布地奈德/福莫特罗干粉吸入剂治疗儿童哮喘的有效性和安全性

支气管哮喘临床表现为反复发作的喘息、咳嗽、气促和胸闷,其本质是由多种炎症细胞和细胞因子参加的气道慢性炎症[1],抗炎、解痉、对症治疗为控制哮喘的基本方法.有报道,在中、小剂量吸入型糖皮质激素(ICS)基础上联合长效β2受体激动剂(LABA),比单纯提高ICS剂量能更好地控制哮喘[2].     

不同剂量丙种球蛋白治疗重症手足口病的疗效观察

目的 观察不同剂量静脉注射免疫球蛋白(IVIG)治疗重症手足口病的疗效.方法 将72例重症手足口病患儿分为4组(A组21例、B组20例、C组17例、D组14例),4组均给予利巴韦林抗病毒及对症治疗,在此基础上,A组给予IVIG 1 g/(kg·d),B组:0.5 g/(kg·d),C组:200 mg/(kd·d),D组:不用IVIG治疗,A、B、C组均连用IVIG 2 d,D组不用IVIG治疗.观察项目包括平均发热缓解时间、皮疹消退时间、临床痊愈时间、住院费用.结果 应用IVIG的患儿(A组、B组、c组)分别与未使用IVIG的D组相比,平均退热时间与临床治愈时间均有缩短,差异有显著性(P<0.05),皮疹消退时间则差异无显著性(P>0.05).应用不同剂量IVIG的A组、B组、C组间两两比较,在平均退热时间、临床治愈时间、皮疹消退时间差异无显著性(P>0.05).在治疗费用方面,A组>B组>C组>D组(P<0.01).用IVIG治疗与不用IVIG的患儿相比,病死率差异无显著性(P>0.05).结论 IVIG治疗重症手足口病疗效肯定,但价格昂贵,且不能降低重症手足口病的病死率.大、中、小剂量IVIG治疗重症手足口病疗效相近,中小剂量IVIG是治疗重症手足口病的有效方法,值得临床推广.     

不同剂量丙种球蛋白治疗重症手足口病的疗效观察

目的 观察不同剂量静脉注射免疫球蛋白(IVIG)治疗重症手足口病的疗效.方法 将72例重症手足口病患儿分为4组(A组21例、B组20例、C组17例、D组14例),4组均给予利巴韦林抗病毒及对症治疗,在此基础上,A组给予IVIG 1 g/(kg·d),B组:0.5 g/(kg·d),C组:200 mg/(kd·d),D组:不用IVIG治疗,A、B、C组均连用IVIG 2 d,D组不用IVIG治疗.观察项目包括平均发热缓解时间、皮疹消退时间、临床痊愈时间、住院费用.结果 应用IVIG的患儿(A组、B组、c组)分别与未使用IVIG的D组相比,平均退热时间与临床治愈时间均有缩短,差异有显著性(P<0.05),皮疹消退时间则差异无显著性(P>0.05).应用不同剂量IVIG的A组、B组、C组间两两比较,在平均退热时间、临床治愈时间、皮疹消退时间差异无显著性(P>0.05).在治疗费用方面,A组>B组>C组>D组(P<0.01).用IVIG治疗与不用IVIG的患儿相比,病死率差异无显著性(P>0.05).结论 IVIG治疗重症手足口病疗效肯定,但价格昂贵,且不能降低重症手足口病的病死率.大、中、小剂量IVIG治疗重症手足口病疗效相近,中小剂量IVIG是治疗重症手足口病的有效方法,值得临床推广.     

