对慢性喘息型支气管炎气道反应性特点及其本质的探讨

目的 研究慢性喘息型支气管炎对乙酰甲胆碱和运动激发试验的气道反应性特点,并对其本质进行初步探讨。方法 对诊断明确的支气管哮喘患者,单纯型慢性支气管炎患者及慢性喘息型支气管炎患者分别进行乙酰甲胆碱吸入激发和运动激发试验,观察血嗜酸嗜酸粒细胞计数,血ＩｇＥ水平并测定慢性喘息型支气管炎患者血肖嗜酸细胞阳离子蛋白含量。     

Ventilatory capacity, working capacity and exercise-induced bronchoconstriction in a population sample of subjects with bronchial asthma or chronic bronchitis.

We have studied a representative population sample comprising 185 persons, aged 35-54 years, having certain respiratory symptoms and considered to have chronic bronchitis and/or bronchial asthma. There were 86 with bronchial asthma (without chronic bronchitis), 69 with chronic bronchitis (without asthma) and 30 with both chronic bronchitis and bronchial asthma. Fifty-one of the 116 asthmatics had reaginic bronchial allergy. In the groups with chronic bronchitis or bronchial asthma, the mean ventilatory capacities were slightly below the normal, being 89 and 91%, respectively, of the predicted values for FEV1 and 85 and 87% of those for MVV40. In the group of persons with both diseases, the mean FEV1 was 77% and the mean MVV40 84% of that predicted. Of the 21 persons with a mean FEV1 below 70% of that predicted 10 had both asthma and bronchitis. Exercise-induced bronchoconstriction, defined as a 15% fall of PEF after exercise, occurred in 22 of the 116 asthmatics and in one of the 69 persons with chronic bronchitis without bronchial asthma. In the asthmatics there was a significant correlation between resting PEF or the difference in PEF before and after orciprenaline inhalation on the one hand, and exercise-induced bronchoconstriction on the other hand. This was taken as an indication of increased bronchial hyperreactivity.     

Reaginic bronchial allergy and the occurrence of reagins against mites in a representative sample of a local Swedish population.

This study involves an investigation of 185 subjects, aged 35--54 years, a representative sample of persons with chronic obstructive lung disease in a local Swedish population. Bronchial asthma was diagnosed in 86 persons, chronic bronchitis in 69 and a combination of bronchial asthma and chronic bronchitis in 30. Reaginic bronchial allergy as a provoking factor was considered as definite when the case history, an intracutaneous test, a bronchial provocation test and a radioallergosorbent test were all positive with regard to one and the same allergen. This was found in 28% of the asthmatics. In 16% of the asthmatics, the diagnosis of reaginic bronchial allergy was not supported by all the four diagnostic criteria used but was considered as probable since the case history or the bronchial provocation test was positive in association with a positive RAST or intracutaneous test with the same allergen. Reaginic (IgE) antibodies in serum to mites (Dermatophagoides pteronyssinus) were found in 20 subjects, 18 of whom also had a positive intracutaneous test for house dust. Four of these 20 subjects had definite and 12 had probable reaginic bronchial allergy. One of the remaining four subjects had chronic bronchitis without asthma. The percentage of definite reaginic bronchial allergy may possibly be increased when reliable bronchial provocations with mite allergen can be performed. Increased IgE levels in serum were found in only eight of the 51 asthmatics with reaginic bronchial allergy and in two of the 65 other asthmatics.     

