53例哮喘患儿个体化的阶梯式治疗体会

支气管哮喘是当今全世界最常见的慢性疾患，严重威胁人类健康。随着城市化进程的加快，哮喘的发病率呈现上升趋势，在儿童中尤其明显。早期的诊断和正确的治疗是控制哮喘的惟一方法。我院儿科门诊设立儿童哮喘专科对53例哮喘患儿采用了个体化的阶梯式治疗方案，取得了满意的效果，现报道如下。     

卫生假说的免疫学机制在哮喘防治中的研究进展

哮喘的特征是慢性气道炎症和气道高反应性。目前对哮喘治疗的认识是“可以控制,但不能治愈”。近年来,哮喘发病的“卫生假说”提出早期微生物的暴露可能对哮喘的发病起保护作用。传统的解释是微生物负荷增加可诱导免疫反应向Th1偏移。由于哮喘是由免疫耐受缺陷导致的疾病,因此诱导抗原特异性T细胞耐受可能是此假说的另一种解释,并有望因此为防治哮喘提供新的思路。     

屋尘提取物暴露对过敏性哮喘的免疫调节机制

人们大部分时间是在室内度过的,特别是婴幼儿.室内环境对生命早期免疫的成熟影响极大.屋尘能够反映室内环境卫生状况以及各种刺激因子的暴露水平.动物实验研究表明,屋尘提取物既有Th2免疫佐剂效应,又有免疫保护效应,这取决于屋尘提取物暴露的持续时间和剂量.为进一步明确室内环境暴露与过敏性哮喘的关系并为早期防治提供更好的策略,文章分别从微生物成分与哮喘、屋尘提取物干预的哮喘动物模型、屋尘提取物对过敏性哮喘小鼠影响的激活路径等三个方面,综述屋尘提取物暴露对过敏性哮喘的免疫调节机制.     

儿童哮喘与气道重塑的研究进展

儿童支气管哮喘（简称哮喘）严重威胁儿童健康,其发病率在全世界范围内有增高趋势。气道炎症和气道重塑是哮喘的两个主要病理学特征,而气道重塑是影响哮喘疗效的重要因素之一。糖皮质激素是目前作用最强、应用最广泛的抗哮喘药物,也是目前预防气道重塑的首选药物。早期吸入激素及口服白三烯受体拮抗剂等可能有助于气道重塑的预防,但是不能逆转已形成的气道重塑,所以早期诊断及干预气道重塑的发生是儿童哮喘防治的关键。     

支气管哮喘防治研究进展

近十多年来,在美国、英国、澳大利亚及新西兰等国家,无论是哮喘的发病率及死亡率均有所增加。在美国,哮喘发病率从1980年至1987年增加31%,死亡率增加29%。在澳大利亚墨尔本,5岁儿童哮喘的发病率由1960年的19%增加到1990年的46%。其中虽有诊断准确性的因索,但发病率的增加是肯定的,并且引起国际上广泛的关注。美国国家卫生研究院(Nil4)于1991年8月发布了“哮喘诊断与治疗指南”,并召集了十二个国家的专家共同制订了“国际哮喘诊断和治疗报告”。联合国世界卫生组织(WHO)将于1993年拟出“全球性哮喘防治战略”的文件,就哮喘的流行病学、病医学、发病学、定义、诊断及治疗、社会经济问题及预防教育等方面取得共识,以提高对哮喘的防治效果。     

Toll样受体与支气管哮喘的相关性研究进展

支气管哮喘（哮喘）是一种发病率较高的免疫性疾病。近年来，尤其在发达国家，发病率有持续升高的趋势，有关其发病机制及治疗策略的研究越来越受到重视。哮喘的本质是由多种炎症细胞、免疫细胞参与的慢性气道炎症，其免疫学基础与Th1和Th2细胞反应失衡密切相关。Toll样受体（TLR）属于模式识别受体，是一个介导天然免疫的跨膜信号转导受体家族，近年来提出的“卫生学假说”提示了TLR与哮喘之间存在密切的关联性，并且哮喘的发病与遗传因素关系密切，而遗传因素可以决定TLR的多态性。目前有关TLR基因的多态性与哮喘相关性的研究不断出现，本文结合近年来众多相关文献，就TLR的信号转导及其多态性与哮喘关系的研究作一综述。     