静注丙种球蛋白治疗重症哮喘30例报告

我科于1997年1月～2002年3月收治重症支气管哮喘患儿58例 ,诊断均符合儿童支气管哮喘及分度标准。其中男27例 ,女31例 ;学龄期39例 ,学龄前期19例。随机分为两组 ,观察组30例 ,对照组28例 ,两组性别、年龄无明显差异。两组均给予常规治疗 :激素 (全身用药或/和吸入疗法 ) +β2 受体激动剂 +茶碱类 ,抗炎及对症支持治疗。观察组在常规治疗基础上 ,给予IVIG200～400mg/(kg·d) ,疗程3d。结果以呼吸困难、喘息、咳嗽缓解 ,喘鸣音消失天数及平均住院天数为标准 ,统计结果采用方差分析 q检验和秩和检验。呼吸困难缓解时间观察组 (1.8±0.10)d ,…     

不同剂量丙种球蛋白治疗重症手足口病的疗效观察

目的 观察不同剂量静脉注射免疫球蛋白(IVIG)治疗重症手足口病的疗效.方法 将72例重症手足口病患儿分为4组(A组21例、B组20例、C组17例、D组14例),4组均给予利巴韦林抗病毒及对症治疗,在此基础上,A组给予IVIG 1 g/(kg·d),B组:0.5 g/(kg·d),C组:200 mg/(kd·d),D组:不用IVIG治疗,A、B、C组均连用IVIG 2 d,D组不用IVIG治疗.观察项目包括平均发热缓解时间、皮疹消退时间、临床痊愈时间、住院费用.结果 应用IVIG的患儿(A组、B组、c组)分别与未使用IVIG的D组相比,平均退热时间与临床治愈时间均有缩短,差异有显著性(P<0.05),皮疹消退时间则差异无显著性(P>0.05).应用不同剂量IVIG的A组、B组、C组间两两比较,在平均退热时间、临床治愈时间、皮疹消退时间差异无显著性(P>0.05).在治疗费用方面,A组>B组>C组>D组(P<0.01).用IVIG治疗与不用IVIG的患儿相比,病死率差异无显著性(P>0.05).结论 IVIG治疗重症手足口病疗效肯定,但价格昂贵,且不能降低重症手足口病的病死率.大、中、小剂量IVIG治疗重症手足口病疗效相近,中小剂量IVIG是治疗重症手足口病的有效方法,值得临床推广.     

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目的观察布地耐德(BUD)联用福莫特罗(FOM)与单用双倍剂量BUD干粉吸入疗法对轻度持续性哮喘患儿的有效性和安全性,探讨儿童轻度持续性哮喘的理想治疗方案。方法选取2005-01—2005-06在广州医学院附属第一医院呼研所专科门诊就诊的轻度持续哮喘患儿50例,采取开放、随机、平行对照方法把50例患儿分为两组,分别吸入BUD联用FOM(B+F组)或双倍剂量BUD(Double B组)8周,药物均用都保干粉吸入装置吸入。8周的观察期内由患儿或家长记录哮喘日记,包括日间和夜间症状评分、无症状天数、其它平喘药物(包括应急用速效β2-受体激动剂、长效缓释茶碱、口服长效β2-受体激动剂、全身用糖皮质激素)使用情况,同时以简易峰流速仪监测其呼气峰流速值(PEF)作为主要肺功能指标。结果B+F组和Double B组在治疗8周后,日间症状及PEF均较治疗前明显改善,无症状天数明显增加,差异具有统计学意义(均P<0.05);与治疗前比较,B+F组在治疗8周后夜间症状评分明显下降(P<0.05),而Double B组治疗前后比较差异无统计学意义(P>0.05);两组间日间症状评分、夜间症状评分、无症状天数及PEF治疗前及治疗后比较差异均无统计学意义(均P>0.05)。两组间病情反复发作次数、需联合应用速效β2-受体激动剂次数及口服强的松、长效缓释茶碱或口服长效β2-受体激动剂的天数均无统计学意义(均P>0.05)。结论低剂量吸入糖皮质激素(ICS)联用长效β2-受体激动剂(LABA)与单用双倍剂量ICS治疗儿童轻度持续性哮喘的疗效相当。但从减少或避免ICS潜在的全身性副反应方面考虑,联用低剂量ICS+LABA可能是更好的选择。     