Measurement of the non-specific threshold stimulus for the bronchial tree by continuous monitoring of respiratory resistance using the oscillation method

Bronchial hyperreactivity to various stimuli has been used as one of the diagnostic criteria of chronic obstructive lung diseases. We studied bronchial responsiveness to histamine in 30 patients with acute or chronic bronchitis, 28 patients with bronchial asthma and in 42 more patients with other lung diseases, using a new device--the Astograph--which yielded graphically a continuous dose-response curve of the respiratory resistance by the oscillation method during the inhalation of histamine diphosphate. The results of this method were compared with the results of FEV1 and FEF25-75 before and after the challenge procedure. An increase of the respiratory resistance (Ros) during the challenge test gave an indication of a decrease of FEV1. The increase of Ros and the decrease of FEV1 and FEF25-75 were most pronounced in the asthmatics. Not in all cases was there a correlation between the increase of Ros and the decrease of FEV1, possibly due to imperfections in the design of the equipment. We believe that the Ros measurement cannot be totally exchanged for the conventional method. The use of the Astograph alone cannot be recommended because of the false-negative reactions. A combination Astograph/Floop equipment is rather expensive, but it is the most rational and ideal. The test itself does not induce bronchoconstriction and is simple and time-saving. However, this procedure is not yet advised as a diagnostic tool for a challenge test with allergens in the diagnosis of bronchial asthma. A further investigation on the validity and security of such a provocation is still needed.     

Pulmonary function parameters in patients with allergic rhinitis.

Rhinitis patients may have abnormal airway function as demonstrated by an obstruction in large or small airways and increased bronchial reactivity to inhaled nonspecific provocating agents. The nonspecific bronchial hyperreactivity (BHR) is particularly important in patients with rhinitis because they are more prone to develop asthma. However, the factors associated with BHR in rhinitis patients have not yet been explained. Therefore, we performed this study to determine the differences in airflow rates, and bronchial and nasal resistance between nonasthmatic rhinitis patients with or without BHR, and to evaluate the relationship between these parameters and bronchial reactivity to methacholine. A total of 66 patients with allergic rhinitis but not asthma were selected for the study and divided into two groups; Group 1 (40 patients with allergic rhinitis and negative mechacholine provocation test) and Group 2 (26 patients with allergic rhinitis and positive methacholine provocation test). Pulmonary function tests, methacholine provocation tests, anterior rhinomanometry, and skin prick tests were performed on the patients. The study groups were homogeneous with regard to gender, age, duration of illness, and smoking ratio. Expiratory airflow parameters including FVC, FEV1, PEFR, and FEF25 were similar in both groups, however FEV1/FVC, FEF25-75, FEF50, and FEF75 were significantly lower in Group 2. Additionally, sRaw was significantly higher in Group 2 and negatively correlated with the expiratory airflow parameters for small airways. Total nasal resistance was not different between the groups. There was no correlation between nasal resistance and BHR to methacholine or airway resistance. The present study suggests that nonasthmatic rhinitis patients with BHR may have mild but significant changes in the small airways. Clinical and functional follow-up of these patients should assess the long-term consequences of these parameters and their clinical importance.     

Sulfur dioxide-induced bronchial constriction in asthmatics and its prophylaxis by salbutamol

Patients with bronchial asthma often develop acute attack in kitchen while burning honeycomb briquet which is widely used for cooking in southern China. Burning of a honeycomb briquet produces 0.6-4.3 ppm sulphur dioxide (SO2) in the kitchen air. To assess whether the above concentration of SO2 can induce bronchial constriction, we performed SO2 bronchial provocation test on 21 asthmatics (male 11, female 10, average age 28.8 +/- 2.0 years), 10 patients with allergic rhinitis (male 3, female 7.28 +/- 1.6 years) and 20 healthy non-smokers (male 13, female 7, 28.1 +/- 1.5 years). FEV1 showed no significant change in both healthy and rhinitis group even a maximal amount of SO2 (10 ppm) was given. The calculated PC20 FEV1 and PC35 SGaW in asthmatics were 3.7 +/- 0.22 ppm and 2.5 +/- 0.18 ppm respectively, which fell into the SO2 range yielded by a burning honeycomb briquet. Orally administered slow release salbutamol created protective effect in 5 out of 8 patients. Salbutamol inhalation, however, completely blocked SO2 induced bronchial constriction. We suggest that patient with bronchial asthma should receive salbutamol aerosol inhalation before cooking with burning honeycomb briquet.     

Comparison of exhaled nitric oxide measurement with conventional tests in steroid-naive asthma patients.