儿童哮喘吸入型糖皮质激素治疗依从性的研究进展

<正>支气管哮喘是儿童时期最常见的慢性气道炎症性疾病。根据2010年第三次全国城市儿童哮喘流行病学调查报告显示,我国儿童哮喘现患率、累计患病率与10年前相比有明显增高[1]。作为一种需要长期坚持治疗的慢性疾病,儿童哮喘如不经过合理的治疗,不仅会给患儿及其家长带来巨大的精神和经济负担[2],更会对儿童的生长发育、学习及日常生活产生极大的影响,严重的哮喘急性发作及并发症甚至可以危及生命。因此早期诊断、治疗与合理预防儿童哮喘,对于减少哮喘的急性发作以及并发症的发生具有重大的临床意义     

STAT6及其基因多态性与支气管哮喘

支气管哮喘是一种常见的疾病，近年来随着大气的污染加重，哮喘在世界各国的发病率呈上升趋势。1950～1997年，日本的哮喘的病死率升高；而美国儿童哮喘的流行率从1980～1996年平均每年增长4．3%，疾病负担亦加重，哮喘已经严重威胁人类的健康。目前认为，哮喘主要是气道慢性非特异性炎症，是一种多基因病，其发病由环境和遗传共同作用所致。     

幽门螺杆菌感染与儿童支气管哮喘发病的相关性研究

目的探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与儿童支气管哮喘发病的关系。方法采用14C呼气试验检测H.pylori感染,比较H.pylori感染儿童与正常儿童之间的哮喘发病率和病情发展情况。结果 H.pylori感染儿童哮喘发病率较正常儿童低(6.33%vs 12.66%,P0.05);H.pylori阳性的哮喘儿童较H.pylori阴性的哮喘儿童拥有更长的缓解期(P0.05)。结论H.pylori感染与儿童哮喘的发病和复发呈负相关,具体机制有待进一步研究。     

卫生假说的免疫学机制在哮喘防治中的研究进展

哮喘的特征是慢性气道炎症和气道高反应性.目前对哮喘治疗的认识是"可以控制,但不能治愈".近年来,哮喘发病的"卫生假说"提出早期微生物的暴露可能对哮喘的发病起保护作用.传统的解释是微生物负荷增加可诱导免疫反应向Th1偏移.由于哮喘是由免疫耐受缺陷导致的疾病,因此诱导抗原特异性T细胞耐受可能是此假说的另一种解释,并有望因此为防治哮喘提供新的思路.     

The hygiene hypothesis and asthma

PURPOSE OF REVIEW: Reduced exposure to childhood infections may explain the increased prevalence of allergic diseases in industrialized countries (the hygiene hypothesis). This review will examine recent epidemiologic studies of the hygiene hypothesis and asthma. RECENT FINDINGS: Recent studies have confirmed previous findings of an inverse association between increased exposure to other children during childhood and either allergen sensitization or hay fever. However, there is conflicting evidence regarding the relation between exposure to other children and asthma. Although it has been hypothesized that vaccinations may influence the development of asthma, recent findings do not support this association. Serologic evidence of exposure to certain gastrointestinal pathogens (eg, hepatitis A virus) has been inversely associated with either allergen sensitization or asthma in some, but not all, recent studies. Although heavy infestation with certain parasites (eg, helminths) is protective against allergen sensitization, there is conflicting evidence regarding the relation between parasitic infection and asthma. The results of recent studies suggest that the relation between endotoxin exposure and asthma is complex and likely influenced by factors related to the exposure itself, the host, and other covariates. Although it has been postulated that antibiotic use in early life is a risk factor for asthma, this hypothesis is not supported by recent findings. SUMMARY: For every exposure studied with regard to the hygiene hypothesis, there are inconsistent findings in relation to asthma. The hygiene hypothesis is not likely to be the sole explanation for the ongoing asthma epidemic in industrialized nations.     

