支气管激发试验在判断职业性哮喘中的作用

支气管激发试验在判断职业性哮喘中的作用郭棣华ＰａｕｌＣｕｌｉｎｕｍ职业性哮喘是在工作环境中吸入特定致敏剂引起的哮喘〔１〕,目前是发达国家最常见的职业性呼吸系疾病之一〔２,３〕。Ｂｌａｎｅ曾对６０００名美国人进行调查,发现４６８名哮喘病人中７２名（占１...     

职业型支气管激发试验诊断TDI职业性哮喘一例报告

职业型支气管激发试验诊断ＴＤＩ职业性哮喘一例报告北京市劳动卫生职业病防治研究所（朝外东大桥北，１０００２０）袁忠孝，洪屹ＴＤＩ，又名二异氰酸甲苯酯，用于制造聚氨酯树脂及其它泡沫塑料，是常见的化学致敏物。本文报道通过职业型支气管激发试验确诊为ＴＤＩ职业...     

二异氰酸甲苯酯作业工人血清IgE抗体的观察

二异氰酸甲苯酯(TDI)广泛用于纤维、泡沫塑料及橡胶的合成等工业，可引起化学性肺炎和职业性哮喘。为进一步探讨其发病机制，我们对TDI作业工人、TDI哮喘组患者与不接触TDI的健康人血清中抗原特异性IgE抗体(S-IgE)水平进行比较，观察结果如下：     

二异氰酸甲苯酯（TDK）对工人健康危害的三年动态观察

对四家工厂106名TDI接触工人的健康效应进行了连续三年动态观察,125名非接触工人做对照,并对车间空气中TDI浓度做了监测。调查表明,接触工人的呼吸、神经系统、粘膜刺激症状和体征较对照组明显增多,细胞免疫功能增强,血胆碱酯酶活性逐年降低;肺功能呈逐年下降趋势,且有剂量——效应关系。本文还对国家现行TDI空气卫生标准的可行性做了探讨。     

作业现场支气管激发试验在职业性哮喘诊断中的应用体会

作业现场支气管激发试验可以确认支气管哮喘是否由于职业接触致喘物所致。通过对2例职业性哮喘患者的诊断,认识到在诊断中通过现场职业卫生学调查可以确认作业场所是否存在职业性致喘物,通过作业现场支气管激发试验可以确认支气管哮喘是否由职业接触致喘物所致。因此,职业性哮喘诊断中满足病因的确认和疾病的诊断,既要良好地把握诊断标准,又要灵活运用诊断方法,在科学诊断的同时,也要避免对患者的再次伤害,保护劳动者健康。     

支气管激发试验对咳嗽变异性哮喘的诊断意义

<正>咳嗽变异性哮喘(CVA)是一种特殊类型的支气管哮喘,是慢性咳嗽最常见的病因之一。气道高反应是其重要的病理生理特征[1]。2010年7月~2011年3月,我们对气道反应性测定在咳嗽变异性哮喘诊断中的临床意义进行了观察。1对象与方法1.1检测对象门诊与住院慢性咳嗽患者165例,男性71例,女性94例,其中疑诊CVA患者96例,疑诊CVA患者的诊断标准为;咳嗽为唯一的或主要     

邻苯二甲酐作业哮喘患者的免疫学观察

对10例PA作业哮喘患者进行免疫学指标观察。发现以苯酐为变应原的支气管激发试验(A-BPT)有半数阳性,其中双相反应3例,速发及迟缓反应各1例。血中抗原特异性IgE 及IG(S-IgE,S-IgG)分别有50%及80%阳性,与正常人对照有明显差异。本观察认为PA 哮喘在临床上基本符合一种变应性机制;但鉴于某些病例的非典型性,特别是体内存在较高水平的S-IgG 抗体,因此不能用单一的IgE 介导的速发型变态反应来解释。这种非典型病例更多的可能是一种慢性气道刺激反应以及体内IgG 型抗体增高的全身性反应。     

7―氨基头孢烷酸职业性哮喘8例支气管激发试验护理体会

7―氨基头孢烷酸是制药行业中生产头孢霉素抗生素的重要中间体,某些人接触会产生呼吸系统症状和哮喘。而职业性激发试验是病因诊断最可靠的依据。作好临床检查和辅助检查,特别是作好激发试验前、后的护理及健康指导,将对病人早日康复起重要作用。     

7-氨基头孢烷酸职业性哮喘8例支气管激发试验护理体会

7-氨基头孢烷酸是制药行业中生产头孢霉素抗生素的重要中间体,某些人接触会产生呼吸系统症状和哮喘.而职业性激发试验是病因诊断最可靠的依据.作好临床检查和辅助检查,特别是作好激发试验前、后的护理及健康指导,将对病人早日康复起重要作用.     

