呼吸道合胞病毒感染后婴幼儿喘息患者血清leptin水平的变化

目的 通过测量呼吸道合胞病毒肺炎儿童患者瘦素(leptin)的水平,探讨瘦素与呼吸道合胞病毒感染后婴幼儿喘息间的相互关系.方法 43例呼吸道合胞病毒感染后婴幼儿分别于入院后24h内、治疗结束及出院后12周用放射免疫法检测血清leptin水平,并随访2年.根据患儿喘息发作的情况,分为婴儿哮喘组和非哮喘组;另选10名健康儿童血清标本作对照.结果 BSV感染后喘息发作≥3次的婴幼儿患儿,占41.9%.治疗前,哮喘组和非哮喘组血清leptin水平均高于对照组,差异有统计学意义(t=3.41、2.64,P<0.05).治疗后,哮喘组血清leptin水平高于非哮喘组和对照组,差异有统计学意义(t=5.74、6.23,P<0.05).出院12周后复查,哮喘组血清leptin水平仍高于非哮喘组和对照组,差异有统计学意义(t=6.32、6.11,P<0.05);而非哮喘组血清leptin水平和对照组比较,差异无统计学意义(t=0.81,P>0.05).结论 呼吸道合胞病毒感染后喘息发作≥3次的婴幼儿血清leptin水平较健康同龄儿童及非哮喘儿童明显升高,持续高leptin水平可能是BSV感染后婴儿哮喘的高危因素之一.     

支气管哮喘与急性呼吸道感染患儿血浆β防御素3水平的对照研究

目的β防御素3(HBD3)除了具有天然免疫功能,还发挥调节后天适应性免疫的作用。本研究拟通过支气管哮喘患儿、急性上呼吸道感染患儿及正常儿血浆HBD3浓度的比较,探讨HBD3在哮喘发病中的作用。方法研究对象选择2009年4月到12月在哈尔滨医科大学附属第一医院儿科就诊病例共81例,其中哮喘组21例,为急性发作期支气管哮喘患儿,感染组29例,为急性上呼吸道感染患儿,正常对照组31例,为健康体检儿。采用酶联免疫吸附试验(ELISA)法进行血浆HBD3水平测定。同时测定血嗜酸性粒细胞总数和白细胞数,9例哮喘儿测定了血清IgE浓度。结果血浆HBD3浓度正常儿为(8.028±1.078)μg/ml,哮喘患儿(12.212±1.124)μg/ml感染患儿(8.976±1.110)μg/ml,哮喘患儿与急性呼吸道感染及正常儿3组总体比较,血浆HBD3浓度明显升高,差异有显著性(F=4.448,P<0.05);哮喘组与正常组比较,差异显著,P<0.01;哮喘组与感染组比较,差异有显著性P<0.05;感染组与正常组比较,差异无显著性P>0.05;同时发现血浆HBD3水平与血清总IgE,血嗜酸性粒细胞及白细胞水平无显著相关性。结论支气管哮喘发作时HBD3表达升高,HBD3可能是超越感染之外,参与哮喘发病的独立因素。HBD3是否始动因素尚待进一步探索。     

支气管哮喘患儿治疗前后血清GM-CSF、CGRP检测的临床意义

目的:探讨了支气管哮喘患儿血清巨噬细胞集落刺激因子(GM-CSF)和降钙素基因相关肽(CGRP)水平的变化及意义.方法:应用放射免疫分析对33例支气管哮喘患儿进行了血清GM-CSF和CGRP测定,并与35名正常健康儿作比较.结果:支气管哮喘患儿在治疗前血清GM-CSF水平非常显著地高于正常儿组(P＜0.01),血清CGRP水平则显著地低于正常儿组(P＜0.01),经治疗3个月后则与正常儿组比较无显著性差异(P＞0.05).结论:血清GM-CSF水平的升高和CGRP水平的降低是支气管哮喘患儿发病的病理因素之一,有重要临床价值.     

支气管哮喘与免疫

支气管哮喘已成为严重威胁人类健康的一种主要的疾病.全世界支气管哮喘患者有一亿人,我国的患者达一千万人,哮喘发病率为2.5%-9.0%,居于老年期疾病发病率的第二位.支气管哮喘患者多在夜间或凌晨发作,并有气短、胸闷和咳嗽等症状.因气道对多种刺激因子反应性增高,哮喘可反复发作,出现喘息和呼吸困难,甚至发生哮喘持续状态.     