Asthma Management Issues in Infancy and Childhood

The prevalence of asthma has been increasing worldwide over the past 2 decades, especially the prevalence of childhood asthma. Currently, the prevalence of childhood asthma is around 3-20% in different countries based on the report from the International Study of Asthma and Allergies in Children (ISAAC). Asthma in childhood is predominantly an extrinsic asthma. In general, countries in the coastal, temperate, and subtropical zones have the highest prevalence of mite- and cockroach-sensitive asthma. Countries in the sub-arctic or semi-arid areas have a lower prevalence of childhood asthma, mostly associated with sensitization to pet dander, moulds, and pollens. Many genes have been linked to asthma in different ethnic populations. A global consensus for the management of asthma in adults and children >5 years of age has been made possible in the Global Initiative for Asthma (GINA) guidelines, where a step-wise management program using inhaled medication with and without oral anti-inflammatory drugs is recommended. The management of asthma in children <5 years of age remains inconclusive. Recent studies suggest that inherited susceptibility associated with risk factors from the prenatal and postnatal environment is likely to promote allergic sensitization and development of asthma. Consequently, early prevention of prenatal sensitization in utero and environmental control of early life exposure to various allergens may decrease the incidence of childhood asthma. In the management of moderate persistent asthma in infants and young children <5 years of age, airway resistance tests (FEV(1) or PEF) are not of significance, but assessment of respiratory rate and skin pulse oximeter measurements of arterial oxygen saturation are helpful. Moreover, recent advances in pharmacogenetics and pharmacogenomics may provide better individualized care for early pharmacological prevention of childhood asthma via selective modulation of airway remodeling.     

Otitis Media in Infancy and the Development of Asthma and Atopic Disease

Otitis media is a frequent respiratory infection of early childhood and it is important to fully understand the long-term complications and sequelae. Literature examining otitis media in early childhood and subsequent development of atopic disease is sparse despite there being vast literature on the association between respiratory infections and atopic disease. Current data support the hypothesis that otitis media infections in early life, especially frequent or severe infections, influence the developing immune system, resulting in increased risk for asthma. Recent findings have also reported an association between otitis media and eczema. Atopic children and those with a family history of atopy appear to be at greater risk. Future work should investigate the specific mechanisms involved. It is possible that vaccines and preventive strategies aimed at reducing the burden of otitis media could also reduce the burden of childhood asthma and atopic disease.     

Exposure to cat allergen,maternal history of asthma,and wheezing in first 5 years of life

We looked for an association between early exposure to pets and asthma and wheezing in children whose mothers or fathers did or did not have a history of asthma. We followed up 448 children, who had at least one parent with a history of atopy, from birth to 5 years. Among children whose mothers had no history of asthma, exposure to a cat or a Fel d 1 concentration of at least 8 microg/g at the age of 2-3 months was associated with a reduced risk of wheezing between the ages of 1 and 5 years. However, among children whose mothers did have a history of asthma, such exposures were associated with an increased risk of wheezing at or after the age of 3 years. There was no association between wheezing and exposure to dog or dog allergen, and the father's allergy status had no effect on the relation between childhood wheezing and cat exposure.     

A Review of the Effects of Breastfeeding on Respiratory Infections, Atopy, and Childhood Asthma

The etiology of childhood asthma is not fully understood. Early exposure to certain respiratory infections may be protective for atopy and/or asthma whereas some infections have been suggested to exert the opposite effects. Wheezing lower respiratory illness (LRI) in the first year of life and atopy are independently associated with increased risk for current asthma in childhood and their effects are mediated via different causal pathways. These risk factors are multiplicative when they operate concommitantly within individual children. Exclusive breastfeeding protects against asthma via effects on both these pathways, as well as through other as yet undefined mechanisms. Furthermore, exclusive breastfeeding may protect against asthma and may reduce the incidence of lower respiratory illness, especially respiratory syncytial virus (RSV). We have previously demonstrated a protective effect of exclusive breastfeeding on asthmatic traits in children. The aim of this review was to clarify this protective association from intermediate associations with respiratory infections, atopy, or through other facets of breastfeeding. The bioactivity of breast milk and subsequent pathways that may act upon the development of asthma in children are explored.     

A review of the effects of breastfeeding on respiratory infections, atopy, and childhood asthma.

