现实中哮喘治疗现状的前瞻性、多中心研究

目的过去对支气管哮喘(简称哮喘)现状的研究多采用横断面的回顾性调查,结果有局限性。本研究采用前瞻性的方法对重庆地区哮喘防治的现状进行研究,为改进目前哮喘的防治提供依据。方法利用统一的调查问卷,采用前瞻性、多中心、非干预性的研究方法,对重庆地区9家教学医院、市区级医院就诊的184例哮喘患者进行6个月的前瞻性调查研究,调查患者的哮喘控制水平、用药和经济负担等情况。结果入选患者以重度(62.0%)居多,哮喘控制不佳的患者比例较高,哮喘控制评分(ACT)20分占82.6%,采用吸入激素为主治疗方法的患者仅占29.6%。6个月后失访率为34.8%。研究结束时与基线数据比较,哮喘控制水平明显改善(P0.001),哮喘加重显著减少(P0.001),而且平均医疗费用减低33.9%。结论地区哮喘控制现状不佳,规范化治疗的患者比例很低。但经规范治疗和管理后,哮喘控制水平显著改善,急性加重率和治疗费用均显著降低。但仍有约1/3的患者不能接受医师的随访,改善哮喘的管理还需要更多的努力。     

支气管哮喘药物治疗的现状

支气管哮喘是由包括气道的炎性细胞和结构细胞（如：嗜酸粒细胞,肥大细胞,T淋巴细胞,中性粒细胞,平滑肌细胞,气道上皮细胞等）以及多种细胞组分参与的气道慢性炎性疾病,是一种常见的慢性呼吸道疾病。其诱发因素多种多样,有些机制尚不清楚,目前我们还不能治愈哮喘,     

尼麦角林治疗血管性认知功能障碍的前瞻性、多中心临床研究

目的　验证尼麦角林 (乐喜林 )治疗血管性认知功能障碍的有效性和安全性。　方法　前瞻性、分层随机、阳性药物 (脑通 )对照的多中心临床试验。选择 15 0例认知功能障碍的患者 ,主要评价指标为精神认知能力 (CCSE)和社会活动功能 (FAQ)以及CCI指数 (CCSE +FAQ) ,次要评价指标为血液流变学指标和疗效指数。　结果　CCSE评分由治疗前的 (16 85± 5 2 3)分提高到治疗后的(2 0 6 1± 5 2 6 )分 ,FAQ评分由治疗前的 (14 77± 5 93)分提高到治疗后的 (18 74± 6 12 )分 ,差异均有显著性 (P <0 0 1) ,CCI指数由治疗前 31 6 2± 10 96提高到治疗后 39 35± 11 13(P <0 0 1) ;全血低切黏度由 7 0 7± 2 6 5下降到 6 0 8± 3 2 2、红细胞压积由 (4 3 4 7± 4 30 )下降到 (4 0 82± 3 93) %、血浆比黏度由 1 91± 0 38下降到 1 78± 0 30 ,差异均有显著性 (P <0 0 1) ;通过阳性药物 (脑通 )对照 ,结果表明国产尼麦角林和进口尼麦角林对血液流变学和认知功能方面具有相同的功效 ,对认知功能障碍的总有效率分别为 76 %和 70 %。　结论　乐喜林是治疗血管性认知功能障碍的高效、安全的药物 ,与进口尼麦角林具有相同的品质。     

