支气管哮喘患儿血清TNF-α、IgE水平变化及其与MP感染的相关性分析

目的探讨支气管哮喘患儿血清TNF-α、Ig E、IL-4水平及肺功能指标变化与肺炎支原体(MP)感染的相关性,为临床治疗提供客观参考。方法选取2015年9月-2017年6月医院收治的支气管哮喘患儿94例,按照有无合并MP感染分为非MP感染组59例和MP感染组35例,另选取同期健康体检儿童41例设为对照组,分析血清TNF-α、Ig E、IL-4水平、肺功能指标(FVC、FEV1、FEV1/FVC)及痰嗜酸性粒细胞计数(EOS)、哮喘控制测试(ACT)评分变化,采用pearson相关性分析血清TNF-α、Ig E、IL-4水平与肺功能指标及痰EOS、ACT评分的相关性。结果 MP感染组患儿血清TNF-α、Ig E、IL-4水平明显高于非MP感染组,非MP感染组患儿血清TNF-α、Ig E、IL-4明显高于对照组,差异均有统计学意义(P0. 05)。MP感染组患儿用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、FEV1/FVC明显低于非MP感染组,非MP感染组患儿FVC、FEV1、FEV1/FVC明显低于对照组,差异均有统计学意义(P0. 05)。MP感染组患儿ACT评分明显低于非MP感染组,痰EOS高于非MP感染组;非MP感染组ACT评分明显低于对照组,痰EOS高于对照组,差异均有统计学意义(P0. 05)。血清TNF-α、Ig E、IL-4水平与FVC、FEV1、FEV1/FVC及ACT评分呈负相关(P0. 05),与痰EOS呈正相关(P0. 05)。结论支气管哮喘患儿血清TNF-α、Ig E、IL-4水平升高及肺功能指标下降,MP感染能够加重血清TNF-α、Ig E、IL-4升高程度,降低肺功能,临床治疗过程中需加以注意。     

支气管哮喘患者气道炎症与肺炎支原体感染的关系研究

目的探讨支气管哮喘(BA)患者气道炎症与肺炎支原体(MP)感染的相关性,为临床控制MP感染、降低BA发病率提供参考。方法选择2013年6月-2015年10月确诊为BA急性发作期150例患者,为BA急性发作期组,同期选择BA缓解期150例患者,为BA缓解期组;比较两组患者MP感染率,测定两组患者中MP阳性者和MP阴性者间的哮喘控制测试(ACT)评分、1秒用力呼吸容积占预计值百分比(FEV1/%)、痰嗜酸性粒细胞(EOS)百分比及血清总免疫球蛋白(IgE),并进行相关性分析。结果 BA急性发作期组患者MP感染64例,感染率42.67%,而BA缓解期组患者感染31例,感染率20.67%,差异有统计学意义(P0.05);两组MP阳性患者ACT评分和FEV1均明显低于MP阴性患者,痰液EOS和IgE明显高于MP阴性患者,差异均有统计学意义(P0.05);Pearson相关性分析显示,MP感染率与MP阳性患者ACT评分、FEV1呈负相关性(r=-0.768、-0.742;P=0.041、0.038),与痰液EOS、IgE呈正相关性(r=0.825、0.838;P=0.026、0.031)。结论 MP感染与BA急性发作期和缓解期的气道炎症和哮喘控制密切相关,尤其在BA急性发作期影响较大。     