The etiology of childhood asthma is not fully understood. Early exposure to certain respiratory infections may be protective for atopy and/or asthma whereas some infections have been suggested to exert the opposite effects. Wheezing lower respiratory illness (LRI) in the first year of life and atopy are independently associated with increased risk for current asthma in childhood and their effects are mediated via different causal pathways. These risk factors are multiplicative when they operate concommitantly within individual children. Exclusive breastfeeding protects against asthma via effects on both these pathways, as well as through other as yet undefined mechanisms. Furthermore, exclusive breastfeeding may protect against asthma and may reduce the incidence of lower respiratory illness, especially respiratory syncytial virus (RSV). We have previously demonstrated a protective effect of exclusive breastfeeding on asthmatic traits in children. The aim of this review was to clarify this protective association from intermediate associations with respiratory infections, atopy, or through other facets of breastfeeding. The bioactivity of breast milk and subsequent pathways that may act upon the development of asthma in children are explored.     

Does Exposure to Indoor Allergens Contribute to the Development of Asthma and Allergy?

Common indoor allergens include house dust mite, cockroach, animal dander, and certain molds. In genetically susceptible children, exposure to these indoor allergens during the critical postnatal period may lead to sensitization in early childhood. Consistent evidence indicates that children sensitized to common indoor allergens are at several-fold higher risk of asthma and allergy. Due to conflicting evidence from prospective studies, some doubt remains regarding a direct and dose–response relationship between exposure and development of asthma. However, in recent years, evidence has accumulated that exposure to indoor allergen causes asthma and allergy, but this effect may depend on dose and type of allergen as well as the underlying genetic susceptibility of the child.     

Use of Antibacterials in Infancy

Evidence from experimental studies in rodents and results from epidemiologic studies with a retrospective design suggest a possible causal association between antibacterial use in early childhood and asthma. Such an association is thought to be mediated by antibacterial-induced alterations in the intestinal flora, leading to a skewing of the immune system of young children toward an atopic phenotype. However, results from recently conducted prospective studies suggest that the previously observed association between antibacterial use in early childhood and asthma is not one of 'cause and effect' but rather that frequent antibacterial use in early childhood may be a marker of an increased risk of being diagnosed with asthma later in childhood. Although antibacterials should not be used excessively in young children, their use in early childhood is not likely to explain the increased prevalence of asthma and allergies in children in industrialized countries.     

Effects of glutathione S-transferase M1, maternal smoking during pregnancy,and environmental tobacco smoke on asthma and wheezing in children

The rise in childhood asthma prevalence suggests a role for environmental factors in the etiology of this evolving epidemic; however, genetics also influence the occurrence of asthma. Glutathione S-transferase (GST) M1 may play a role in asthma and wheezing occurrence among those exposed to tobacco smoke, as it functions in pathways involved in asthma pathogenesis such as xenobiotic metabolism and antioxidant defenses. Effects of GSTM1 genotype, maternal smoking during pregnancy, and childhood environmental tobacco smoke (ETS) exposure on asthma and wheezing were investigated in 2,950 children enrolled in 4th, 7th, and 10th grade classrooms in 12 Southern California communities. The effects of in utero exposure to maternal smoking on asthma and wheezing occurrence were largely restricted to children with GSTM1 null genotype. Among GSTM1 null children, in utero exposure was associated with increased prevalence of early onset asthma (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0-2.5), asthma with current symptoms (OR 1.7, 95% CI 1.1-2.8), persistent asthma (OR 1.6, 95% CI 1.1-2.4), lifetime history of wheezing (OR 1.8, 95% CI 1.3-2.5), wheezing with exercise (OR 2.1, 95% CI 1.3-3.3), wheezing requiring medication (OR 2.2, 95% CI 1.4-3.4), and emergency room visits in the past year (OR 3.7, 95% CI 1.9-7.3). Among children with GSTM1 (+) genotype, in utero exposure was not associated with asthma or wheezing. Our findings indicate that there are important long-term effects of in utero exposure in a genetically susceptible group of children.     

Indoor Water and Dampness and the Health Effects on Children: A Review

Exposure to dampness and mold in indoor environments has received significant attention in recent research. This review focuses on studies looking at the impact of dampness, moisture and microbial agents on children’s health. We then look more broadly at how research studies have tried to describe dampness and exposure to moisture. Papers published from 2010 onwards were reviewed and are briefly summarized. Most of the papers using dampness as a proxy for microbial exposure focused on respiratory tract infections, especially asthma. This review highlights new findings and also discusses the variety of approaches used to assess dampness in indoor environments.