卡介苗接种预防毛细支气管炎婴儿日后发生喘息的探讨

为观察卡介苗（BCG）单用或联用干扰素γ（IFN-γ）和维生素A（VitA)对毛细支气管炎（毛支）患儿结核菌素纯蛋白衍化物（PPD）皮肤试验，喘息发作及单核细胞源性细胞因子白细胞介素18（IL-18）水平的变化。给予44例毛支患儿单纯BCG或合并IFN-γ/VitA治疗，于治疗前和3个月后进行PPD皮试，测定外周血单个核细胞体外产生IL-18的水平。随访时间平均1年，观察喘息发作情况，未接受BCG接种的19例毛支婴儿作为对照组。结果 BCG接种后PPD平均硬结直径大于干预前及毛支对照组恢复期，以合并IFN-γ，VitA治疗组更为突出。BCG接种组1年内喘息发作频率低于对照组恢复期。干预后IL18水平明显升高，尤以合并IFN-γ，VitA治疗组为高；PPD皮试强度与IL-18水平呈正相关。提示BCG可促进毛支患儿PPD皮试阳转率，增强IL-18活性，具有预防毛支患儿日后发展为哮喘的作用。IFN-γ，VitA可协同BCG的上述作用。     

卡介苗、干扰素γ及维生素A预防毛细支气管炎患儿发生哮喘的临床研究

目的　探讨卡介苗 (BCG)或联用干扰素γ(IFN γ) /维生素A(VitA)预防毛细支气管炎 (毛支 )患儿发生喘息的效果。方法　 4 4例毛支患儿予单独BCG或联用IFN γ/VitA治疗 ,于治疗前和治疗 3个月后进行PPD皮试 ,并随访 ,平均 1年时间 ,观察喘息发作情况。 19例未接受BCG接种的毛支患儿 ,作为疾病对照组。结果　BCG接种后PPD平均硬结直径大于干预前及对照组恢复期 ,以联合IFN γ/VitA治疗组更突出。BCG单用或联用IFN γ/VitA组 1年内喘息发作频率低于对照组恢复期 ,单用或联用组间差异无显著意义。结论　BCG可促进毛支患儿PPD皮试阳转 ,1年内喘息发作频率降低 ,可预防毛支患儿日后发展为哮喘。IFN γ/VitA与BCG具有一定的协同作用。     

临床缓解毛细支气管炎患儿采用布地奈德气雾剂干预对哮喘发病率的影响

目的观察布地奈德气雾剂对降低毛细支气管炎（毛支）患儿哮喘发病率的作用。方法．急性毛支临床缓解后患儿54例，采用布地零德气雾剂200μg／d局部吸入治疗，1次／d，疗程6个月，观察1．5a时患儿哮喘发病率、喘息发生情况及干琢治疗前后血清总IgE变化。并以64例毛支患儿作对照。结果随访1．5a，观察组哮喘发病率较对照组明显下降（X^2=19．063 P〈0．01），发生喘息病例数明显减少（X^2=8.914 P〈0．01），喘息发作平均持续时间缩短（P〈0．01），平均首次喘息复发时间推迟（P〈0.01）；且随访观察0．5a，其血清总IgE水平恢复正常（P〈0.01）。结论急性毛支患儿临床缓解后吸入布地奈德气雾剂200μg／d、疗程6，个月进行哮喘干预治疗，可明显降低哮喘发病率。     

激素吸入治疗及干预毛细支气管炎的疗效观察

目的 分析普米克吸入治疗毛细支气管炎(简称毛支)及预防日后哮喘发作的疗效.方法 50例患儿随机分成2组,对照组只予以基础治疗,治疗组除基础治疗外予以普米克雾化吸入,观察2组急性期疗效,治疗组于毛支痊愈后继续吸入3个月普米克气雾剂进行干预治疗,观察1年内哮喘的发病率.结果 急性期治疗组病情恢复明显比对照组快,一年随访结果,治疗组喘息发作率明显低于对照组(P＜0.05).结论 提示普米克令舒雾化吸入治疗毛支急性期效果好,小剂量序贯疗法能明显减少日后哮喘的发病率.     