血浆一氧化氮水平与支气管哮喘的相关性研究

目的：观察支气管哮喘患者血浆一氧化氮水平的变化,研究其与支气管哮喘的相关性。方法：将70例支气管哮喘患者分为哮喘缓解期组30例,轻度急性发作期组10例,中度急性发作期组12例,重度急性发作期组18例;正常对照组15例,采用硝酸还原酶法测定血浆一氧化氮水平并检测肺功能和测定诱导痰细胞的计数及分类。结果：支气管哮喘患者的血浆一氧化氮水平显著高于正常对照组（P〈0.01）,其中急性发作期组显著高于缓解期组（P〈0.01）,急性发作期组中轻度、中度、重度三者之间比较差异均有统计学意义（P〈0.01）。线性相关性分析显示,一氧化氮水平与支气管哮喘发作有相关性。研究对象所处的状态（健康、哮喘缓解期及哮喘发作期）与血浆一氧化氮水平明显相关（r=0.786,P〈0.01）。急性发作期患者血浆一氧化氮水平与FEV1.0%预计值（r=-0.872,P〈0.01）和诱导痰巨噬细胞百分比（r=-0.820,P〈0.01）呈负相关;与诱导痰细胞总数、中性粒细胞百分比及诱导痰嗜酸细胞百分比呈正相关（分别为0.857、0.816和0.825,P〈0.01）。结论：血浆一氧化氮水平升高,与支气管哮喘发生、发展相关,可能参与哮喘的发病,内源性一氧化氮作为一种无创性指标监测疾病的严重程度和活动度具有一定意义。     

哮喘控制测试评分与第1秒用力呼气容积的关系

目的 观察哮喘患者的哮喘控制测试(ACT)评分与第1秒用力呼气容积(FEV1)的相关性.方法 选择门诊确诊为支气管哮喘的患者104例,患者填写ACT表,上午进行肺功能测定,分析FEV1占预计值百分比(FEV1%pred)与ACT评分的相关性.结果 ACT评分＜20分患者与ACT评分≥20分患者FEV1%pred分别为(62.22±15.91)%和(89.85±12.28)%,差异有统计学意义(P＜0.01).FEV1%pred＜60%患者、60%≤FEV1%pred＜80%患者及FEV1%≥80%患者的ACT评分分别为(9.62±3.52)、(15.91±3.12)、(20.59±2.31)分,三者比较差异有统计学意义(F=95.657,P＜0.01).三者间两两比较,P值均＜0.05.ACT评分与FEV1%pred具有良好的相关性(r=0.820,P＜0.01).结论 ACT评分与患者的FEV1具有良好的相关性,可作为肺功能测试的补充,有助于指导哮喘患者的治疗.     

香烟烟雾对支气管哮喘患者气道炎性反应及肺功能的影响

目的 探讨香烟烟雾对支气管哮喘（简称哮喘）患者气道炎性反应及肺功能的影响。方法 哮喘香烟烟雾暴露组患者25例,哮喘非香烟烟雾暴露组患者22例,对照组20例,诱导痰检测痰液中各种炎性细胞百分比及血清中白细胞介素(IL)-8和IL-4的含量,所有入选者均测定肺功能指标第1秒用力呼气容积占预计值百分比（FEV1％预计值）、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC％)。结果 哮喘香烟烟雾暴露组患者痰液中以中性粒细胞浸润为主,而哮喘非香烟烟雾暴露组患者以嗜酸粒细胞浸润为主。哮喘香烟烟雾暴露组患者外周血血清中IL-8和IL-4水平分别为(277.02±71.37)、(171.69±31.01) ng/L,明显高于哮喘非香烟烟雾暴露组的(158.88±21.95)、(111.42±21.69)ng/L和对照组的(116.78±71.37)、(73.94±15.72) ng/L,差异均有统计学意义(P＜0.01)。哮喘香烟烟雾暴露组患者肺功能指标FEV1％预计值和FEV1/FVC％分别为(51.12±13.30)％、(49.16±11.09)％,均低于对照组的(95.50±10.11)％、(83.18±6.04)％和哮喘非香烟烟雾暴露组的(81.81±5.82)％、(79.00±3.86)％,差异均有统计学意义(P＜0.01)。血清中IL-8水平与痰液中中性粒细胞百分比呈正相关(r=0.742,P＜ 0.01),与FEV1％预计值呈负相关(r=-0.739,P＜0.01)。结论 香烟烟雾可能通过促进哮喘患者中性粒细胞趋化因子I_8的产生而影响气道炎性反应,加速其肺功能的受损。     

