儿童支气管哮喘的防治现状

支气管哮喘（以下简称哮喘）是呼吸系统常见、多发病,目前是国际上最常见的慢性呼吸道炎症疾病之一,儿童发病率呈逐年上升趋势,我国对儿童哮喘发病率进行调查后发现,1990年患病率为0．91％,2000年患病率为1．5％^[1],     

卡介苗及卡介苗制剂在支气管哮喘防治中的研究现状

卡介苗及卡介苗制剂用于支气管哮喘防治的研究已有十余年的历史。医学界普遍认为卡介苗及卡介苗制剂对支气管哮喘的防治有一定疗效。引起了制剂对支气管哮喘的防治研究热潮。但卡介苗及卡介苗制剂对支气管哮喘的防治到底有无价值,本文就此方面的有关研究进行简述。     

支气管哮喘防治的新起点——写在中国哮喘联盟成立2周年之际

作为全国支气管哮喘（简称哮喘）防治机构——中国哮喘联盟（China Asthma Alliance，CAA）于2005年6月4日成立。哮喘联盟的成立标志着我国哮喘防治工作又向前迈进了一步。     

积极推广我国新版支气管哮喘防治指南

支气管哮喘(简称哮喘)是常见的慢性呼吸道疾病之一.据估计,我国目前至少有2000万左右的哮喘患者.随着人们生活水平的提高,哮喘的发病率逐年增加,哮喘已成为严重的公共卫生问题.大量的临床研究表明,规范化的诊断和治疗,特别是长期管理对提高哮喘的控制水平,改善哮喘患者生活质量有重要作用.1994年美国国立卫生院心肺血液研究所与世界卫生组织共同发起,组织了17个国家的30多名哮喘专家首次制定了全球哮喘防治创议(global initial for asthma, GINA),于1995年发表,以后在1998年、2002年和2006年分别对GINA作了修订.GINA文件对世界各国的哮喘防治工作起到了非常积极的作用.     

我国支气管哮喘防治研究重点及努力方向

在我国支气管哮喘（简称哮喘）是严重影响人们（特别是儿童和青少年）健康的常见病。据粗略统计，我国约有1500万～2000万人罹患哮喘。近几年来哮喘患病率有增加的趋势，如一项全国儿童（0～14岁）哮喘患病率的流行病学调查（简称流调）显示，从1990至2000年哮喘患病率由1．00％增加到1．97％。     

从新的医学模式探讨支气管哮喘的发病与防治

1977年美国罗彻斯特大学精神病和心身医学教授G．L．Engel在《需要新的医学模式：对生物医学的挑战）一文中提出现代生物医学逐渐演变为生物。心理、社会医学是医学发展的必然，应当建立生物心理社会医学模式，至今已近20年。1980年《医学与哲学》杂志率先介绍了G．L．Eopl的文章。此后国内医学界曾就医学模式的转变进行了广泛、深人的讨论，后来又将医学模式的转变写人了教科书。从表面上看，心理、社会因素在疾病的发生、发展、转归中的作用已为人们所承认。以生物心理社会医学模式取代生物医学模式的观点早已为人们熟悉和普遍接受，似…     

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。     

Atherosclerosis: Current Status of Prevention and Treatment

The reality of regression of atherosclerotic plaques was established as long ago as 1987 by aggressive cholesterol reduction even before the era of statin therapy. Nevertheless, the most important aspect of patient benefit to prevent cardiovascular (CV) disease events is stabilization of these plaques so they will not rupture. Lowering of low-density lipoproteins is critical to this goal and can be considered the gold standard of preventive CV medicine. The major goal for the high-risk patient and the diabetic patient is lowering these harmful lipoproteins to less than 70 mg/dL. No discussion of CV disease prevention is complete without considering tobacco abuse and its elimination. Even secondhand smoke has been established as harmful. Control of hypertension is another major aspect of CV disease prevention, and a blood pressure less than 120/80 mm Hg is ideal. With obesity a major problem in the developed world, its role in the metabolic syndrome is of major significance as is the high prevalence of this so-called syndrome versus collection of specific risk factors in a population with poor health habits. Control of diabetes mellitus has established benefit from the standpoint of CV disease prevention except that some problems have been reported with extremely tight blood sugar control. Exercise was long considered good but now there are evidence-based reasons to recommend it as essential in CV disease prevention. There are many unforeseen frontiers in CV disease prevention but, for now, everything points to elevation of high-density lipoproteins as the next focus of this prevention.     