吸入糖皮质激素预防呼吸道合胞病毒毛细支气管炎后反复喘息的临床观察

目的 观察吸入糖皮质激素能否预防呼吸道合胞病毒(RSV)毛细支气管炎(简称毛支)后反复喘息的发生.方法 选择2003年7月-2004年12月住院的RSV毛支患儿200例,入院后查外周血嗜酸性粒细胞、血清总IgE,血TH1/TH2水平及肺功能.毛支治愈后随机分为治疗组(100例)和对照组(100例),治疗组吸入布地奈德气雾剂3个月,对照组未给予治疗.3个月后随访,复查肺功能.停止治疗后继续观察2年,了解吸入激素3个月对患儿反复喘息发生的影响.结果 ①毛支治愈后的3个月内,治疗组无症状天数为(78.92±8.03)d,对照组为(74.83±9.54)d,两组比较差异有统计学意义(P＜0.01).②3个月后治疗组肺功能各项指标均比对照组明显好转(P＜0.05).③治疗组按吸入激素疗效分为毛支后喘息组和未再喘息组,这两组患儿入院时外周血嗜酸性粒细胞、血清总IgE、血Th1/Th2差异均有统计学意义(P＜0.05),而肺功能差异无统计学意义(P＞0.05).④停止治疗后2年两组患儿喘息再发比例差异无统计学意义(P＞0.05).结论 RSV毛支患儿治愈后吸入布地奈德气雾剂3个月,可改善肺功能.外周血嗜酸性粒细胞增多、血清总IgE升高、Th2功能亢进者,治疗期间可以减少毛支后喘息再发.吸入激素3个月不能减少停药后2年内喘息的发生.     

雾化吸入糖皮质激素联合特布他林及异丙托溴铵治疗毛细支气管炎的疗效及预后

目的观察糖皮质激素联合异丙托溴铵、特布他林雾化吸入治疗毛细支气管炎的疗效,探讨不同疗程吸入糖皮质激素对毛细支气管炎预后的影响。方法将108例收治住院的毛细支气管炎患儿随机分为3组,均采用综合治疗。治疗1组予布地奈德混悬液联合特布他林、异丙托溴铵三联雾化吸入治疗7d,继续丙酸氟替卡松雾化吸入治疗至12周;治疗2组予布地奈德混悬液联合特布他林溶液二联雾化吸入治疗7d;对照组单用特布他林溶液雾化吸入治疗7d。观察3组患儿临床症状消失时间、住院天数,并进行临床疗效评定及追踪停药1a为喘息性疾病患病人数及患病率。结果治疗1组和治疗2组在咳嗽、喘憋症状缓解、肺部哮鸣音消失时间及缩短住院天数方面均优于对照组(Pa<0.05),治疗1组在临床缓解率方面较治疗2组更具优势(P<0.05)。治疗1组在停药1a喘息性疾病患病率明显降低,与对照组比较差异有统计学意义(P<0.05),治疗2组在停药1a喘息性疾病患病率与对照组比较稍低,但无显著性差异(P>0.05)。结论糖皮质激素联合特布他林二联雾化吸入治疗毛细支气管炎疗效肯定,糖皮质激素联合特布他林、异丙托溴铵三联雾化吸入治疗毛细支气管炎,对急性期症状的缓解优势更为明显,毛细支气管炎患儿吸入性糖皮质激素早期干预治疗至12周,可降低发展为支气管哮喘的几率。     