诱导痰白细胞介素-4及尿白三烯E4与儿童哮喘发作严重程度的关系

目的 观察哮喘急性发作期患儿诱导痰白细胞介素(IL)-4及尿白三烯E4(LTE4)变化及其与哮喘发作期病情分度的关系,探讨其在哮喘发病机制中的作用和临床诊治中的意义.方法 选取82例哮喘急性发作期患儿和30例健康儿童,采用超声雾化0.9%NaCl溶液诱导痰液,入院24h留尿标本.以ELISA法测定IL-4的水平,同时测定诱导痰中嗜酸粒细胞(EOS)计数,测定肺功能指标第1秒用力呼气比值(FEV1%).以ELISA法测定哮喘患儿尿LTE4水平.结果 哮喘急性发作期患儿诱导痰中IL-4、EOS计数、尿LTE4均高于健康儿童[分别为(111.00±180.30)ng/L比(4.78±1.98)ng/L、0.30±0.17比0.07±0.05、(28.20±5.72)pmol/μmol比(1.21±0.02)pmol/μmol],FEV1%则低于健康儿童[(50.96±24.77)%比(119.80±14.19)%],差异均有统计学意义(P<0.01),且痰液中IL-4及尿LTE4与EOS计数呈正相关(r=0.482、0.437,P<0.01),与FEV1%呈负相关r=-0.647、-0.689,P<0.01).结论 测定诱导痰IL-4及尿LTE4可能较EOS计数更能准确反映哮喘患儿气道炎性反应及哮喘发作时病情程度,可作为临床评价哮喘病情及药物疗效的准确灵敏指标.     

哮喘患儿体内EOS、IgE、IL-4及IFN-γ水平的检测及临床意义

目的：探讨哮喘患儿体内嗜酸性粒细胞(eosinophil,EOS)、免疫球蛋白E(IgE)、白介素4(IL-4)及γ干扰素(IFN-γ)水平的检测及临床意义,为临床疾病的诊断和治疗提供依据。方法抽选湖北省鄂州市鄂钢医院2012年11月至2013年6月收治的95例哮喘患儿(哮喘组,其中急性发作期47例、缓解期48例),并抽选同期在本院体检的79例健康患者为对照研究(健康组),采用肺功能仪测定两组的肺功能,并采用痰液诱导、酶联免疫吸附法( ELISA)分别测定患儿痰液中的EOS百分率及血清中IgE、IL-4、IFN-γ水平。结果哮喘组患儿的1秒用力呼气容积(FEV1)/用力肺活量(FVC)的比值(FEV1%)为(69.67±6.63)%,明显低于健康组的(102.27±11.93)%,差异具有统计学意义(t=22.750,P<0.001);哮喘组患儿的FEV1占预计值百分比为(70.45±9.62),明显低于健康组的(90.13±6.34),差异有统计学意义(t=15.582,P<0.001)。哮喘组患儿的痰EOS百分率、血清中IgE、IL-4水平均高于健康组(t值分别为321.962、82.644、76.913,均P<0.05),哮喘组患儿的IFN-γ水平明显低于健康组(t=30.207,P<0.001)。急性发作期哮喘患儿的痰EOS百分率及血清中IgE、IL-4水平均高于缓解期哮喘患儿的(t值分别为15.752、40.762、31.162,均P<0.05),急性发作期哮喘患儿的IFN-γ水平明显低于缓解期哮喘患儿的(t=35.892,P<0.05)。结论血清中IL-4、IgE水平及痰液中EOS百分率升高、血清IFN-γ水平降低,与哮喘的发生、发展密切相关,对其治疗及病情判断具有重要价值。     

支气管哮喘患者诱导痰和血清C反应蛋白临床意义及相关性的研究

目的：观察血清及诱导痰C反应蛋白（CRP）是否可以作为支气管哮喘急性发作期病情判断的敏感指标。方法：检测本科收治的30例支气管哮喘急性发作期患者（治疗组）治疗前及治疗后同期血清和诱导痰中CRP的浓度,同时检测30例健康体检者（对照组）的血清CRP浓度,并进行比较分析。结果：治疗组治疗前的血清CRP、诱导痰CRP均明显高于治疗后及对照组,且治疗后的血清CRP明显高于对照组,差异均有统计学意义（P〈0.05）。治疗组治疗前、后的血CRP和诱导痰CRP均存在显著正相关性（r=0.907、0.743, P〈0.01）。结论：血清及诱导痰CRP可作为一种动态监测气道炎症以及评估支气管哮喘患者疾病严重程度的实用及无创的检测方法。     