按哮喘预测指数分组治疗在5岁以下喘息儿童中的应用

目的 观察按哮喘预测指数（asthma predictive index, API）分组治疗在5 岁以下喘息儿童中的应用价值。方法 239 例5 岁以下喘息患儿,API 阳性组126 例,API 阴性组113 例,分别随机分为糖皮质激素吸入治疗组（ICS 治疗组）及孟鲁司特钠治疗组（LTRA 治疗组）。治疗开始4 周内2 组所用药物种类和剂量相同,在疾病稳定期（第4 周后）ICS 治疗组仅使用布地奈德混悬液雾化吸入治疗,LTRA 治疗组仅使用孟鲁司特钠口服治疗,评估记录各组患儿不同时间点哮喘症状评分。结果 API 阳性组及阴性组在治疗后的前4 周,ICS和LTRA 2 种方法均有效,哮喘症状评分与治疗前比较差异有统计学意义,但2 个治疗组间比较差异无统计学意义;在治疗24 周时,2 种治疗方法仍有效,但API 阳性组中LTRA 治疗组较ICS 治疗组更有效;在API 阴性组中,LTRA 治疗组与ICS 治疗组疗效比较差异无统计学意义。结论 5 岁以下的儿童喘息,在疾病稳定期,可根据不同的API 分组,选择不同治疗方案,以达到更有效地控制喘息的目的。     

静脉注射丙种球蛋白佐治婴幼儿病毒相关性喘息的临床研究

目的 为评估静脉注射人丙种球蛋白(IVIG)治疗婴幼儿病毒相关性喘息的临床疗效.方法 总结2003年1月～2006年8月泉州市人民医院儿科收治的71例婴幼儿病毒相关性喘息的诊断和临床特点.IVIG治疗组在对照组常规治疗的基础上加用IVIG 250～400 mg/(kg·d),连用3 d.比较33例对照组和38例IVIG治疗组患儿症状体征消失时间.结果 与对照组相比,治疗组退热、肺喘鸣音消失、肺音消失、咳嗽消失时间及住院时间明显缩短[分别为(2.93±0.53) d vs.(4.01±0.43) d,(4.03±0.70) d vs.(8.05±0.86) d,(6.02±0.70) d vs.(9.05±0.83) d,(7.02±0.91) d vs.(10.73±0.99) d,(8.04±0.57) d vs.(11.09±0.77) d,P均＜0.01].结论 从婴幼儿喘息性支气管炎中区分出病毒相关性喘息有很大的治疗意义,用IVIG治疗病毒相关性喘息有较确切的疗效.     

支气管哮喘的治疗

支气管哮喘(简称哮喘)的治疗包括吸入性糖皮质激素(ICS)、长效β2受体激动剂(IABA)、ICS加LABA联合疗法、白三烯受体拮抗剂、抗胆碱药及茶碱等.ICS加LABA联合疗法可使大部分哮喘得到控制,白三烯受体拮抗剂对儿童哮喘,尤其病毒感染诱发的喘息效果良好,抗IgE抗体为难治性哮喘提供了新的治疗途径.免疫治疗的进展可能最终治愈哮喘.对哮喘发病机制的进一步研究,可发现新的治疗策略.     

小剂量静注丙种球蛋白治疗儿童免疫性血小板减少性紫癜的疗效观察

为寻求应用静脉丙种球蛋白 (IVIG)治疗免疫性血小板减少性紫癜 (ITP)的最佳方法 ,将我院自 1 996年 1 1月以来收住的 ITP患儿随机分为两组 :A组应用小剂量 IVIG,即 0 .4g/ (kg·d)连用 2天 ;B组应用大剂量 IVIG,即 0 .4g/ (kg·d)连用5天。结果显示 :小剂量 IVIG与大剂量 IVIG治疗 ITP的疗效相当。小剂量 IVIG可以替代大剂量 IVIG作为 ITP患儿的急救方法     