雾化吸入布地奈德混悬液治疗婴幼儿轻中度喘息性疾病的疗效

目的探讨雾化吸入布地奈德混悬液治疗婴幼儿轻中度喘息性疾病的疗效。方法将2006年1—12月收入重庆医科大学附属儿童医院呼吸中心病房的轻中度喘息性疾病婴幼儿120例作为研究对象。其中毛细支气管炎56例，喘息性支气管炎11例，婴幼儿哮喘53例。男64例，女56例；年龄1个月-3岁。按入院先后顺序随机分为治疗和对照组。治疗组患儿在常规综合治疗（解痉平喘、止咳化痰及病因治疗等）基础上，空气压缩泵雾化吸入布地奈德混悬液，1个月～1岁0．5mr／次，〉1—3岁1．0mg／次，2次／d。对照组采用空气压缩泵雾化吸入地塞米松，1个月～1岁5．0mg／次，〉1—3岁7．5mg／次，2次／d。二组患儿喘息症状缓解停药。对二组治疗前后症状、体征、病程及肺功能进行比较。采用SPSS12．0软件进行统计学分析。结果治疗组在喘息缓解、咳嗽缓解、哮鸣音消失及住院时间缩短方面均明显优于对照组（t=3．98，5．44，4．61，2．96Pa〈0．01）。治疗组治疗后（5～7d）的肺功能指标与对照组比较，潮气量（VT）和最大呼气流量（PEF）改善非常明显（t=5．57，2．96Pa〈0．01），呼吸频率（RR）、达峰时间比（％T-PF）、达峰容积比（％V—PF）也明显改善（t=2．26，2．29，2．41Pa〈0．05）。结论雾化吸入布地奈德混悬液治疗婴幼儿轻中度喘息性疾病临床疗效确切、安全性高，优于地塞米松雾化吸入。     

肌注α-干扰素及普米克令舒、肾上腺素、沐舒坦超声雾化治疗毛细支气管炎32例

目的探讨肌注α干扰素、普米克令舒、肾上腺素、沐舒坦雾化治疗小儿毛细支气管炎(简称毛支)的疗效。方法将64例毛支患儿随机分两组，两组均采用综合治疗，观察组加用α-干扰素肌注，普米克令舒、肾上腺素、沐舒坦超声雾化，对治疗前后症状、体征进行比较。结果观察组在治愈率、喘憋缓解、咳嗽持续时间、哮鸣音及湿哕音消失，平均住院天数，均优于对照组(P＜0．05)。结论肌注α-干扰素，普米克令舒、肾上腺素、沐舒坦超声雾化治疗毛支疗效确切，值得推广。     

肝素钙雾化吸入治疗呼吸道合胞病毒肺炎临床观察

目的在综合治疗的基础上，观察肝素钙雾化吸入辅助治疗呼吸道合胞病毒（RSV）肺炎的疗效。方法将临床确认的RSV肺炎患儿115例随机分组，在综合治疗的基础上，对照组采用常规雾化吸入（地塞米松、γ－糜蛋白酶、庆大霉素），观察组采用肝素钙雾化吸入。观察两组用药前后患儿喘憋缓解时间、肺部体征消失时间、平均住院时间。结果观察组喘憋缓解时间、肺部体征消失时间、平均住院时间均明显少于对照组（分别为P〈0．05，P〈0．01，P〈0．05）。结论对RSV肺炎患儿，在综合治疗基础上，加用肝素钙雾化吸入，对改善症状、缩短住院时间均明显优于常规雾化吸入，疗效显著。     

博利康尼联合布地奈德雾化吸入治疗婴幼儿喘息

目的观察博利康尼、布地奈德经氧驱动雾化吸入治疗婴幼儿喘息的疗效。方法将168例毛细支气管炎和喘息样支气管炎婴幼儿随机分为两组，两组均在综合治疗基础上，治疗组用博利康尼加布地奈德雾化吸入，对照组予以地塞米松、病毒唑雾化吸入，对两组显效率及有效率进行比较。结果治疗组疗效明显优于对照组（P〈0．001）。结论博利康尼联合布地奈德雾化吸入治疗婴幼儿喘息有协同作用，能缩短病程，提高治愈率，可作为治疗婴幼儿喘息的主要药物，也是早期干预婴幼儿哮喘的有力措施。     