支气管哮喘患者诱导痰嗜酸性粒细胞计数、呼出气一氧化氮浓度和肺功能的关系

目的探讨支气管哮喘患者诱导痰嗜酸性粒细胞(EOS)计数、呼出气一氧化氮(NO)浓度以及肺功能的关系。方法收集轻-中度非急性发作期支气管哮喘患者40例和健康志愿者20例,分别设为观察组和对照组,比较两组的诱导痰EOS计数、FEV1及呼出气NO浓度。结果治疗前,观察组的诱导痰EOS计数、呼出气NO浓度、FEV1与对照组比较差异显著(P<0.05)。治疗9、12个月后,观察组的诱导痰EOS计数、呼出气NO浓度与FEV1与对照组比较,差异均无统计学意义(P>0.05)。支气管哮喘患者的EOS计数与呼出气NO浓度呈正相关,FEV1与呼出气NO浓度呈负相关(P<0.05)。结论诱导痰EOS计数和呼出气一氧化氮浓度监测可评价支气管哮喘患者的气道炎症水平,反映肺功能改善情况,为疗效及预后评估提供可靠依据。     

进展性脑梗死L选择素及P选择素的研究

目的 观察哮喘急性发作期患儿诱导痰白细胞介素(IL)-4及尿白三烯E4(LTE4)变化及其与哮喘发作期病情分度的关系,探讨其在哮喘发病机制中的作用和临床诊治中的意义.方法 选取82例哮喘急性发作期患儿和30例健康儿童,采用超声雾化0.9%NaCl溶液诱导痰液,入院24h留尿标本.以ELISA法测定IL-4的水平,同时测定诱导痰中嗜酸粒细胞(EOS)计数,测定肺功能指标第1秒用力呼气比值(FEV1%).以ELISA法测定哮喘患儿尿LTE4水平.结果 哮喘急性发作期患儿诱导痰中IL-4、EOS计数、尿LTE4均高于健康儿童[分别为(111.00±180.30)ng/L比(4.78±1.98)ng/L、0.30±0.17比0.07±0.05、(28.20±5.72)pmol/μmol比(1.21±0.02)pmol/μmol],FEV1%则低于健康儿童[(50.96±24.77)%比(119.80±14.19)%],差异均有统计学意义(P<0.01),且痰液中IL-4及尿LTE4与EOS计数呈正相关(r=0.482、0.437,P<0.01),与FEV1%呈负相关r=-0.647、-0.689,P<0.01).结论 测定诱导痰IL-4及尿LTE4可能较EOS计数更能准确反映哮喘患儿气道炎性反应及哮喘发作时病情程度,可作为临床评价哮喘病情及药物疗效的准确灵敏指标.     

Validation of the asthma impact survey,a brief asthma-specific quality of life tool

Background The Asthma Impact Survey (AIS-6) is a new six question asthma outcome tool for which information on validity has not been published. Objective To provide validation for the AIS-6 as a brief asthma-specific quality of life tool. Methods Surveys were sent to a random sample of members of a large managed care organization who were at least 35 years of age and in the two-year period preceding the survey had either (1) at least one documented asthma-related medical encounter, or (2) at least a 6 months supply of asthma medication dispensed. In addition to the AIS-6, the survey included a validated quality of life tool [the mini-Asthma Quality of Life Questionnaire (AQLQ)]; a validated asthma control questionnaire [the Asthma Therapy Assessment Questionnaire^TM (ATAQ)]; a validated symptom severity scale (AOMS); and information regarding demographics, co-morbidities, asthma severity, and asthma management. The results of the AIS-6 were compared to the results of the other tools by means of correlation and factor analysis. Independent predictors of AIS-6 and AQLQ scores were determined by multiple stepwise linear regression analyses. Results AIS-6 scores were significantly related to female sex, educational level, income, smoking, body mass index (BMI), COPD, steroid use, and hospitalization history in bivariate analyses. The AIS-6 score significantly correlated (r = − 0.84, p < 0.0001) with the AQLQ total score and loaded on the three factors (activity, symptoms, and concern/bother) reflected by the survey information and on which the AQLQ also loaded. Significant but somewhat smaller correlations were found between the AIS-6 and the ATAQ (r = 0.70, p < 0.0001) and the AOMS (r = 0.55, p < 0.0001). Independent predictors were the same for the AIS-6 and AQLQ and included oral steroid use, COPD history, BMI, female sex, educational level, and hospitalization in the past year. Conclusion These data support the validity of the short six-question AIS-6 as an asthma-specific quality of life tool.     