哮喘与慢支患者血浆和肺泡灌洗液中TXB2与6-K-PGF1α测定的临床意义

观察TXB2(血栓素B2)、6-K-PGF1α(6-酮-前列腺素F1α)在支气管哮喘、慢支喘息型和慢支单纯型患者体内的变化. 对照组30名, 支气管哮喘组30例,慢支喘息型组30例, 慢支单纯型组30例, 均用RIA法测定血浆和BALF(支气管肺泡灌洗液)中的TXB2、6-K-PGF1α.三组患者血浆和BALF中的TXB2、6-K-PGF1α均增高, 其中支气管哮喘组增高最为显著, 与慢支两组比较有显著意义(P＜0.01);慢支喘息型组BALF中的增高较单纯型组明显(P＜0.05).TXB2、6-K-PGF1α在支气管哮喘中起重要作用, 在慢支喘息型中也有明显作用. BALF中的TXB2、6-K-PGF1α两项指标的变化对区别慢支喘息型和单纯型提供一定的参考依据.     

儿童支气管哮喘反复喘息发作的相关性危险因素分析

目的：就儿童支气管哮喘反复喘息发作的相关性危险因素进行分析。方法选择我院2012年11月~2013年1月所收治的支气管哮喘患儿45例为观察组,同时,选择本院同期健康体检结果显示为正常的小儿45例为对照组,使用自行设计的诱发儿童哮喘高危因素统一调查问卷表来对两组儿童的家长进行面对面地仔细询问及调查。结果单因素Logistic回归分析结果显示差异有意义(<0.05)的因素有11个院剧烈运动、呼吸道感染、气候变化、情绪压抑、哮喘史、家族过敏史、儿童有特应性体质、常接触泡沫制品、甜食习惯、父母吸烟史、海产品摄入。多因素Logistic回归分析,最后能进入主效应模型的因素有6个因素,分别是剧烈运动、呼吸道感染、气候变化、情绪压抑、哮喘史、家族过敏史。结论儿童支气管哮喘反复喘息发作与多种相关性危险因素密切相关,对这些危险因素进行研究,能够有效地治愈患儿。     

内皮素－1在支气管哮喘发病机制中的作用

本文应用特异性放射免疫分析法测定了２０名健康儿童及４３例支气管哮喘患儿血浆内皮素－１（ＥＴ－１）水平，用过敏性哮喘豚鼠进行验证。结果显示：轻中度哮喘患儿血浆ＥＴ－１与健康儿童组比较差异无显著性，而重症哮喘患儿血浆ＥＴ－１则明显增高，与健康对照组比较差异显著（Ｐ＜０．００１）；过敏性哮喘豚鼠血浆ＥＴ－１水平无明显变化，而其支气管肺泡灌洗液中却明显升高，与正常对照组有非常显著的差异（Ｐ＜０．０１），糖皮质激素及ＥＴ－１抗血清可降低ＥＴ－１水平，减轻哮喘发作。提示ＥＴ－１参与了支气管哮喘的发病机制，糖皮质激素和ＥＴ－１抗血清具有治疗作用     

支气管哮喘药物治疗进展

支气管哮喘是有多种细胞(如嗜酸性粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、气道上皮细胞等)和细胞组分参与的气道慢性炎症性疾病.通常出现广泛多变的可逆性气流受限,并引起反复发作的喘息、气急、胸闷和咳嗽等症状,常在夜间和(或)清晨发作、加剧,多数患者可自行缓解或经治疗缓解.不正确的治疗可导致哮喘的反复发作.     