接触低浓度二异氰酸甲苯酯工人的健康研究

目的 研究接触低浓度二异氰酸甲苯酯(TDI)对工人健康的影响.方法 通过健康体检对34例接触组工人与32名对照组工人进行比较研究.结果 接触组工人头昏、手足多汗、乏力、咽痛、皮疹等症状发生率高于对照组(P<0.05),接触组工人FVC、FEV1、FEV1/FVC、HR(心率)及全血胆碱酯酶活性均低于对照组(P<0.01),而接触组的RMSSD则高于对照组(P<0.01).结论 低浓度的TDI对工人的呼吸道功能、胆碱酯酶的活性和RMSSD均有一定的影响.     

二苯甲烷二异氰酸酯哮喘患者的气道反应性与免疫学研究

10例MDI哮喘病人进行了支气管组胺激发试验(BHPT),4例阳性,6例阴性,后者有4例已脱离MDI工作1～3年;对照人员BHPT全部阴性。12例MDI哮喘病人测定了血清总IgE、MDI-HSA(人血清白蛋白)结合物的特异性IgE(S-IgE)和特异性IgG(S-IgG)抗体含量,均显著高于对照组,阳性率分别为66.7％、91.7％和91.7％。10例MDI哮喘病人进行MDI-HSA皮肤挑刺试验,7例阳性,均伴有S-IgE增高;其中呈双相反应的3例,还伴有BHPT阳性和S-IgG增高。未检出血清沉淀素抗体。T细胞ANAE阳性率与对照组无差别(P>0.05)。结果表明,MDI哮喘的发病机理与IgE、IgG介导的变态反应有关,细胞免疫反应无明显影响。     

Role of Acetylcholinesterase Inhibition in Toluene Diisocyanate (TDI) Induced Bronchoconstriction

Summary Two groups of subjects (ten controls and 13 with a clinical history of bronchial asthma attributed to TDI exposure in industry), underwent a specific bronchial stimulation test with TDI at concentrations around the MAC. Five other subjects not exposed to TDI, underwent an a specific bronchial stimulation test with carbachol. AChE and CHE activity and respiratory function (FEV₁ and V max 50%) were determined before, immediately after and 4 h after exposure. In vitro, the ID₅₀ and ID₉₀ of TDI on AChE activity is very high (7.2 x 10⁻⁵ and 6.8 × 10⁻⁴ mol/l, respectively). In vivo, AChE activity of the control group and of the group exposed to carbachol is not inhibited, while in TDI professionally exposed subjects, five show only a fall of ACNE activity after 4 h (6% lower than the base, P < 0.005), without respiratory impairment, five show a “late” response with AChE inhibition of 13% (P < 0.001); three show a “dual” response with AChE activity inhibition of 16% (P < 0.001) after 4h. There was no variation of CHE activity in any subject. The authors hypothesized a “biochemical” effect mediated by an immune mechanism due to the presence of antibodies against acetylcholinesterase-TDI complex with a threshold effect on respiratory impairment due to acetylcholinesterase inhibition.     

Occupational asthma related to low levels of airborne methylene diphenyl diisocyanate (MDI) in orthopedic casting work

Orthopedic plaster casts contain methylene diphenyl diisocyanate (MDI). A few case reports have suggested occupational asthma to MDI in casting work. However, the knowledge of the exposure levels related to the occupational asthma cases is lacking. We report on two occupational asthma cases due to MDI in nurses irregularly applying orthopedic plaster casts, verified with placebo controlled specific inhalation challenge. The levels of MDI in the air were measured in the exposure chamber during the specific inhalation challenges with a quantitative method including filter collection and subsequent liquid chromatography-mass spectrometry (LC-MS) analysis of the isocyanate groups. In order to estimate the level of airborne MDI in casting work, measurements were conducted also in two hospitals during the application and removal of synthetic plaster casts using the same method. The concentrations were well below the occupational exposure limit in both specific inhalation challenge and hospital measurements. Based on our findings, even minor exposure to airborne MDI in casting work can cause an asthmatic reaction in some patients.     

人工支气管激发试验在儿童慢性咳嗽诊断中的应用

目的 探讨使用乙酰甲胆碱(MCH)对慢性咳嗽儿童进行人工支气管激发试验(BPT)判定呼吸道高反应性(AHR)及其程度的应用价值及安全性.方法 选择2010年1月至2011年8月在本院就诊并治疗的700例慢性咳嗽儿童为研究对象,并根据其年龄分为≤3岁组(n=534)和＞3岁组(n=166)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会的批准,分组征得受试对象监护人的知情同意,并与之签署临床知情同意书).对其使用MCH进行BPT,记录试验前、后患儿生命体征,咳嗽情况及肺部哮鸣音改善情况等.结果 700例患儿中,BPT的总阳性率为80％(560/700).两组患儿BPT阳性率比较,差异无统计学意义(P＞0.05).700例患儿试验前、后生命体征比较,差异亦无统计学意义(P＞0.05).两组无一例患儿出现严重不良反应.结论 对慢性咳嗽儿童使用MCH进行BPT安全可靠,在其病因诊断中具非常重要作用,适用于不具备儿童潮气肺功能仪等设备的基层医院.     