毛细支气管炎患儿肺功能特点及应用吸入性糖皮质激素的疗效

目的探讨毛细支气管炎患儿肺功能特点及吸入性布地奈德（普米克令舒）、丙酸氟替卡松（辅舒酮）治疗毛细支气管炎的疗效。方法毛细支气管炎患儿100例分为观察组、对照组。2组均采用综合治疗,观察组加用普米克令舒/辅舒酮吸入。测定治疗前、出院时、出院后3个月二组患儿潮气呼吸肺功能;观察其急性期症状缓解情况;回访出院后3个月及1a后健康情况。30例同龄健康儿童的肺功能为健康对照组。结果1.观察组在改善临床症状、减少住院天数上优于对照组（Pa〈0.05）。2.观察组出院后3个月,咳嗽、气喘发作次数较对照组减少（Pa〈0.05）。3.出院时观察组潮气量（TV/kg）的增加、呼吸频率（RR）的下降优于对照组（Pa〈0.05）;观察组25%潮气量时的潮气呼气流速（TEF25%）、达峰时间比（TPEF/TE）、达峰容积比（VPEF/VE）较入院时上升（Pa〈0.05）,3个月后恢复正常,与健康对照组比较无明显差异（P〉0.05）。对照组出院时TEF25%、TPEF/TE、VPEF/VE与入院时无明显改变（Pa〉0.05）,3个月后仍未恢复正常。4.随访1a,观察组发展为支气管哮喘的几率低于对照组（P〈0.05）。5.毛细支气管炎急性期临床评分与TPEF/TE、VPEF/VE呈负相关,临床评分数值越高,病情越重,TPEF/TE、VPEF/VE值越低。结论1.毛细支气管炎患儿用吸入性糖皮质激素早期干预治疗,对急性期症状的缓解、降低发展为支气管哮喘的几率有较好疗效。2.TPEF/TE及VPEF/VE可判断毛细支气管炎呼吸道阻塞严重程度。     

Bronchoalveolar lavage cellular composition in acute asthma and acute bronchiolitis

OBJECTIVE: To compare cellular inflammation in the airways between acute bronchiolitis and asthma. STUDY DESIGN: Using a bronchoalveolar lavage with flexible bronchoscopy procedure, we investigated the cellular constituents of BAL fluid in children with acute exacerbation of asthma (n = 18) and infants with acute bronchiolitis caused by respiratory syncytial virus (n = 20). These results were compared with those of healthy control subjects (n = 14). RESULTS: Total lavage fluid recovered was similar in all groups. The total cell numbers were highest in the bronchiolitis group. The BAL cellular profile in the asthma group was characterized by a higher median (interquartile range) ratio of eosinophils (2.4% [1.6%-9.5%]; P <.01) than in the bronchiolitis group (0% [0%-0%]) or the control group (0% [0%-0%]). Neutrophil ratio was higher in the bronchiolitis group (40.0% [26.5%-50.0%]; P <.01), with no difference found between the asthma group (3.3% [2.0%-7.9%]) and the control group (2.0% [0.8%-5.5%]). CONCLUSIONS: Asthma and acute bronchiolitis are characterized by an elevated cellular percentage of eosinophils and neutrophils, respectively, in bronchoalveolar lavage fluid.     

Increased levels of BAL cysteinyl leukotrienesinacute [corrected] RSV bronchiolitis

BACKGROUND: Cysteinyl leukotrienes (CysLTs), including LTC4, LTD4 and LTE4, are pivotal mediators in the pathophysiology of asthma. AIM: To determine whether CysLT levels are increased in the lower airways of children with respiratory syncytial virus (RSV) bronchiolitis, as they are in asthmatic children, and to investigate a possible heterogeneity in CysLT levels in children with RSV bronchiolitis. METHODS: Bronchoalveolar lavage (BAL) fluids were obtained from children with acute RSV bronchiolitis (n = 20), from children with acute asthma who had no identifiable virus infection (n = 16) and from control subjects (n = 14). BAL cell counts and differentials were determined, and the concentrations of CysLTs were measured by ELISA. RESULTS: CysLT levels in the asthma (70.6 +/- 52.7 pg/ml, p < 0.001) and bronchiolitis groups (21.9 +/- 23.3 pg/ml, p < 0.05) were significantly higher than in the control group (8.7 +/- 5.2 pg/ml). Among bronchiolitis subjects, the eosinophil-positive subgroup (n = 6) showed significantly higher CysLT levels (49.0 +/- 26.7 pg/ml, p = 0.001) than the control group, but this was not observed in the eosinophil-negative subgroup (n = 14, 10.3 +/- 6.3 pg/ml, p = 0.47). CONCLUSION: CysLT levels are increased in the lower airways during RSV bronchiolitis, although their intensities are lower than those in acute asthma. Among bronchiolitis subjects, high CysLT producers could be distinguished from low CysLT producers by the presence of eosinophilia in BAL fluids, suggesting a pathophysiological heterogeneity in RSV bronchiolitis.     

Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis

Background: The objective of this study was to determine the efficacy and safety of nebulized 3% hypertonic saline solution and salbutamol in the treatment of mild to moderate bronchiolitis. Methods: In a randomized controlled trial, 93 infants with mild to moderate bronchiolitis were divided into two groups. The infants received inhalation of 2.5 mg (0.5 mL) salbutamol dissolved in either 4.0 mL normal (0.9%) saline (control group, n= 43) or 4.0 mL hypertonic (3%) saline (treatment group, n= 50). The therapy was repeated three times daily until discharge. Cough, wheezing, pulmonary physical signs, and the length of hospital stay were recorded. Results: Wheezing remission time was 3.8 ± 1.1 days in the control group and 2.7 ± 0.9 days in the treatment group (P < 0.01). Cough remission time was 6.3 ± 0.9 days in the control group and 5.3 ± 0.8 days in the treatment group (P < 0.01). The moist crackles disappeared at 5.4 ± 0.8 days in the treatment group versus 6.2 ± 0.9 days in the control group (P < 0.01). Furthermore, the average length of hospital stay decreased from 7.4 ± 1.5 days in the control group to 6.0 ± 1.2 days in the treatment group (P < 0.01). No obvious adverse effects were observed. Conclusions: Inhalation of nebulized 3% hypertonic saline solution and salbutamol is a safe and effective therapy for patients with mild to moderate bronchiolitis.     

Long and short-term effect of prednisolone in hospitalized infants with acute bronchiolitis

OBJECTIVE: To assess long and short-term effect of prednisolone in hospitalized infants with bronchiolitis. METHODOLOGY: A randomized and controlled trial was carried out at the Federal University of Rio Grande, Rio Grande-RS, Brazil. Twenty-eight patients were randomly allocated prednisolone (1 mg/kg/day for 5 days) plus standard care, and 24 patients allocated standard care alone. The primary endpoint was the prevalence of post-bronchiolitis wheezing at 1, 3, 6 and 12 months after hospital discharge. The secondary endpoints were: length of hospital stay, duration of oxygen therapy and time to clinical improvement during the hospitalization. RESULTS: There were no significant differences between the prednisolone and control group in the prevalence of post-bronchioltis wheezing at 1 month (73.1 vs 83.3%, P = 0.5), 3 months (73.1 vs 79.2%, P = 0.7), 6 months (65.4 vs 66.7%, P = 0.9) and 12 months (50.0 vs 58.3%, P = 0.5) after hospital discharge. No reduction was observed in the prednisolone group, compared with the control group, in terms of length of hospital stay (6.0 vs 5.0 days, P = 0.7), duration of oxygen therapy (24.0 vs 24.0 h, P = 0.4) and time to clinical resolution (4.0 vs 4.0 days, P = 0.8). CONCLUSIONS: Prednisolone has no significant effect on reducing the prevalence of post-bronchiolitis wheezing and on improving the acute course of illness in hospitalized infants with bronchiolitis.     

吸入型糖皮质激素治疗儿童哮喘有效性与安全性的临床研究

目的　吸入型糖皮质激素作为儿童哮喘预防性抗炎治疗的第一线药物,其效应性、安全性已成为 医患双方共同关注的焦点。但目前长期吸入治疗对肾上腺皮质功能和生长发育影响的国内研究为数不多,因此我 们进行一项对照研究以观察二丙酸倍氯米松(BDP)治疗儿童哮喘的疗效及副作用。方法　50例哮喘儿童根据病 情严重程度,在快速缓解后给予不同剂量二丙酸倍氯米松吸入,为期6月～2.5年。治疗期间定期随访,观察临床 疗效,监测最高呼气流速(PEFR)值,测量体重、身高及修改吸入剂量,并进行24小时尿游离皮质醇含量测定。结 果　临床总有效率90%(45/50),与对照组[70%(21/30)]相比差异有显著性意义(P<0.05),吸入BDP后6个 月时PEFR值和初诊时相比较差异有显著性意义(P<0.05),患儿身高、体重与同龄正常值比较无异常(P> 0.05);24h尿游离皮质醇在正常范围。结论　吸入二丙酸倍氯米松治疗不同严重程度的儿童哮喘,疗效好,而且 安全。     