哮喘儿童支气管肺泡灌洗液IL-17、 IL-8和VEGF水平测定及意义

目的: Th17细胞是以分泌IL-17为主的新型T细胞亚群,其在哮喘中的作用尚不十分清楚。本文通过观察哮喘急性发作儿童支气管肺泡灌洗液(BALF)IL-17、IL-8、血管内皮生长因子(VEGF)等的水平变化,探讨其在哮喘急性发作儿童气道炎症中的作用。方法: 我院2009年2月-2009年12月期间行纤维支气管镜检查患儿共88例,包括哮喘急性发作组(哮喘组,n=52)、非喘息组(肺炎组,n=25)及对照组(n=11),收集所有病例的BALF,进行细胞学分类,ELISA法测定BALF中细胞因子IL-17、IL-8、VEGF、IL-4、IFN-γ和IL- 4/IFN-γ水平。结果: 与对照组比较,哮喘组和肺炎组患儿的IL-17和IL-8水平均明显增高(均P<0.05);哮喘组患儿的IL-8水平较肺炎组低(P<0.05),而2组IL-17水平无显著差异(P>0.05);与肺炎组和对照组比较,哮喘组患儿VEGF水平明显增高(均P<0.01);肺炎组与对照组患儿VEGF水平无显著差异(P>0.05);3组患儿的IL-4,IFN-γ和IL-4/IFN-γ水平均无显著差异(均P>0.05)。与对照组比较,哮喘组及肺炎组患儿中性粒细胞百分比明显增高(均P<0.01),而哮喘组与肺炎组患儿的中性粒细胞百分比无显著差异(P> 0.05)。结论: IL-17、IL-8及VEGF在哮喘儿童气道炎症中发挥重要作用,Th17细胞可能参与儿童哮喘急性发作的发病机制。     

血清肌酸激酶在支气管哮喘急性发作中的临床意义

目的探讨血清肌酸激酶(CK)活性测定在支气管哮喘(简称哮喘)急性发作中的临床意义。方法测定82例哮喘急性发作患者和30例健康体检者的CK、CK-MB,同步测定哮喘急性发作患者最大呼气流量占正常预计值的百分比(PEF%)。结果①哮喘重度急性发作组患者CK活性与哮喘轻、中度发作组、正常对照组比较差异均具有显著性(P<0.001);②哮喘轻、中度发作组CK活性与对照组比较差异均无显著性(P>0.05);③哮喘急性发作患者CK活性与PEF%间呈显著负相关(r=-0.589,P<0.001);④哮喘重度发作组患者CK-MB活性显著高于对照组(P<0.001)但CK-MB均只占同步测定的CK活性的6%以内,而CK-MB活性与CK活性呈正相关(r=0.745,P<0.001)。结论CK不仅可用于哮喘急性发作患者病情的判断而且可与心肌损伤鉴别。     

Assessment of serum myeloperoxidase in children with bronchial asthma

BACKGROUND: The role of neutrophils and myeloperoxidase (MPO) - assumed to be a marker of neutrophil activation - in bronchial asthma is still unclear, and the literature is controversial. METHODS: To investigate the participation of neutrophils and their products in childhood asthma, we assessed neutrophil counts and serum MPO in 175 children with bronchial asthma. Ninety of them were asymptomatic, and 85 of them were symptomatic within the last 2 weeks before examination. Bacterial infection of the lower respiratory tract (LRTI) was present in 34 and viral infection in 49 patients. As controls, 45 patients with cystic fibrosis, 23 patients with bacterial LRTI, and 87 healthy children were recruited. RESULTS: Median neutrophil counts (3135 cells/microl) and serum MPO levels (352 microg/l) were not different in children with bronchial asthma from healthy controls (2220 cells/microl and 401 microg/l, respectively), whereas in patients with cystic fibrosis and bacterial LRTI, neutrophil counts and MPO levels were increased. Asthmatic children with bacterial infection had significantly higher serum MPO and neutrophil counts then asthmatic children with viral infection or without infection. In addition, a significant correlation was found between serum MPO and neutrophil counts and C-reactive protein (CRP), and between neutrophil counts and CRP, but no relationship was detected for serum MPO and disease activity or lung function. CONCLUSIONS: Our data indicate that serum MPO - a marker of neutrophil activation - does not contribute to the assessment of the inflammatory process in childhood asthma. In addition, measurement of serum MPO appears not to be useful in assessing the participation of the neutrophil in asthmatic children. However, assessment of MPO may be useful to distinguish between bacterial and viral infection.     