支气管哮喘的规范化诊断与治疗

支气管哮喘（简称哮喘）是一个世界性问题,儿童和成人哮喘患病率分别约为3．3％～29％和1．2％～5．5％,且呈逐年增长趋势,全球约1．6亿患者。其疗程长,患者对治疗的依从性差。支气管哮喘的规范化诊治是提高哮喘控制水平的保证。     

心力衰竭的社区防治现状及进展

心力衰竭是常见病,有很高的患病率和逐年增加的发病率、致死率和致残率,消耗了大量的医疗卫生资源。现就心力衰竭的病因、危险因素、早期识别和有效管理作一综述。     

Chronic Pancreatitis: Current Status and Challenges for Prevention and Treatment

This paper reviews the current status of our understanding of the epidemiology, diagnosis, and management of the continuum of pancreatic diseases from acute and recurrent acute pancreatitis to chronic pancreatitis and the diseases that are often linked with pancreatitis including diabetes mellitus and pancreatic cancer. In addition to reviewing the current state of the field, we identify gaps in knowledge that are necessary to address to improve patient outcomes in these conditions.     

乙型肝炎的流行病学和防治现状

乙型病毒性肝炎目前仍是全球急、慢性肝病的主要原因。据估计[1],全球有3～3.5亿人感染乙型肝炎病毒（HBV）,每年约有100万人死于乙型肝炎     

自发性细菌性腹膜炎的治疗、预防和预后的现状

大约有50%的自发性细菌性腹膜炎(spontaneous bacte-rial peritonitis,SBP)患者在入院时已有腹水感染。因腹水而住院的肝硬化患者约有8%~30%发生SBP。因此,肝硬化腹水患者在入院初即应作腹腔诊断性穿刺,其目的有二:一是判定有无SBP,二是作为治疗效果的参照。活动性感染的治疗[1     

Effectiveness and Safety of Bronchial Thermoplasty in the Treatment of Severe Asthma

Journal. American J Respir Crit Care Medicine 2010; 181:116–124. Rationale. The treatment of severe asthma has been expanded with the introduction of a recent bronchoscopic procedure entitled bronchial thermoplasty in which controlled heat energy is impacted on the airway wall to produce a decline in smooth muscle. The objectives of the authors was to assess the effectiveness and safety of bronchial thermoplasty versus a sham protocol in individuals with severe asthma who continue to be symptomatic despite conventional therapy with high dose inhaled corticosteroids and long-acting beta agonists. Methods. A total of 288 adult with severe asthma using an intent to treat analysis were randomized to bronchial thermoplasty or sham control. Each subject was evaluated with three bronchoscopic procedures. The primary outcome was the difference in asthma quality-of-life questionnaire scores from baseline to average of 6, 9 and 12 months (integrated AQLQ). Adverse events and health care utilization were determined to evaluate safety. Statistical design and analysis of the primary endpoint was Bayesian. The target posterior probability of superiority of bronchial thermoplasty over sham was 95% except for the primary endpoint (96.4%). Results and outcomes. The amelioration from baseline in the integrated AQLQ score was superior in the bronchial thermoplastic group when compared with sham (bronchial thermoplasty 1.35 plus or ?1.10; sham 1.16 plus or ?1.23)(PPS, 96% intention to treat and 97.9% per protocol). 79% of the bronchial thermoplasty and 64% of sham subjects developed changes in the AQLQ of 0.5 or greater (PPS, 99.6%). Six percent more of bronchial thermoplasty individuals were hospitalized in the treatment period up to six weeks after bronchial thermoplasty. In the post therapy period, which was 6 to 52 weeks after bronchial thermoplasty, the bronchial thermoplasty group experienced fewer severe exacerbations, ER visits and absence from work or school when compared with the sham group (PPS 95.5, and 99.9 and 99.3% respectively). Conclusions of the authors. Bronchial thermoplasty in individuals with severe asthma ameliorates asthma specific quality of life with a decline in severe exacerbations, in health care utilization in the post treatment period. Reviewer's comments. The strengths of the study were the relatively large number of subjects as well as the multicenter, randomized, double blind with sham study design. The findings of the study hold that bronchial thermoplasty provides clinically significant amelioration of severe exacerbations requiring corticosteroids, ED visits and time lost from work and school during the post treatment therapy in individuals with severe asthma or those with inadequately controlled asthma, together with an improvement in quality of life. The authors conclude that increased risk of adverse events in the short-term after bronchial thermoplastic is outweighed by the benefits of bronchial thermoplastic that continues for at least one year. Bronchial thermoplasty provides a novel supplementary procedure that provides additional therapy beyond conventional utilization of high-dose inhaled steroids and long-acting beta agonist to decrease the morbidity from severe asthma. Further large prospective studies randomized with sham are needed to confirm the author's findings. An associated editorial in the same issue indicates that long-term clinical morphologic research in various severe asthma phenotypes is still needed to obtain required information for clinical decisions regarding this procedure.