肥胖对哮喘预测指数阳性喘息婴幼儿治疗效果的影响

目的 探讨肥胖对哮喘预测指数（API）阳性喘息婴幼儿治疗效果的影响。方法 选取API 阳性的喘息婴幼儿208 例,按Kaup 指数分为肥胖组（93 例）和非肥胖组（115 例）。在急性喘息发作期给予综合治疗,缓解期给予吸入性糖皮质激素（ICS）布地奈德混悬液压缩泵雾化吸入治疗。根据临床控制情况调整ICS治疗用量,共治疗6 个月。治疗后2 周随访1 次,之后每月随访1 次。结果 治疗后2 周、1 个月肥胖组的临床症状缓解率分别为35.5% 及75.3%,低于非肥胖组的53.0% 和87.8%（P P 结论 肥胖可抑制API 阳性喘息婴幼儿对ICS 治疗的反应。     

硫酸镁微量气泵吸入治疗毛细支气管炎的疗效

目的探讨硫酸镁微量气泵吸入治疗毛细支气管炎的疗效。方法毛细支气管炎患儿90例随机分为3组,分别予硫酸镁吸入、静点及生理盐水吸入,观察各组用药前后各项指标的改变。结果硫酸镁吸入组与静点组在血气、临床评分、症状、体征持续时间、住院天数及临床总有效率方面均优于生理盐水对照组(P<0.01),而硫酸镁吸入组各项指标又明显优于静点组(P<0.01),且无明显不良反应。结论硫酸镁微量气泵吸人治疗毛细支气管炎是一种更为安全、有效的给药方式。     

毛细支气管炎患儿血清肺表面活性蛋白A和D的检测及临床意义

目的：探讨血清肺表面活性蛋白A（SP-A）和D（SP-D）在不同程度毛细支气管炎患儿中的变化及其临床意义。方法：将70例毛细支气管炎患儿依据临床症状分为毛细支气管炎急性期组（42例）和恢复期组（28例）,另选取26例同期因非感染性疾病住院的小儿外科术前患儿为对照组;同时依据症状严重程度将急性期毛细支气管炎患儿分为重症组（12例）和轻症组（30例）。采用竞争性ELISA法定量测定各组血清SP-A和SP-D水平变化。结果：毛细支气管炎急性期组患儿血清SP-A和SP-D水平显著高于恢复期组和对照组（均P<0.01）,且恢复期组与对照组比较,血清SP-A和SP-D仍维持在较高水平（P<0.01）;重症组患儿血清SP-A和SP-D水平明显高于轻症组（P<0.01）。结论：毛细支气管炎患儿急性期血清SP-A和SP-D水平明显增高,且随病情加重而增高;临床症状缓解后,血清SP-A和SP-D水平仍然维持在较高水平。     

Vascular endothelial growth factor overexpression in induced sputum of children with bronchial asthma

Vascular endothelial growth factor (VEGF) induces angiogenesis and increases vascular permeability participating in narrowing of the airway lumen that follows lung injury. We sought to investigate the expression of VEGF in induced sputum during and after recovery from acute episodes of bronchial asthma in children. Eighteen asthmatic children with acute attacks of varying severity were subjected to VEGF estimation by an enzymatic immunoassay in induced sputum. They were followed up till complete remission of symptoms and signs and were then retested. VEGF was also estimated in sputum induced from age 34 and sex-matched healthy children enrolled as a control group. The sputum VEGF levels during acute asthma [median = 71 ng/ml; mean (s.d.) = 114.6 (121.8) ng/ml] were significantly higher than the levels estimated during remission [median = 50 ng/ml; mean (s.d.) = 45.7 (24.2) ng/ml] and both were higher than the corresponding levels of the control group [median = 36 ng/ml; mean (s.d.) = 31.3 (17.2) ng/ml]. VEGF levels during asthmatic episodes correlated positively to the recovery levels (r = 0.6, p = 0.009). The patients' VEGF expression did not vary with asthma severity, serum total IgE concentration, peripheral blood eosinophil count, or erythrocyte sedimentation rate of patients. Children on corticosteroids inhalation therapy at enrollment had sputum VEGF levels that were comparable to those on other therapies. The increased expression of sputum VEGF in asthmatic children reinforces the concept that it might have a pathogenetic role in bronchial asthma and may represent a biomarker of airway inflammation.