儿童血清特异性IgE水平与哮喘临床及气道反应性之间的关系

目的:为了探讨儿童血清特异性免疫球蛋白(SIgE)同哮喘临床(喘息、咳嗽)及气道反应性(BHR)的关系方法:对4000例学龄儿童(10—11岁)作哮喘调查,并随机抽查了其中64例有哮喘症状者(Ⅰ组)和60例无症状者(Ⅱ组)用荧光酶联免疫法测定其血清SIgE,和采用乙酰甲胆碱激发试验测定BHR结果:SIgE的阳性率在Ⅰ组58例(90.6%),在Ⅱ组17例(28.3%).而其中气道高反应(BHR)58例中SIgE的阳性56例(96.6%),正常BHR66例SIgE的阳性19例(28.8%).Ⅰ组中且具备BHR者,SIgE的阳性率呈现100%.3者分别作卡方检验p<0.001.说明儿童血清SIgE与哮喘临床症状及气道反应性有显著相关.结论:Ⅰ.吸入性变应原与儿童哮喘及气道高反应性具有密切相关.2.SIgE检测可作为哮喘诊断的重要参考指标,尤适用于不能完成气道激发试验的幼儿.     

支气管哮喘患儿治疗前后血清GM-CSF、IL-8和IL-6联检的临床意义

目的：探讨了支气管哮喘患儿血清GM—CSF、IL-8和IL-6水平的变化及意义。方法：应用放射免疫分析对32例支气管哮喘患儿进行了血清GM—CSF、IL-8和IL-6水平测定,并与30例正常健康儿作比较。结果：支气管哮喘患儿血清GM—CSF、IL-8和IL-6水平非常显著地高于正常儿组（P〈0．01）。经治疗3个月后则与正常儿比较无显著性差异（P〉0．05）。结论：血清GM—CSF、IL-8和IL-6水平的异常升高足支气管哮喘患儿发病的病理因素之一．有重要的临床价值。     

How accurate is diagnosis of asthma in a general practice database? A review of patients' notes and questionnaire-reported symptoms.

BACKGROUND: Planned care of patients with chronic diseases in primary care depends on being able to identify them. A recorded label of asthma does not necessarily mean that the patient is currently symptomatic, and failure to record the diagnosis may influence future care. AIM: To determine the degree of under- and over-reporting of the diagnosis of asthma for patients aged 16-55 years inclusive in one large general practice. DESIGN: A questionnaire validated for the detection of bronchial hyper-reactivity was sent to all patients recorded as having asthma and their matched controls. Patients with a diagnosis of asthma and symptomatic bronchial hyper-reactivity were considered to have asthma. Evidence of asthma in the written and computer records was sought for two groups: patients with asthma and without symptoms of bronchial hyper-reactivity, and controls with symptoms of bronchial hyper-reactivity. SETTING: A semi-rural group practice with 14 830 patients. METHOD: Questionnaires were sent to 833 patients and 831 controls matched by age and sex. RESULTS: Response rates were 79.1% (659/833)for patients with asthma and 70.6% (587/831) for control patients. Of the patients with asthma who replied, 60.5% (399/659) had symptomatic bronchial hyper-reactivity. Of those with asthma and a negative bronchial hyper-reactivity status (based on the questionnaire), 190/260 (73.1%) were considered to have had asthma when diagnosed, on review of their primary care records.There was no evidence to suggest asthma in 45 (17.3%) of the 260 patients who had a negative bronchial hyper-reactivity status. Of the control patients, 41 (7.0%) of the 587 responders had symptomatic bronchial hyper-reactivity and nine of these may have asthma. By extrapolation, we estimate that there were possibly another 99 patients with symptoms of asthma, who had not been labelled as having asthma, and 362 patients with symptoms of bronchial hyper-reactivity who had not reported them to their doctors or had not had them recognised. CONCLUSIONS: There is an 89.4% chance that a patient recorded as having asthma has, or has had, asthma.     