BACKGROUND: Nitric oxide (NO) is a molecule with potent biological activity that plays an important role in the physiology of the respiratory system. Increased expression of inducible nitric oxide synthase (iNOS) and elevated fractional concentration of exhaled nitric oxide (F(ENO)) are seen in asthmatic patients. Measurement of F(ENO) has become increasingly recognized for use in the evaluation of bronchial inflammation during monitoring of antiinflammatory treatment. OBJECTIVES: The aim of this study was to evaluate F(ENO) in a group of steroid-naive asthmatics and assess the relationship of this parameter with the results of other tests used in the diagnosis of asthma and monitoring of antiinflammatory treatment in asthmatic patients. METHODS: The study was conducted in a group of 101 steroid-naive asthmatics (56 allergic and 45 nonallergic) and 39 healthy volunteers. All patients underwent measurement of F(ENO), skin prick tests with common inhaled allergens, analysis of serum eosinophil cationic protein (ECP) and blood eosinophilia, and flow-volume spirometry. When the forced expiratory volume in the first second (FEV1) was less than 80% of predicted, reversibility of airway obstruction with a beta2-agonist was assessed. A nonspecific bronchial provocation test with histamine was carried out in asthmatic patients with a baseline FEV1 of more than 70% of predicted. RESULTS: Compared to the healthy volunteers, F(ENO) was elevated in both groups of asthmatics. F(ENO) in the allergic asthma group was higher than in the group of nonallergic asthmatics. In allergic and nonallergic asthmatics, F(ENO) was significantly correlated with bronchial hyperresponsiveness to histamine, reversibility of airway obstruction, serum ECP levels, and blood eosinophilia. F(ENO) did not correlate with baseline FEV, in either group of asthmatics. In 31% of nonallergic and 9% of allergic patients, F(ENO) was less than 20 parts per billion. CONCLUSIONS: We suggest that measurement of F(ENO) could be clinically useful in steroid-naive asthmatics and should be more widely used in clinical practice. Measurement of F(ENO) is a noninvasive, simple, and reproducible procedure, the results of which correlate with other routinely used methods in the diagnosis of asthma. However, it is worth noting that some patients, especially those with nonallergic asthma, do not display elevated F(ENO).     

A preliminary study on the relation of peripheral blood lymphocyte beta-adrenoceptors and airway reactivity in asthmatics

The beta-adrenoceptors on intact peripheral blood lymphocytes were studied in 21 allergic asthmatics. 11 TDI asthmatics and 17 normal subjects with radioligand binding assay technique. The airway responsiveness to methacholine provocation test was determined. The results indicated that beta-adrenoceptor Bmax values in allergic and TDI asthmatics were reduced but the affinity between receptor and ligand was increased there was a positive correlation between the values of Bmax and FEV1%, V25/Pr in both asthmatic groups, a positive correlation between the values of Bmax and PC20 in allergic asthmatics. The beta-adrenoceptor responsiveness was remarkably reduced in allergic asthmatics.     

Exercise, methacholine, and adenosine 5'-monophosphate challenges in children with asthma: relation to severity of the disease

