哮喘患者血清Th1／Th2类细胞因子水平变化及意义

目的探讨Th1／Th2类细胞因子在哮喘发病中的作用。方法采用ELISA法检测52例急性哮喘患者（急性组）和56例慢性哮喘患者（慢性组）外周血血清Th1类细胞因子（IL-2、γ-IFN）和Th2类细胞因子（IL4、IL-5、IL—10）水平,并选择60例正常健康人群（对照组）作对照比较。结果与慢性组及对照组比较,急性组IL-2和1-IFN水平均明显下降;而IL-4、IL-5、IL-10水平均明显升高（P均〈0．05）;慢性组γ-IFN水平明显低于对照组,IL-5水平明显高于对照组（P均〈0．05）。结论Th1／Th2类细胞因子失平衡状态可能是哮喘发病的重要原因,在哮喘’防治中应重视对失衡的细胞因子进行调节。     

变应性鼻炎和哮喘患者血清IL-9、IL-4、IL-5变化及临床意义

目的探讨血清IL-9、IL-4、IL-5在变应性鼻炎、支气管哮喘（哮喘）、变应性鼻炎合并哮喘中的作用。方法采用双抗体夹心ELISA法检测哮喘组、过敏性鼻炎组、过敏性鼻炎合并哮喘（合并组）患者及查体健康者（对照组）的血清IL-9、IL-4、IL-5。结果与对照组比较,三组患者的血清IL-4、IL-5、IL-9均明显升高（P均〈0．01）;其中血清IL-5合并组高于哮喘组及过敏性鼻炎组（P〈0．01,〈0．05）,过敏性鼻炎组高于哮喘组（P〈0．01）;IL-4合并组高于哮喘组（P〈0．05）。结论IL-4、IL-5、IL-9参与过敏性鼻炎和哮喘的发病,三组患者均表现为Th2型细胞因子过度表达;变应性鼻炎合并哮喘的炎症程度较高,哮喘和鼻炎也有不同炎症反应。     

过敏性鼻炎与支气管哮喘的关系

过敏性鼻炎和支气管哮喘常常共同存在于同一患者,过敏性鼻炎常发生在哮喘之前,患者中支气管哮喘的发病率明显高于一般人群,用乙酰甲胆碱或组织胺作支气管激发试验,发现一部分不伴哮喘的过敏性鼻炎患者气道反应性增高,可能是进一步发展为支气管哮喘的高危人群,治疗过敏性鼻炎可以减轻哮喘的症状,改善肺功能,降低气道反应性。鼻－支气管反射,鼻腔阻塞后呼吸方式的改变,后鼻滴漏的炎性分泌物吸入下呼吸道可能是过敏性鼻炎与支     

支气管哮喘合并过敏性鼻炎的临床治疗观察

目的了解布地奈德鼻喷剂联合舒利迭吸入剂对过敏性鼻炎-哮喘综合症患者的治疗效果。方法60例过敏性鼻炎-哮喘综合症患者,随机分为两组,对照组30例,给予吸入舒利迭50/100μg或50/250μg,1吸/次,2次/日。试验组30例,在吸入舒利迭治疗基础上,同时给予布地奈德鼻喷剂治疗,每个鼻孔各1喷,64μg/喷,2次/日。治疗时间为8周。结果试验组比对照组能显著提高患者的生存质量,对照组不能有效改善患者的鼻炎症状。结论联合治疗过敏性鼻炎和支气管哮喘比单纯治疗支气管哮喘更能有效地提高患者的生存质量。     

过敏性鼻炎哮喘综合征

过敏性鼻炎（allergic rhinitis,AR）和支气管哮喘（ bronchial asthma,BA）已经列为21世纪的＂全球性健康问题＂,是全球发病率上升最快的疾病,两者均为呼吸道常见的过敏性疾病,除临床表现的部位不同外,在病因学、发病机制和病理学改变等方面均极为相似,许多病人常先后或同时罹患过敏性鼻炎和支气管哮喘.两者的相关性已引起国内外学者的广泛关注,世界卫生组织（WHO）于2001年专门为此制订了过敏性鼻炎及其对哮喘的影响（allergic rhinitis and its impact on asthma,ARIA）指南[1].过敏性鼻炎-哮喘综合征（Combined Allergic Rhinitis and Asthma Syndrome,CARAS）是近年来世界变态反应组织（WAO）提出的新的医学诊断术语,是指同时发生临床或亚临床的上呼吸道过敏（过敏性鼻炎）和下呼吸道的过敏性症状（哮喘）,两者往往同时并存[2].     