Serum gastrin concentrations in children with primary gastroesophageal reflux and gastroesophageal reflux secondary to cow's milk allergy

PurposeThe assessment of the serum gastrin concentrations and the role of enterohormone in children with primary acid gastroesophageal reflux (GER) and GER secondary to cow's milk allergy (CMA).Materials/Methods138 children were diagnosed with pathological acid GER on the basis of pH-metric examination. 76 (28.8%) patients had primary GER and 62 (23.5%) patients had GER secondary to CMA.Serum gastrin concentration (fasting and postprandial) was assessed before treatment and 1 and 2 years after initiation of the therapy.ResultsThe children with primary GER had the fasting gastrin concentration 69.46 ± 11.87 μU/ml before treatment, 77.86 ± 26.35 μU/ml after 1 year and 83.78 ± 25.21 μU/ml after 2 years of treatment. The children with GER secondary to CMA had gastrin concentrations 89.61 ± 26.75, 73.17 ± 19.49 and 73.90 ± 20.31 μU/ml respectively. The mean postprandial gastrin concentration after treatment was higher than before treatment in children with both primary and secondary GER. The primary GER group had postprandial gastrin concentration 96.07 ± 33.51 μU/ml before treatment and 116.06 ± 33.95 μU/ml and 118.48 ± 33.96 μU/ml after 1st and 2nd year of therapy respectively. The secondary GER group had postprandial gastrin concentration 85.33 ± 14.12 μU/ml before treatment and 106.55 ± 24.51 μU/ml and 110.36 ± 24.67 μU/ml after 1st and 2nd year of therapy respectively.ConclusionsThe mean fasting serum gastrin concentrations in patients with primary and secondary GER were similar and mean postprandial concentrations were higher than fasting concentrations in both study groups.     

支气管哮喘患儿TNF、IL-8和GM-CSF检测的临床意义

目的:探讨了支气管哮喘患儿血清TNF、IL-8和集落刺激因子(GM-CSF)水平的变化及临床意义。方法:应用放射免疫分析测定了32例支气管哮喘患儿血清中TNF、IL-8和GM-CSF含量,并与30名正常健康儿童作比较。结果:支气管哮喘患儿血清中TNF、IL-8和GM-CSF水平均非常显著地高于正常组(P<0.01)经一周治疗后与正常人组比较仍有显著性差异(P<0.05)。结论:观察支气管哮喘患儿血清中TNF、IL-8和GM-CSF水平的变化,对探讨其发病机理,指导临床用药具有十分重要的临床价值。     

血清MTL、GASRIA在慢性丙型肝炎患者中的变化及临床意义

目的：探讨了血清胃动素（MTL）、胃泌素（GAS）水平在慢性丙型肝炎患者中的变化及意义。方法：应用放射免疫分析对36例慢性丙型肝炎患者进行了血清MTL、GAS水平测定,并与35名正常人作比较。结果：慢性丙型肝炎患者血清MTL、GAS水平非常显著地高于正常人组（P〈0．01）,且MTL、GAS呈明显的正相关（r=0.8117,P〈0．01）。结论：检测慢性丙型肝炎患者血清MTL、GAS水平的变化对疾病的诊断、治疗是一个十分有用的临床检测指标。     

支气管哮喘患儿治疗前后血清IL-6、IL-10和GM-CSF检测的临床意义

目的：探索了支气管哮喘患儿治疗前后血清IL-6、IL-10和GM-CSF水平的变化及临床意义。方法：应用放射免疫分析对33例支气管哮喘患儿进行了治疗前后血清IL-6、IL-10和GM-CSF测定,并与30名正常健康儿作比较。结果：支气管哮喘患儿在治疗前后血清IL-6、IL-10和GM-CSF水平均非常显著地高于正常儿（P〈0.01）,经治疗三个月后则与正常儿组比较无显著性差异（P〉0.05）。结论：检测血清IL-6、IL-10和GM-CSF水平变化对支气管哮喘患儿的治疗、预后均具有重要的临床价值。     

Bronchial hyperresponsiveness in younger children with asthma

We have previously reported a new technique of evaluating bronchial responsiveness by monitoring the transcutaneous oxygen pressure (tcPO2). This method is so simple, painless, and effortless with high reproducibility that it is possible to use the technique on children as young as 2 years old. Consequently, we used this method to study bronchial hyperresponsiveness in 141 children with asthma and 46 disease controls without asthma or chronic respiratory disorder. The bronchial responsiveness in asthmatic children aged 2 to 5 years was higher than in the disease controls (P less than .001). Further, bronchial responsiveness was significantly higher in moderately as opposed to minimally affected asthmatics (P less than .01), and was gradually higher according to clinical severity. In other age groups as well, the bronchial responsiveness of asthmatic children was higher than of disease controls. There was a close relationship between the level of increased bronchial responsiveness and the clinical severity of asthmatic children.