吗替麦考酚酯治疗系统性红斑狼疮的多中心前瞻性研究

目的　观察吗替麦考酚酯 (骁悉 )治疗系统性红斑狼疮的疗效及安全性。方法　通过观察治疗前后狼疮病情活动指数 (SLEDAI)、2 4h尿蛋白定量等指标的变化 ,对比分析骁悉与环磷酰胺的疗效和安全性。结果　 6 8例SLE患者完成为期 6个月的研究 ,骁悉组 36例 ,环磷酰胺 (CTX)组 32例。骁悉组SLEDAI由治疗前的 2 0± 8减少至治疗后 4± 3(P <0 0 1) ,CTX组由 2 1± 6减少至 7± 8(P <0 0 1) ,治疗后两组对比实验组改善较对照组明显 (P <0 0 1)。尿蛋白的变化 :骁悉组由 (3 2±2 8)g降至 (1 1± 1 1)g (P <0 0 1) ,环磷酰胺组由 (2 6± 2 4 )g降至 (1 3± 1 4 )g (P <0 0 1) ,治疗后两组对比差异无显著性 (P >0 0 5 )。总有效率骁悉组为 97 2 % (35 / 36 ) ,环磷酰胺组为 93 8% (30 / 32 )(P >0 0 5 )。骁悉组的副作用发生率为 2 2 2 % (8/ 36 ) ,环磷酰胺组为 6 9 7% (2 3/ 33) (P <0 0 5 )。结论　骁悉作为一种免疫抑制剂治疗SLE和环磷酰胺一样有效 ,并且安全性更高 ,对于CTX无效的患者亦有效。     

尼多考米纳治疗支气管哮喘的研究现状

本介绍了具有抗炎性质的防治哮喘新药尼多考米纳的药理学、临床疗效、临床应用及安全性。该药是一种抗炎作用强、临床疗效好、副作用少的仅供吸入使用的防治哮喘新药。     

支气管哮喘靶向治疗的研究现状

哮喘由慢性炎症引起，并引起与之相关的气道高反应性增加，导致喘息、呼吸困难、胸闷和咳嗽的反复发作。虽然90％～95％的哮喘患者通过吸入β2激动剂和糖皮质激素治疗可以控制症状，但仍有患者在使用大剂量激素治疗、联合使用长效β2受体激动剂或者白三烯调节剂时症状仍控制欠佳，这些患者需要其他的治疗方法。     

尼多考米纳治疗支气管哮喘的研究现状

本文介绍了具有抗炎性质的防治哮喘新药尼多考米纳的药理学、临床疗效、临床应用及安全性。该药是一种抗炎作用强、临床疗效好、副作用少的仅供吸入使用的防治哮喘新药。     

吸入皮质类固醇治疗支气管哮喘的有效性与安全性研究现状

支气管哮喘是全球最常见的慢性疾病之一 ,全世界约有1亿 5千万哮喘患者。在许多地区近 10～ 2 0年哮喘患病率增加了 1倍 [1 ]。吸入皮质类固醇是目前治疗支气管哮喘的主要方法 ,国内外研究对其疗效和安全性评价尚无统一意见。本文就近年来有关文献进行综述。1　抗炎机制皮质类固醇吸入疗法药理机制的核心是抗炎作用 [1～ 3] ,主要包括 :1减少气道局部免疫球蛋白 E( Ig E)合成和降低Ig E的活性。通过作用于 T淋巴细胞、B淋巴细胞、巨噬细胞而抑制 IL- 4、IL- 5、IL- 13等的合成与活性 ;抑制 CD+ 4 细胞活性 ,抑制 B淋巴细胞转化为浆细…     

我国硫酸镁治疗急性哮喘研究现状的分析

硫酸镁用于急性哮喘发作的治疗早在 19世纪30年代已有报道[1] 。近几十年来 ,我国亦有大量的有关硫酸镁治疗急性哮喘的各类报道。为了了解我国目前此类研究的现状 ,以及能否向临床实践提供可靠的研究依据 ,我们查阅了自 1980年 1月至 2 0 0 0年 10月共 62种杂志 ,并对结果进行了分析。在《中国生物医学文献数据库》中以硫酸镁和哮喘为检索词 ,检索出文章的索引 ,然后逐篇查找翻阅每一篇文献 ,对每一篇文献原文均认真阅读 ,筛选出其中的随机对照试验 (ｒａｎｄｏｍｉｚｅｄｃｏｎｔｒｏｌｌｅｄｔｒｉａｌｓ ,ＲＣＴ)文章 ,对其随机分配方法…     