哮喘控制测试在哮喘管理中的应用

目的调查哮喘的控制现状，评价哮喘控制测试（ACT）在哮喘管理中的应用。方法随机抽取呼吸科门诊和首次参加“哮喘之家”的哮喘患者共100例，采用问卷调查的方式收集哮喘患者发病的病情信息，同时进行ACT。结果调查的哮喘患者以老年和老年前期患者居多（62％）；病程长[（13±7）年]；合并症多；行肺功能检查者少（36％）；治疗不规范，长期持续吸人糖皮质激素者少（9％）。ACT平均分为（15±6）分，仅6％的患者达到了完全控制和良好控制。结论哮喘控制现状不容乐观，哮喘的教育和管理有待加强。ACT是一种简便有效的评估哮喘控制的方法，也是一项用以改善哮喘管理质量的新工具，值得推广应用。     

Changes in the health burden of a national sample of children with asthma

This paper focused on the extent to which factors that are modifiable by health policies or provider recommendations influenced the level and changes in the burden of childhood asthma. Demographic factors, access to health care services, and asthma control activities were posited to potentially influence the level and changes in health burden of children with asthma. The Medical Expenditure Panel Survey data from 1996–1999 on 3–11 year old U.S. children with asthma (N = 784) were used. The findings of multilevel models of perceived burden indicated unfavorable trajectories among those families who had public health insurance. Asthma control activities were associated with favorable trajectories of both perceived and objectively measured burden. These findings emphasized the significance of asthma control and access to high quality and stable health care services as health policy targets.     

Measures of asthma control and quality of life: longitudinal data provide practical insights into their relative usefulness in different research contexts

Purpose  To further our understanding of the relationships between asthma control and health-related quality of life (HRQOL) and provide insights into the relative usefulness of various measures in different research contexts. We present a conceptual model and test it with longitudinal survey data. Methods  Participants recruited via population sampling and hospital Emergency Departments completed questionnaires every 6 months for up to 3 years. Measures included: sleep disturbance, use of short-acting beta agonists (SABA), activity limitation, urgent medical visits, hospital use, Marks’ Asthma Quality of Life Questionnaire (AQLQ-M) and the SF-36 Health Survey. Correlation analysis and multi-level models tested predictions from the conceptual model. Results  A total of 213 people with asthma aged 16–75 years provided 967 observations. Correlations between asthma control and asthma-specific HRQOL were stronger than those between asthma control and generic HRQOL. The asthma control variables explained 54–58% of the variance in asthma-specific HRQOL and 8–25% of the variance in generic HRQOL. Activity limitation was the main contributor to between-person variation, while sleep disturbance and SABA use were the main contributors to within-person variation. Conclusions  Sleep disturbance and SABA use may be most useful in evaluating treatment effectiveness, while activity limitation may be better when monitoring the impact of asthma in populations.     

Asthma: An Annotated Guide to Resources on the World Wide Web

ABSTRACT

An increasing number of children and adults are diagnosed with asthma. Current, accurate sources of information are needed to help both patients and physicians manage treatments. This article includes some background information on asthma and a list of selected Internet resources for both health care professionals as well as consumers.     