喘息性疾病婴幼儿外周血单个核细胞淋巴细胞功能相关抗原-1和巨噬细胞分化抗原-1的表达

目的探讨婴幼儿喘息性疾病患儿外周血单个核细胞(PBMC)表面淋巴细胞功能相关抗原-1(LFA-1)和巨噬细胞分化抗原-1(Mac-1)的表达及相关性,探讨喘息性疾病的免疫学发病机制,鉴别儿童喘息临床表型的炎性指标。方法随机选取在本院住院的3岁以下喘息患儿29例。男17例,女12例。从同期在本院住院的呼吸道感染但不伴有喘息的患儿中随机抽取同年龄患儿26例作为非喘息组,男15例,女11例。从同期在本院儿保门诊体检的健康儿童及外科非感染性疾病患儿中随机抽取同年龄患儿25例作为对照组。男15例,女10例。3组婴幼儿均在治疗前抽取静脉血2 mL,分离PBMC,采用流式细胞术检测PBMC中LFA-1、Mac-1的表达情况。结果喘息组和非喘息组LFA-1的表达[(47.46±13.94)%和(35.88±12.64)%]明显高于对照组[(26.62±10.41)%],喘息组和非喘息组Mac-1的表达[(7.43±3.42)%和(4.53±3.04)%]明显高于对照组[(2.92±1.80)%]。其中喘息组患儿LFA-1和Mac-1的表达高于非喘息组,差异均有统计学意义(Pa<0.01);相关性分析显示LFA-1和Mac-1在喘息组呈正相关(r=0.403,P<0.05)。结论 LFA-1、Mac-1在喘息性疾病发病机制中具有重要作用,检测LFA-1、Mac-1的表达可作为鉴别婴幼儿喘息临床表型的炎性指标。     

Diagnosis and prognosis of wheezing disorders in young children in the city of São Paulo, Southeast Brazil

Three‐hundred‐and‐ninety‐seven children aged 2–59 mo presenting to the paediatric emergency departments of five public hospitals in São Paulo, Brazil, with an acute episode of lower respiratory disease were examined. The children were classified into the following diagnostic categories: acute bronchitis, acute bronchiolitis, pneumonia, asthma, post‐bronchiolitis wheezing and wheezing of uncertain aetiology. Three years after the initial study, the homes of the children diagnosed as asthmatic or as having wheezing of uncertain aetiology were visited to collect information on subsequent episodes of lower respiratory disease. This paper reports the proportional incidence of different categories of lower respiratory disease and the results of an analysis to investigate clinical features that might distinguish wheezing children between those with asthma and those with an infectious disease. The predictions made for children with wheezing of uncertain aetiology were then compared with the follow‐up data. Recurrent wheezing disorders (asthma, post‐bronchiolitis wheezing) were common in the study sample (47% of children). Thirty‐six percent of children with an initial diagnosis of wheezing of uncertain aetiology were diagnosed as asthmatic by another doctor over the next 3 y. We were unable to identify any clinical features that were useful in identifying those children likely to be diagnosed subsequently as asthmatic. Conclusions: The use of a diagnostic category similar to that which we have called “wheezing of uncertain aetiology” might help to alert physicians early to the possibility of asthma without interfering in the management of the illness. Such a classification might also be useful in epidemiological investigations of the aetiology of lower respiratory diseases.     