Bronchial hyperreactivity is a characteristic feature of asthma and can be evaluated by different challenges. The aim of this study was to compare exercise, methacholine (MCH), and adenosine 5'-monophosphate (AMP) challenges in 135 children and young adults (mean age +/- SD, 12.4+/-3.9 years) with asthma, and to examine the utility of the different challenges in predicting those children with asthma likely to require prophylactic antiinflammatory treatment. The sensitivity of MCH challenge in detecting bronchial hyperreactivity (at or below 8 mg/mL) was 98%, that of AMP challenge (at or below 200 mg/mL) 95.5%, and that of exercise (more than 8.2% fall in FEV(1)) was 65%. There was a significant difference between mild asthmatic children (85 patients, intermittent asthma, step 1 of NIH guidelines) and moderate asthmatics (50 patients, steps 2 and 3 of guidelines) in relation to the logarithmic mean provocation concentration to elicit a 20% fall in FEV(1) (PC(20)) to MCH (0.49 mg/mL vs. 0.15 mg/mL, P<0.00001), that to AMP (7.67 mg/mL vs. 3.60 mg/mL, P = 0.001), and in relation to the mean percent fall in FEV(1) after exercise (13.9% vs. 22.0%, P = 0.001). Sensitivity and specificity curves between the two severity groups of asthma were constructed, and the intersection point of the two curves for each type of challenge was determined. When mild asthmatics were compared to moderate asthmatics, the intersection points for MCH, AMP, and exercise were 66%, 63%, and 61%, respectively. Logistic regression analysis and receiver operating characteristic (ROC) curves of the three challenges for the two severity groups of asthma showed that methacholine was a better discriminating challenge between the severity groups than the other two challenges. We conclude that the sensitivities of AMP and MCH challenges in the detection of bronchial hyperreactivity in children and young adults with asthma are very similar and higher than that of exercise. There is a significant difference between mild and moderate asthmatics within the three bronchial challenges, with MCH discriminating better than AMP or exercise between groups.     

Responsiveness to three bronchial provocation tests in patients with asthma

STUDY OBJECTIVES: To compare a new bronchial provocation test, the mannitol challenge, with cold air and histamine challenges to demonstrate airway hyperresponsiveness (AHR) in patients with difficult-to-diagnose asthma. DESIGN: A prospective study. PARTICIPANTS: Thirty-seven consecutive patients with recently diagnosed, steroid-naive, mild, or atypical asthma fulfilling the diagnostic criteria of Finnish Social Insurance Institution, and 10 healthy control subjects. INTERVENTIONS: Each subject completed a symptom questionnaire and underwent spirometry, diffusion capacity measurement, skin-prick tests, and bronchial provocations with mannitol, histamine, and cold air. The severity of asthma was classified according to the Global Initiative for Asthma (GINA). RESULTS: Fifty-one percent of the asthmatic patients responded to mannitol (> or =15% fall in FEV(1)), 24% to cold air (> or =9% fall in FEV(1)), and 81% or 49% to histamine (provocative dose causing a 15% fall in FEV(1) [PD(15)] < 1.0 mg or < 0.4 mg, respectively). None of the healthy control subjects responded. The GINA classification was not associated with responsiveness to any of the challenges. CONCLUSIONS: Mannitol is more sensitive than cold air in demonstrating AHR in patients with mild or atypical asthma. Histamine was more sensitive than both mannitol and cold air if 1.0 mg was used as a cut-off value for histamine PD(15). However, if the cut-off value for histamine PD(15) is lowered to 0.4 mg, which represents a specific diagnosis of asthma according to previous studies, the sensitivity values of mannitol and histamine challenges are comparable.     

蚓激酶引起职业性哮喘:附2例病例报道

目的探讨皮肤点刺试验、结膜和(或)支气管激发试验,在蚓激酶这类罕见的职业环境中引起的职业性哮喘的诊断意义。方法对2例怀疑职业环境中接触蚓激酶粉尘引起的哮喘患者进行临床表现总结,并用蚓激酶粉剂稀释液(10μgml)分别对2例患者和3例健康对照进行皮肤点刺试验;对例1进行支气管激发试验;对例2进行结膜激发试验。结果 2例患者蚓激酶皮肤点刺试验均为阳性,3例健康对照者均为阴性。例1支气管激发试验阳性,FEV1.0从103%预计值降到83%预计值。例2左侧眼结膜激发试验阳性,作为对照的右侧眼结膜为阴性。结论蚓激酶作为一种药用蛋白质,其粉尘可以引起职业性哮喘,特异性皮肤点刺试验、结膜和(或)支气管激发试验有助于诊断。     

Cut-off points defining normal and asthmatic bronchial reactivity to exercise and inhalation challenges in children and young adults.