支气管哮喘与结核菌素反应的研究

目的：研究支气管哮喘与结核菌素反应之间的关系。方法：用ELISA法测定受试者,IgE、IFN-γ浓度，然后再与相对应的结核菌素反应结果比较。结果：（1）支气管哮喘患者结核菌素反应多为阴性，而结核病患者多为阳性且常为强阳性。（2）结核菌素反应阳性者血清IgE浓度明显低于阴性者，但血清IFN-γ浓度高于阴性者。结论：支气管哮喘病人Th1细胞免疫功能低下，而其Th2细胞免疫功能增强。     

哮喘儿童行为问题的预防

本文阐述了哮喘对患儿和家庭可能产生的不良作用如身体不适、睡眠差、焦虑、学习问题、受约束和家庭功能紊乱等,这些不良的作用可造成儿童不良的行为,如精力差、兴趣减少、自尊心低下、过分依赖、孤独、忧郁等。预防措施包括控制哮喘的症状,向家庭说明疾病的过程和家庭咨询,并提及识别哮喘患儿有关的社会心理因素。     

气道高反应性对青少年支气管哮喘的影响

目的：探讨气道高反应性在青少年哮喘发病过程中的作用。方法：利用遗传流行病学的方法,收集了支气管哮喘核心家系的资料,对家系中每一成员测定其气道反应性。结果：气道高反应性的亲属患哮喘的危险性明显增加,是没有气道高反应性亲属的8．10倍（P＜0．01）;其中气道高反应性的双亲和子女患哮喘的危险性分别增加7．10倍和4．59倍,有高度显著性意义;即使调整了遗传因素可能的混杂作用,气道高反应性子女患哮喘的危险性仍较无气道高反应性子女增加2．96倍（P＜0．01）。结论：气道高反应性不仅是支气管哮喘的重要特征,而且可能是支气管哮喘的重要危险因素。     

Impacto de la administración del cuestionario Asthma Control Test en atención primaria sobre la puntuación de control del asma

ObjectiveTo compare the score indicative of asthma control obtained using the Asthma Control Test (ACT^®) questionnaire administered by primary health care physicians, habitual users of the questionnaire, and those were not.DesignA multicentre, prospective, epidemiological study.SettingPrimary health care centres in Spain.ParticipantsTwo study populations were defined: «ACT^® users» and «non-ACT^® users», according to the use of the ACT^® questionnaire by their respective primary health care physicians.Main measurementsThe patients completed the ACT^® questionnaire during a baseline visit, and in another follow-up visit at 8 weeks. The primary outcome was the percentage of patients with an ACT^® score ≥ 20. The change in the ACT^® score was analysed if there was a change in treatment.ResultsThere was a higher percentage of patients with well-controlled asthma in the ACT^® users group after 8 weeks (68.5% vs. 55.6%; P=.01). A significant increase in the ACT^® score was observed in the follow-up visit compared to the baseline visit, when there was a change in treatment in both groups (2.5 and 3.8 points, ACT^® users and non-ACT^®-users, respectively, P=.001 and P<.0001).ConclusionsThe administering of the ACT^® questionnaire improved the score indicative of asthma control in both populations of the study, with a higher score being obtained in those patients attended by physicians with previous experience in the use of ACT^®. The administering of the ACT^® questionnaire could contribute to improving the long-term outcome of the patient, and favouring the appropriateness of the treatment.     

威布尔回归分析在哮喘患者中的应用

目的 分析哮喘患者季节史、发作频度和发作严重度、控制治疗情况等因素与病程长短的关系,以发现其密切相关的影响因素.方法 利用SAS6.12软件对87例哮喘患者基本资料进行威布尔回归模型拟合并作假设检验.结果 通过参数估计,得出x5哮喘患者发作频度,x6哮喘患者急性发作严重度,x7哮喘患者控制治疗情况与哮喘患者病程长短有关系,且其回归系数B5,B6,B7的估计值有统计学意义(P＜0.05),形态参数γ=0.3391,其标准误为0.0364.据此可得出Weibull回归下哮喘病人的死亡风险函数,生存函数及概率密度函数为:h(y)=0.3391y-0.6609exp(1.9559-0.2501x5-0.4899x6 0.4618x7),s(Y)=exp(-Y0.3391exp(1.9559-0.2501x5-0.4899x6 0.4618x7)),f(Y)=h(Y)s(Y).结论 Weibull回归模型不仅可用于定量评价病人生存情况及其因素间的关系,而且还可用于预测预报病人的预后情况.