Clara细胞分泌蛋白10在5岁以下喘息儿童外周血中的表达

目的：探讨外周血中Clara细胞分泌蛋白10（CC10）和血清总IgE浓度在5岁以下喘息儿童中的表达。方法：随机选取5岁以下反复喘息患儿59例,分为有特应质高危因素的喘息Ⅰ组（n=33）和无特应质高危因素的喘息Ⅱ组（n=26）,对照组为近期无感染疾病史的外科术前患儿(n=23)。采用固相夹心酶免疫吸附实验（ELISA）测定3组患儿外周血CC10与IgE水平。结果：喘息Ⅰ组、Ⅱ组CC10水平(3.95±1.26, 5.41±1.64 ng/mL)均低于对照组(8.72±2.23 ng/mL),差异有统计学意义(P<0.01);喘息Ⅰ组CC10水平低于喘息Ⅱ组(P＜0.05)。喘息Ⅰ组IgE水平高于喘息Ⅱ组和对照组,差异有统计学意义（P＜0.05）,喘息Ⅱ组和对照组之间差异无统计学意义（P＞0.05）。喘息Ⅰ组血清CC10与IgE呈负相关（r=-0.912, P＜0.01）。结论：外周血CC10水平在5岁以下患儿喘息发作期显著降低,有特应质高危因素的患儿降低更为明显,并与外周血IgE水平呈负相关。     

儿童肾病综合征与喘息性疾病关系研究进展

肾病综合征合并喘息性疾病的患儿其临床表现有其特殊性,但肾病综合征与喘息性疾病有何关系目前尚难定论。通过对肾病综合征及喘息性疾病在遗传学、特应质、血IgE水平、Th1/Th2细胞功能、一氧化氮水平、呼吸道病毒感染等方面的研究,推测肾病综合征与喘息性疾病可能存在相似的免疫发病机制,有一定的潜在关系和发病基础。     

具有喘息症状或过敏性疾病的年幼儿皮肤点刺试验结果分析

目的：通过分析0~5岁儿童变应原皮肤点刺试验结果,了解具有喘息症状的可疑哮喘及过敏性疾病症状的患儿对吸入变应原过敏反应的特点,为儿童哮喘及过敏性疾病的早期诊断提供依据。方法：选择2010年9月1日至12月31日长沙市某社区0~5岁具有喘息症状或过敏性疾病症状的患儿共102例为变应原筛查组;对照组选择同年龄组无喘息及过敏性疾病史的儿童94例。两组均进行变应原皮肤点刺试验。结果：变应原筛查组皮肤点刺试验阳性率61.8%（63/102）明显高于对照组的9.6%（9/94）,差异有统计学意义（P<0.05）;反复喘息合并过敏性鼻炎者的皮肤点刺试验阳性率明显高于单纯喘息组（P<0.05）;喘息次数与皮肤点刺试验阳性率呈正相关（r=0.91,P<0.05）;对螨虫的皮肤点刺试验阳性率（24.2%）明显高于其他过敏原（3.5%）,差异有统计学意义（P<0.05）;粉尘螨的皮肤点刺阳性率（50.0%）明显高于屋尘螨（14.7%）,差异有统计学意义（P<0.05）。结论：早期儿童喘息可能是发生过敏性哮喘的重要因素;变应原皮肤点刺试验是诊断过敏性疾病的重要依据,并有助于评估喘息患儿对吸入性变应原的过敏反应特点。     

Moisture and mould problems in schools and respiratory manifestations in schoolchildren: clinical and skin test findings

Objective: We performed a clinical study in 99 children attending schools with moisture problems and compared the findings with those of 34 children from a reference school. The aim of the study was to evaluate the possible association between respiratory or allergic diseases in the pupils and moisture or mould problems in the school buildings. Results: Asthma was diagnosed in nine (6. 7%) children: eight of them came from the moisture-problem schools and all were over 10 y old. In addition, 17 non-asthmatic children had suffered from wheezing and 21 from long-term cough, both symptoms being suggestive of occult asthma. If moisture problems were observed both at home and in the school, the frequency of asthma was 21% and the combined frequency of asthma and wheezing was 43%. The presence of allergic rhinocon-juntivitis or atopic dermatitis had no association with moisture or mould problems. We performed skin-prick tests to 13 moulds in all the 133 children. A positive reaction (> 3 mm) was observed in only six (5%) of them. All six positive children reacted to at least one moisture-indicative mould, Fusarium roseum, Aspergillus fumigatus, Phoma herbarum or Rhodotorula rubra. None of these cases came from the reference school. There was a significant association between positive reactions to moisture-indicative moulds and asthma; four (44%) of the nine children with asthma had such reactions. In addition, all the 6 reactive children had either asthma or wheezing. Conclusions: We report preliminary evidence for an association between moisture or mould problems in the school building and the presence of manifest and occult asthma in the pupils. Our results show that skin-test positivity to moulds is rare in children. However, reactivity to moisture-indicative moulds seems to be associated with the occurrence of asthma or wheezing.     

