Two Offline Methods and Bronchial Hyperresponsiveness in Japanese Adults with Asthma.

Background: Exhaled nitric oxide (eNO) is a useful marker of eosinophilic airway inflammation in asthmatics. There have been no studies to show the relationship between eNO measured by offline methods and the degree of bronchial hyperresponsiveness in asthmatic patients treated with inhaled corticosteroids. Methods: The study population comprised asthmatics at our outpatient clinic. We measured eNO levels by two methods ("eNOs" was measured with a Sievers kit; and "eNOc" was measured with a kit from the Center for Environmental Information Science, Japan). We also used spirometry to test bronchial hyperresponsiveness to acetylcholine (PC(20Ach)). Results: We recruited 192 stable asthmatics. There was a significant relationship between eNOs and eNOc (r = 0.919, p < 0.001). LogPC(20Ach) levels were negatively correlated with eNOs or eNOc levels (eNOs, r = -0.31, p < 0.001; eNOc, r = -0.23, p = 0.0013). We classified the subjects into two groups based on eNOs levels ((A) the subjects with high eNOs levels (n = 92) and (B) the subjects with normal eNOs levels (n = 100)) ; logPC(20Ach) was significantly correlated with eNOs (r = -0.34, p = 0.001) or eNOc (r = -0.28, p = 0.0075) but not correlated with %FEV(1) in (A), whereas logPC(20Ach) was not significantly correlated with eNO but significantly correlated with %FEV(1) (r = 0.33, p = 0.002) in (B). Conclusions: Levels of eNOs and eNOc were correlated with the degree of bronchial hyperresponsiveness to acetylcholine in adult asthmatics treated with inhaled corticosteroids. Our findings suggest that offline monitoring of eNO will facilitate the management of bronchial asthma in patients treated with these drugs.     

Exercise provocation test in the diagnosis of bronchial asthma and detection of airway responsiveness]

Exercise provocation test was performed on a bicycle ergometer in 110 asthmatics, 15 allergic rhinitis patients, 10 patients with moderate chronic bronchitis and 22 healthy subjects. 87.5% (21/24) of atypical asthmatics revealed positive exercise induced asthma (EIA), with the overall positive rate of asthmatics being 90% (99/110). There was a close negative linear correlation between the maximal reduction rate in FEV1 induced by exercise (delta FEV1%) and the inhaled histamine dose needed to reduce FEV1 by 20% (PD20FEV1) (r = -0.59, P less than 0.01). None of the healthy subjects, one of 15 allergic rhinitis patients and one of 10 patients with moderate chronic bronchitis showed positive response to exercise test. In contrast, seven of 18 allergic rhinitis patients and all nine patients with moderate chronic bronchitis had positive response to histamine bronchial provocation test. Therefore, exercise provocation test is a reliable method for diagnosing EIA and detecting airway responsiveness and it may possess higher specificity than histamine provocation test in diagnosing bronchial asthma, particularly in atypical bronchial asthma.