难治性哮喘的诊断与治疗现状

支气管哮喘（简称哮喘）患者大部分通过吸入糖皮质激素和B2受体激动剂等规范化治疗可获得有效控制。但仍有约5％～10％的患者虽经规范化治疗疗效不满意，经常需要急诊和住院治疗，临床上通常称为“难治性哮喘”，是导致哮喘治疗费用增加的主要原因。     

Severe asthma in children: Evaluation and management

Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines^1,2, should be referred to an asthma specialist with expertise in severe asthma.     

Comparison of nebulized terbutaline and subcutaneous epinephrine in the treatment of acute asthma

Nineteen children who presented for treatment of acute asthma symptoms were studied. They were randomized to receive either subcutaneous epinephrine 0.01 mg/kg (0.3 mg maximum) or nebulized terbutaline 1 mg in 2 mL normal saline. The drugs were administered using the double-blind method. Each patient received either subcutaneous epinephrine with concurrent nebulized normal saline or nebulized terbutaline with a concurrent subcutaneous injection of normal saline. Depending on the patient's clinical status, up to three doses of the same drug and placebo were administered. Pulmonary functions (FEV1, FVC, FEF25-75), heart rate, respiratory rate, and pulmonary index were obtained before treatment, at 20 minutes, and at one hour after the final treatment. Except for the baseline respiratory rate, the mean number of treatments, pulmonary index, heart rate, and respiratory rate (at 20 minutes and one hour) were not statistically different. Pulmonary functions were not significantly different at any time. The one-hour post-treatment pulmonary functions (percentage of predicted normal) for terbutaline and epinephrine were FEV1, 49.2 +/- 18.4% and 49.4 +/- 16.9%; FVC, 72.7 +/- 23.4% and 62.7 +/- 21.6%; and FEF25-75, 31.8 +/- 18.6% and 39.0 +/- 12.2%, respectively. The data presented support our hypothesis that terbutaline by nebulization is at least as effective as epinephrine in the management of children with similar degrees of pulmonary obstruction.     

呼出气一氧化氮检测在儿童支气管哮喘诊断和管理中的应用

呼出气一氧化氮（fraction of expired nitric oxide,FeNO）是反映嗜酸粒细胞性气道炎症的生物学指标之一,且FeNO测量具有安全、简便、无创、可重复性好的特点,在儿童中有广泛的应用价值。FeNO测量可以帮助鉴别与支气管哮喘（简称哮喘）相似的疾病,在经过吸入性糖皮质激素治疗后该指标可以迅速降低。FeNO值对于预测激素反应类型、调整哮喘用药及预测哮喘复发方面可能有一定的价值,但目前研究尚未得出肯定的结论。     

急性期和慢性期哮喘小鼠模型在哮喘致病过程中的对比研究

目的 比较卵清蛋白(ovalbumin,OVA)诱导的急性期和慢性期哮喘小鼠模型在气道炎症、气道重塑和气道高反应方面的差异,明确在哮喘致病过程中肺组织的病理变化.方法 48只BALB/c小鼠随机分为急性组和慢性组,其中急性组包括正常对照组(A1组)和急性哮喘组(A2组),慢性组包括正常对照组(B1组)和慢性哮喘组(B2组).OVA致敏和激发方法分别构建急性早期哮喘模型和慢性期哮喘模型后,测定气道阻力,BALF细胞计数和分类计数,酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)检测IL-4、IL-5、转化生长因子-β1(transforming growth factor-β1,TGF-β1)、血管内皮生长因子(vascular endothelial growth factor,VEGF)和γ-干扰素(interferon-γ,IFN-γ).HE染色观察气道炎症,AB-PAS和Masson染色测定气道重塑.结果 与正常小鼠相比,A2组和B2组小鼠气道阻力均明显升高,但B2组小鼠气道阻力在基础值即发生明显改变.相比于慢性组哮喘小鼠,急性组哮喘小鼠BALF中细胞总数和嗜酸粒细胞数,IL-4、IL-5和IFN-γ水平,肺组织气道血管周围炎症细胞聚集,以及气道黏液分泌水平等炎症性改变更为明显.相比于A2组,B2组哮喘小鼠BALF中TGF-β1和VEGF水平,气道平滑肌增厚,上皮下胶原沉积,上皮下纤维化等改变更为显著.结论 在急性早期哮喘中主要是以炎症性改变为主,但在哮喘早期即开始出现轻度的重塑性改变;而在慢性期哮喘中虽然存在炎症性改变,但影响哮喘症状的因素却主要以器质性改变为主.     