An analysis was undertaken to determine the optimal cut-off separating an asthmatic from a normal response to a bronchial provocation challenge by exercise and the inhalation of methacholine or histamine in children and young adults. Data were extracted, after appropriate correction, from published studies available in Medline of large random populations that complied with preset criteria of suitability for analysis, and the distribution of bronchial reactivity in the healthy population for exercise and inhalation challenges were derived. Studies on the response to exercise and methacholine inhalation in 232 young asthmatics of varying severity were carried out by the authors and the distribution of bronchial reactivity of a young asthmatic population obtained. Comparisons of the sensitivity and specificity of the challenges were aided by the construction of receiver operating characteristic curves. The optimal cut-off point of the fall in forced expiratory volume in one second (FEV1) after exercise was 13%, with a sensitivity (power) of 63% and specificity of 94%. For inhalation challenges, the optimal cut-off point for the dose of methacholine or histamine causing a 20% fall in FEV1 was 6.6 micromol, with a sensitivity of 92% and a specificity of 89%. The cut-off values were not materially affected by the severity of the asthma and provide objective data with which to evaluate the results of bronchial provocation challenges in children and young adults.     

呼出气一氧化氮检测在慢性咳嗽病因诊断中的价值

目的评估呼出气一氧化氮（FeNO）检测在慢性咳嗽患者病因诊断中的价值。方法选取2009年1月～2009年4月因慢性咳嗽在我院进行支气管激发试验的患者43例,先后予以FeNO、支气管激发试验检查。结果18例患者支气管激发试验阳性,诊断为咳嗽变异性哮喘。25例激发试验阴性患者,为非哮喘的慢性咳嗽。哮喘组患者FeNO水平显著高于非哮喘组,哮喘组患者FeNO值与LogPD20FEV1存在显著负相关性（r=-0．884）。FeNO诊断咳嗽变异性哮的最佳阈值为15．85ppb,其约登指数为0．753,灵敏度为83．3％,特异度为92．0％,阳性预计值为88．2％,阴性预计值88．5％。结论FeNO对咳嗽变异性哮的诊断具有较高的灵敏度和特异度,在慢性咳嗽的病因诊断中具有重要的应用价值。     

Allergic rhinitis and asthma: more similarities than differences

Clinical epidemiological and pathophysiological studies suggest a strong functional and immunological relationship between the nose and the bronchi. Nasal stimulation, can induce bronchoconstriction by a proposed rhinobronchial reflex and inflammatory mediators originating from the nose could be inhaled and trigger bronchial inflammation. Bronchial provocation in sensitised subjects results in nasal inflammation through systemic circulation. There is an increased prevalence of asthma in patients with rhinitis relatively to patients without nasal complaints and allergic rhinitis patients have an increased risk to develop asthma. Nasal and bronchial co-morbidity is high, 75% of asthmatics have rhinitis and 20% to 40% of rhinitic patient suffer from asthma. In the World Health Initiative on Allergic Rhinitis and its effect on Asthma (ARIA) it is quoted that asthma and rhinitis are common co-morbidities suggesting the concept of one airway one disease. The term allergy rhinobronchitis has been proposed to link the association between asthma and rhinitis. The treatment of rhinitis and sinusitis is important for management of asthma. Treatment of chronic rhinitis not only reduces nasal inflammation obstruction and discharge but also can reduce lower airway hyperesponsiveness and symptoms of asthma. Treating nasal inflammation is a key point in asthma control. These data strength the functional and allergologial link between nose and bronchi. Nasal inflammation induced by nasal challenge in patients with rhinitis has the ability to also induce bronchial changes in some asthmatic patients.     