Asthma and respiratory infections in school children with special reference to moisture and mold problems in the school

AIM OF THE STUDY: Initially, we performed a questionnaire study on 622 school children aged 7 to 13 y. The study was supplemented with a clinical study including skin prick tests to 13 molds in 212 (34%) children with doctor-diagnosed asthma or parental-reported wheezing or prolonged cough. These children were attending one of two elementary schools, one with moisture problems (index) school, the other being the control school. The objective of the study was to evaluate whether exposure to moisture and sensitization to molds are associated with respiratory manifestations in school children. RESULTS: The prevalence of asthma was 4.8%, which was similar in the children from both schools. The children from the index school more often had wheezing (16% vs 6%; p <0.001) and cough (21% vs 9%: p < 0.001) symptoms than control children. Positive skin reactions to molds were rare (2.4%), being present in 7% of asthmatic and in 1-2% of non-asthmatic children (NS). Lower respiratory tract infections were more common in the spring than in the fall in children from the index school, but not in control children, and the difference between the schools was significant in emergency visits (OR =2.0, p <0.01) and antibiotic courses (OR = 2.1, p < 0.01). CONCLUSIONS: We found evidence of an association between moisture or mold problems in the school building and the occurrence of respiratory infections, repeated wheezing and prolonged cough in school children.     

儿童反复肺炎危险因素的病例对照研究

目的：探讨无明确基础疾病儿童反复患肺炎的相关危险因素。方法：选择无明确基础疾病的106例反复肺炎患儿及106例单次肺炎患儿进行成组病例对照研究,采用单因素χ2检验及多因素logistic回归模型调查反复肺炎的危险因素。结果：单因素χ2检验分析结果显示,病例组患儿有喘息病史、食物或药物过敏史、湿疹病史及一过性粒细胞减少症的比例高于对照组,差异有统计学意义。多因素logistic回归分析结果显示,喘息病史（OR=13.387,95% CI: 5.541～32.343）、食物或药物过敏史（OR=4.267,95% CI: 2.081～8.751）及一过性粒细胞减少症（OR=3.606,95% CI: 1.806～7.202）是儿童反复肺炎的独立危险因素。结论：喘息病史、食物或药物过敏史及一过性粒细胞减少症病史增加了无明确基础疾病儿童反复患肺炎的风险。     

婴幼儿喘息与肺炎支原体感染的关系探讨

目的探讨婴幼儿喘息发作与肺炎支原体(MP)感染之间的关系。方法选取228例下呼吸道感染婴幼儿分为初次喘息组(65例)、反复喘息组(83例)和无喘息组(80例)。收集患儿入院当天或次日空腹血清,采用ELISA法检测MP-Ig M,化学发光法测定血清总免疫球蛋白E(TIg E),欧蒙印迹法检测血清常见过敏原特异性免疫球蛋白E(s Ig E),并且收集患儿特应性体质表现及过敏性疾病家族史临床资料。结果初次喘息组和反复喘息组患儿MP感染阳性率及血清TIg E水平高于无喘息组(P0.05);反复喘息组患儿s Ig E检测阳性率显著高于初次喘息组和无喘息组(P0.05),且这部分患儿特应性体质表现及过敏性疾病家族史与发病密切相关。结论 MP感染与婴幼儿喘息密切相关,MP是诱发婴幼儿喘息发作的主要病原体之一,过敏原、特应性体质和过敏性疾病家族史是婴幼儿反复喘息的主要危险因素。     

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.