The relationship between caregivers' subjective social status and asthma symptoms and management for urban children

Objective: Subjective social status (SSS) is a person's perception of his/her social standing among others. We explored the relationship between caregivers' SSS and asthma symptoms, visits, and medication use among children with persistent asthma. Methods: We analyzed baseline data of children (3–10 years) from the SB-TEAM trial in Rochester, NY. Using a modified MacArthur Scale of SSS, caregivers rated themselves “a lot worse off” to “a lot better off” compared to 4 groups (e.g., neighbors). “Low SSS” was defined by a response of “a lot worse off” or “somewhat worse off” for any of the referent groups. Caregivers reported their child's asthma symptoms, healthcare visits for asthma, and medication use. Bivariate and multivariate statistics were used. Results: We found that, of the 230 children enrolled (participation rate:78%, 62% Black, 72% Medicaid), 29% of caregivers had low SSS. Caregivers with low SSS had more depressive symptoms (46% vs. 28%) and lower social support (69.1 vs. 77.7). In multivariable analyses, children of caregivers with low SSS had fewer symptom-free days/2 weeks (5.8 vs. 7.9, p = .01). While they were more likely to have a routine asthma visit in the past year (35% vs. 23%, adjusted p = .03), there was no difference in their use of preventive medication. Conclusions: Many caregivers of children with persistent asthma report low SSS. While children of these caregivers had fewer symptom-free days, they were not more likely to use preventive medications. Efforts are needed to support these caregivers to ensure optimal preventive care and reduce morbidity.     

The impact of socioeconomic status on the intensity of ambulatory treatment and health outcomes after hospital discharge for adults with asthma

Objectives: To examine whether differences in intensities of care by socioeconomic status and race result in worse health among adults with asthma post—hospital discharge. Design: Patients were enrolled during hospitalization and recontacted three months after discharge. Patients: Those aged 18–55 years, with a primary diagnosis of asthma (n=97). Main outcome measures: Regular source of care, “intensive” therapy (use of an anti-inflammatory agent, pulmonary function testing, or an asthma specialist), and patient-reported (Intermediate Activities of Daily Living Scale [IADL] score, dyspnea) and performance-based (peak flow rate) measures of health status post-discharge. Results: 28% of patients with a yearly income less than $16,000 had no regular source of care, compared with 11 % of those with an income from $16,000 to $29,999 and no patient with an income of at least $30,000 (p=0.003). Similarly, intensive therapy was received by 40%, 67%, and 81% of these groups (p=0.005). Education had similar associations. Patients with no regular source of care or who did not receive intensive therapy had significantly worse health. Patients of lower socioeconomic status had health outcomes that were up to 25% lower than those of patients of higher socioeconomic status (p<0.05 for differences in IADL score, dyspnea, and peak flow by educational levels and for differences in dyspnea by income levels), after adjustment for age, gender, race, insurance status, and baseline health. After further adjustment for source of care and intensity of therapy, differences in health outcomes by socioeconomic status uniformly decreased in magnitude and only the differences in IADL scores and dyspnea by educational levels remained statistically significant. Although nonwhite patients were less likely to have a regular source of care or to receive intensive therapy, there was no difference in health outcomes by race. Conclusions: Patients of lower socioeconomic status who have asthma have worse health outcomes post-hospital discharge, which appear to be due in part to less continuous and less intensive treatment. Received from the Division of General Medicine (Section on Health Services and Policy Research) and the Division of Respiratory Diseases, Department of Medicine, the Center for Cost Effective Care, Brigham and Women’s Hospital, and the Department of Health Care Policy, Harvard/Medical School, Boston, Massachusetts. Pesented in part at the annual meeting of the Society of General Internal Medicine, April 29–May 1, 1992, Washington, DC. Supported by the John A. Hartford Foundation and the Brigham and Women’s Hospital. Dr. Haas was the recipient of a National Research Service Award 5-F32-HSOOO5-03 from the Agency for Health Care Policy and Research, and a Postdoctoral Research Fellowship from the Massachusetts Health Research Institute.     