Dysfonctionnement nasal chronique et obstruction des voies aériennes périphériques

Allergic rhinitis often occur at the same time with many upper and lower airway diseases in which there is asthma. Many patients without clinical asthma may have an asymptomatic bronchial hyperreactivity and an allergic rhinitis at the same time. An overview of these actual knowledges is done including clinical, respiratory functional explorations, therapeutic studies, as well as those observed in chronic nasal dysfunctions (allergic or non allergic eosinophilic rhinitis, nasal polyposis, chronic rhinitis).Objectives. – The aim of this study is to determine bronchial hyperresponsiveness of a chronic nasal dysfunction population having allergic or non allergic rhinitis.Material and methods. – Retrospective study of respiratory functional explorations (using a methacholine provocation test) among non asthmatic patients consulting for rhinology-allergy diseases but with broncho-pulmonary symptomatology.Results. – It has been observed an allergic rhinitis population without upper bronchial hyperreactivity but with a small airway obstruction revealed or worsened during the methacholine bronchoprovocation test.Conclusion. – Chronic nasal dysfunction and small airway obstruction are correlated. This association shows an airway inflammation from the nose through the small bronchi. As upper bronchial hyperreactivity can precede asthma, a small airway obstruction could precede a bronchial hyperreactivity. Nasal chronic dysfunction treatment could act upon small airway obstruction, or central bronchial hyperreactivity or asthma appearance.     

Absence of relationships between tuberculin responses and development of adult asthma with rhinitis and atopy

OBJECTIVE: To investigate the relationship between tuberculin skin responses and the development of adult asthma, rhinitis, and atopy. METHODS: Two hundred fourteen patients with mild-to-moderate asthma accompanied with rhinitis and 220 normal volunteers underwent a medical history, chest radiography, allergen skin-prick testing (SPT), bovine Mycobacterium tuberculosis vaccine (BCG) scar identification, purified protein derivative (PPD) tuberculin skin testing, serum-total and serum-specific IgE measurements, and bronchial provocation (provocative dose of histamine causing a 20% fall in FEV(1) [PD(20)]). RESULTS: Thirty-one normal volunteers (14.1%) and 168 asthma-rhinitis subjects (78.5%) had one or more positive skin test results (p < 0.0001). Neither the presence of a BCG scar nor a history of BCG vaccination had a significant effect on atopy in either group. The rate of PPD positivity had no statistical difference between atopy and nonatopy in both groups. In multivariate logistic regression analysis, the odds ratio for tuberculin reactivity was not related to the level of serum-total IgE nor to the level of serum-specific IgE to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF), skin response to DP and DF, and PD(20). Overall, no significant correlations were found between tuberculin skin reactivity and log serum-total IgE or PD(20). CONCLUSION: There is no relationship between history of tuberculosis infection, tuberculin responses, and development of adult bronchial asthma, allergic rhinitis, and atopy. Our study suggests that the protection provided by intradermal BCG vaccination in infants to prevent atopic diseases may be limited in early childhood, when a substantial memory of cellular immune modulation still exists.     

The nature of chronic asthmatic bronchitis

In order to study the nature of chronic asthmatic bronchitis, we compared the clinical features of patients with chronic asthmatic bronchitis, bronchial asthma and simple chronic bronchitis. We also measured FEV1 on these patients before and after inhaling 1% isoproterenol aerosol as well as after administration of oral prednisone (40 mg/day) for a week. The results showed that there was little difference in terms of precipitating factors, attacking features, premonitory symptoms, developing course and relieving measures between the patients with chronic asthmatic bronchitis and bronchial asthma. The improved percentage of FEV1 (more than 15%) on the patients with chronic asthmatic bronchitis after inhalation of bronchodilator aerosol and administration of oral prednisone showed no significant difference from that of bronchial asthma. We suggest that the former term be replaced by the term of chronic bronchitis associated with asthma. It can probably avoid the confusion on the diagnosis of chronic bronchitis and bronchial asthma.     

Sensitivity and specificity of the histamine challenge test for the diagnosis of asthma in an unselected sample of children and adolescents.