Two cases of paraoccupational asthma due to toluene diisocyanate (TDI)

Two cases of paraoccupational asthma caused by toluene diisocyanate (TDI) are reported. The first patient was a metal worker in a machine shop situated near a factory producing polyurethane foam. Symptoms at work were not explainable by any specific exposure to irritants or allergens in the work site. As the patient recalled previous occasional work in the adjacent polyurethane factory with accompanying worsening of respiratory symptoms, a specific inhalation (SIC) test was performed with TDI, which confirmed the diagnosis of TDI asthma. The second case was a woman working part time as a secretary in the offices of her son's factory for varnishing wooden chairs. TDI was present in the products used in the varnishing shed. The SIC test confirmed the diagnosis of TDI asthma, despite the fact that the patient's job did not present risk of exposure to the substance. In both patients, symptoms disappeared when further exposure was avoided. These two cases confirm that paraoccupational exposure to TDI must be considered when evaluating patients with asthma not mediated by immunoglobulin E. They also suggest the need for more prospective studies evaluating the health risk for the general population living near polyurethane factories or other firms that use TDI.


Keywords: paraoccupational exposure; toluene diisocyanate; asthma     

河南省支气管哮喘诊治现状调查分析

目的：了解河南省哮喘诊治现状，改进防治对策。方法：对2000年河南省全人群采用分层随机整群抽样调查，依据询问病史体检，确诊哮喘患者。结果：受检人口65033人，哮喘患病率1．05％，延误7天以上就诊者40．00％，诊断率为20．00％，诊断方法单一，治疗管理混乱，仅0．30％的哮喘病人按全球哮喘防治创议（GINA）要求正规治疗管理。结论：向基层宣传普及GINA知识是哮喘防治取得成功的重要措施。     

Respiratory diseases caused by occupational exposure to 1,5-naphthalene-diisocyanate (NDI): Results of workplace-related challenge tests and antibody analyses

BACKGROUND: 1,5-naphthalene-diisocyanate (NDI) is an aromatic diisocyanate with a very low vapor pressure which is mainly used in the automotive industry. METHODS: In the present study we described five cases with workplace-related asthma and one case with extrinsic allergic alveolitis associated with pulmonary hemorrhage after NDI exposure. RESULTS: Corresponding to case histories, extrinsic alveolitis on asthmatic reactions in three subjects and a rhinitis reaction in one patient could be reproduced by inhalative challenge tests to NDI at a concentration of 10 ppb. Preliminary IgE and IgG antibody analyses in patients' sera did not produce significantly positive results. CONCLUSIONS: According to the outcome of our tests and in comparison with several other studies, we conclude that NDI should be classified as potent airway-sensitizing substance. Improved workplace conditions and decrease in threshold limit values should therefore be recommended.     

沙丁胺醇和布地奈得联合雾化吸入治疗小儿哮喘疗效观察及护理

目的：探讨联合雾化吸入沙丁胺醇和布地奈得辅助治疗小儿哮喘的治疗效果与护理。方法：将82例哮喘轻、中期患儿按先后顺序分为治疗组和对照组,各组41例,两组均给予常规平喘,抗感染及对症治疗。治疗组在此基础上雾化吸入沙丁胺醇和布地奈得溶液。结果：治疗组显效率明显高于对照组,差异具有显著性（P〈0.05）。结论：雾化吸入沙丁胺醇和布地奈得治疗小儿哮喘疗效好,且安全,方便,经济。同时建立了一种较为合理的临床雾化吸入护理方法。     

Transmission/Disequilibrium Test Analysis of Total Serum IgE Levels in the Hutterite and Collaborative Study on the Genetics of Asthma Data Sets

The Hutterite and Collaborative Study on the Genetics of Asthma data sets provided by Genetic Analysis Workshop 12 were analyzed using a regression‐based transmission/disequilibrium test that assesses linkage between a marker locus and quantitative trait locus when allelic association is present, as proposed by George et al. [Am J Hum Genet 65:236–45, 1999]. Because the same marker set and analytical technique was used, the results from these data sets are amenable for comparison. Statistically significant results common to both data sets were found on chromosomes 1 and 3. A noteworthy result, significant at p < 10^‐4, was detected on chromosome 18 in the Hutterites. © 2001 Wiley‐Liss, Inc.