不同碘摄入量对甲状腺肿和甲状腺结节影响的前瞻性研究

目的 研究不同碘摄入量人群非毒性甲状腺肿(甲肿)和非毒性甲状腺结节的流行病学特点及影响其发生、发展和转归的因素.方法 2004年对盘山(长期轻度碘缺乏)、彰武(碘缺乏基础上补碘至碘超足量)和黄骅(长期碘过量)社区于1999年参加本课题组流行病学研究并进行甲状腺B超检查的人群(3 385人)进行甲状腺疾病的随访调查.结果 (1)盘山、彰武和黄骅社区弥漫型甲肿的累积发病率分别为7.1%、4.4%和6.9%,盘山和黄骅均显著高于彰武(均P<0.01);结节型甲肿的累积发病率分别为5,0%、2.4%和0.8%,盘山的发病率最高(P<0.01).(2)三社区甲状腺单发结节的累积发病率分别为4.0%、5.7%和5.6%,多发结节的累积发病率分别为0.4%、1.2%和1.0%.(3)基础碘缺乏、碘过量、甲状腺自身抗体(thyroid autoantibody,TAA)阳性是甲肿发生的独立危险因素.(4)彰武初访时TAA阳性人群非毒性甲肿的发生率显著高于TAA阴性人群(P<0.01),盘山和黄骅无显著差异.(5)三社区非毒性弥漫型甲肿维持人群和黄骅非毒性结节型甲肿维持人群随访前后TAA阳性率均高于同社区正常人群(P<0.05).结论 碘缺乏和碘过量均有可能使甲肿的发病率增加.碘缺乏社区结节型甲肿高发,弥漫型甲肿是碘过量社区甲肿发牛的主要形式.甲状腺自身免疫与甲肿的发生和维持相关,这种相关性在历史上为碘缺乏而后过度补碘的社区更明显.     

ACT在基层医院支气管哮喘管理中的应用

目的观察并评估哮喘控制测试（asthma control test,ACT）在基层医院支气管哮喘（简称哮喘）患者管理中的应用情况。方法选取在烟台市烟台山医院哮喘门诊定期就诊的哮喘患者181例应用ACT测试,每月1次,观察哮喘患者的控制情况及治疗的依从性。在哮喘患者应用ACT前、应用ACT6个月后测定第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEV1％pred）和用力肺活量（FVC）、FVC占预计值百分比（FVC％pred）,并同时进行ACT评分。结果每月1次坚持应用ACT 181例,使用率100％：坚持规范化治疗170例,治疗依从性93．9％：症状完全控制率48．6％,部分控制率28．2％。应用ACT前FEV1％pred为51．57±17．46,ACT评分16．33±3．51。应用ACT6个月后,FEV1％pred为73．41±15．02,ACT评分22．40±3．13。治疗前与治疗后差异有统计学意义（t分别为25．651、35．536,P〈0．01）;ACT与FEV1具有良好相关性（r=0．80,P〈0．01）。结论ACT是一种简单且可信度高评估工具,能提高患者哮喘控制率及治疗的依从性,值得在基层医院中广泛推广应用。