The purpose of this investigation was to study factors of importance for the degree of bronchial responsiveness and, furthermore, to evaluate the sensitivity, specificity and predictive value of a bronchial challenge test with histamine for the diagnosis of asthma in 495 randomly selected children and adolescents, aged 7-16 yrs, from Copenhagen, Rigshospitalet. Detailed history about allergic symptoms, physical examination and bronchial histamine challenge tests were performed at the out-patient clinic. Asthma, atopic disease and height were found to be of great importance for the degree of bronchial responsiveness, whereas the age, sex and smoking habits were of no significance. The percentage of asthmatics with bronchial hyperresponsiveness, i.e. sensitivity to the test, increased towards 100% on inhaling increasing concentrations of histamine, but this was accompanied by a decrease in specificity and predictive values of positive test in regard to the diagnosis of asthma. However, lower concentrations of histamine may be preferable in order to distinguish between asthma and non-asthma in population samples, as inhalation of 2.4 mg.ml-1 and provocative concentration producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) provided an acceptable sensitivity (57%), specificity (98%), and predictive value of a positive test (60%). We conclude that as regards the diagnosis of asthma, a low predictive value confirms that the bronchial challenge test plays only a supplementary, but valuable, role in detecting the disease in population samples.     

Beta-adrenergic receptors of lymphocytes in children with allergic respiratory diseases

The beta-adrenergic receptor binding sites on peripheral lymphocytes in children with bronchial asthma (n = 16) and seasonal allergic rhinitis (n = 8) were examined in comparison with normal controls (n = 18) by means of 124I-cyanopindolol. The number of beta-adrenergic receptors was significantly lower in the asthmatic group (858 +/- 460/lymphocyte) than in the controls (1564 +/- 983/lymphocyte). The value (1891 +/- 1502/lymphocyte in children with allergic rhinitis was slightly higher than that in healthy controls. Of the 24 patients suffering from allergic diseases of the lower or upper airways, the bronchial histamine provocation test was performed in 21; 16 gave positive results, while 5 were negative. No difference in beta-adrenergic receptor count was found between the histamine-positive and negative patients. Neither was there any correlation between the number of beta-adrenergic receptors and the high (16/24) and low (8/24) serum IgE concentrations found in allergic patients. The significant decrease in beta-adrenergic receptor count in asthmatic children lends support to Szentiványi's concept. Further qualitative and quantitative analysis of lymphocyte beta-adrenergic receptors may provide an individual approach to the treatment of bronchial asthma with beta-sympathomimetic drugs.     

成人支气管哮喘患者咽拭子支原体筛查及阳性患者临床特点分析

目的观察成人支气管哮喘（简称哮喘）患者咽拭子支原体阳性率,并对支原体阳性患者临床特征进行分析,从而探讨支原体感染与哮喘的相关性。方法选择潍坊哮喘病医院2012年1月至2012年12月入院的成人哮喘患者,对其进行咽拭子肺炎支原体培养,观察其阳性率,与健康成人及同期住院或门诊的儿童哮喘患者支原体阳性率进行比较,并从血常规、皮质醇、肺功能、哮喘控制测试（ACT）评分、鼻炎症状评分等方面分析成人肺炎支原体阳性哮喘患者的临床特点。结果503例成人哮喘患者中有345例咽拭子支原体培养阳性,阳性率为68．59％,与儿童组（阳性率为71．54％）比较差异无统计学意义,但高于健康对照组,差异有统计学意义。支原体阳性患者与阴性患者相比较,前者外周血嗜酸粒细胞比例及鼻炎症状评分高于后者,两组之间差异有统计学意义,ACT评分、FEV1、FEV1％pred、皮质醇水平均低于后者,两组之间差异有统计学意义。所有成人哮喘患者中,有139例确诊为变应性鼻炎,其中支原体阳性患者109例,阴性患者30例;有106例确诊为鼻一鼻窦炎,其中支原体阳性患者89例,阴性患者17例,支原体阳性组与阴性组相比,变应性鼻炎及鼻-鼻窦炎的患病率明显增高,两组比较差异有统计学意义。结论肺炎支原体感染在哮喘的发病中具有重要作用,肺炎支原体感染可加重哮喘患者的临床症状,可能是哮喘患者临床症状长期不缓解或成为难治性哮喘的重要原因,肺炎支原体感染与变应性鼻炎及鼻-鼻窦炎的发病密切相关。