吸入糖皮质激素对哮喘患者Th1/Th2细胞因子网络影响

支气管哮喘(哮喘)是一种慢性气道炎症疾病,多种炎性细胞和炎性介质参与其过程。目前认为T辅助淋巴细胞两个功能性亚群Th1／Th2相关细胞因子在哮喘发病中发挥重要作用。我们对哮喘患者白细胞介素-5(IL-5)、白细胞介素-8(IL-8)r-干扰素(IFN-r)水平进行检测,探讨吸入糖皮质激素对哮喘患者Th1／Th2细胞因子的影响。     

儿童过敏性鼻炎与支气管哮喘

很久以来一直认为儿童过敏性鼻炎与哮喘具有相关性。新近的流行病学研究证明,上、下呼吸道之间确实存在相互联系。而且,有多个学说解释过敏性鼻炎与哮喘的关系,两者具有相似的免疫学机制和病理生理学基础。越来越多的证据表明,过敏性鼻炎与哮喘具有共同的发病因素,且经常在同一个患者中并存,因此在制定治疗策略时应考虑完整气道的概念。     

过敏性哮喘患者树突细胞表型及分泌细胞因子的研究

目的观察过敏性哮喘患者树突细胞(DC)表达表面分子(CD1a、CD83、CD40、CD86)和分泌细胞因子(IL12和IL10)的情况,及对原始T细胞分化的影响。方法分别取过敏性哮喘患者(9例)和健康对照者(14例)外周血培养成熟DC。另取无哮喘家族史的新生儿脐血分离得到原始T细胞。将2组DC和原始T细胞共同培养。流式细胞仪测DC表面协同刺激分子CD1a、CD83、CD40、CD86的表达。ELISA测DC分泌的IL12、IL10及T细胞分泌的IFNγ、IL4的含量。结果哮喘组DC表达CD86分子比对照组显著升高(P<001)。哮喘组DC分泌IL12、IL12p40和IL10较对照组显著减少(P<001,P<005)。哮喘组T细胞释放IFNγ较对照组减少(P<005),释放IL4较对照组显著增多(P<001)。哮喘组IL12与IFNγ呈正相关(r=0758,P<005),与IL4呈负相关(r=-0756,P<005);IL10与IL4呈负相关(r=-0685,P<005);IL12与IL10呈正相关(r=0926,P<001)。结论过敏性哮喘患者DC存在缺陷,使原始T细胞向Th2优势分化,IL4等的释放增加,且不能有效地形成T细胞耐受,共同导致过敏性哮喘的发生。     

过敏性鼻炎与支气管哮喘的关系

过敏性鼻炎和支气管哮喘均为常见的呼吸道变态反应性疾病,本文综述二者在发病和病理生理方面的相互关系。     

变应性鼻炎与支气管哮喘相关性研究进展

变应性鼻炎能够增加支气管哮喘（简称哮喘）患者的就诊率和用药剂量，不利于哮喘患者的临床控制并使其肺功能下降，但研究结果尚存在争论。变应性鼻炎在哮喘的发生和进展过程中扮演了重要角色，推测肺通气功能异常和气道高反应可能是部分变应性鼻炎患者的特征，该类人群可能更容易发展为哮喘。然而目前尚不明确变应性鼻炎患者的肺功能特点，针对此问题的研究较少。此外，关于治疗变应性鼻炎能否改善存在气道高反应的变应性鼻炎患者的肺功能并预防哮喘发生尚不清楚。这些问题对哮喘的预防具有重要意义，本文将讨论这方面问题的国内外研究进展，并提出可能的研究方向。     

细胞因子在支气管哮喘气道重塑中作用的研究现状

支气管哮喘（简称哮喘）是一种常见的呼吸道疾病，其发病率在全球范围内呈逐年增加趋势，严重影响患者的健康。气道重塑是哮喘的重要特征，是引起哮喘不可逆气流阻塞、难治性哮喘和激素抵抗的重要原因之一。     

Biomarkers in asthma and allergic rhinitis

A biological marker (biomarker) is a physical sign or laboratory measurement that can serve as an indicator of biological or pathophysiological processes or as a response to a therapeutic intervention. An applicable biomarker possesses the characteristics of clinical relevance (sensitivity and specificity for the disease) and is responsive to treatment effects, in combination with simplicity, reliability and repeatability of the sampling technique. Presently, there are several biomarkers for asthma and allergic rhinitis that can be obtained by non-invasive or semi-invasive airway sampling methods meeting at least some of these criteria.In clinical practice, such biomarkers can provide complementary information to conventional disease markers, including clinical signs, spirometry and PC₂₀methacholine or histamine. Consequently, biomarkers can aid to establish the diagnosis, in staging and monitoring of the disease activity/progression or in predicting or monitoring of a treatment response. Especially in (young) children, reliable, non-invasive biomarkers would be valuable.Apart from diagnostic purposes, biomarkers can also be used as (surrogate) markers to predict a (novel) drug’s efficacy in target populations. Therefore, biomarkers are increasingly applied in early drug development.When implementing biomarkers in clinical practice or trials of asthma and allergic rhinitis, it is important to consider the heterogeneous nature of the inflammatory response which should direct the selection of adequate biomarkers. Some biomarker sampling techniques await further development and/or validation, and should therefore be applied as a “back up” of established biomarkers or methods. In addition, some biomarkers or sampling techniques are less suitable for (very young) children. Hence, on a case by case basis, a decision needs to be made what biomarker is adequate for the target population or purpose pursued.Future development of more sophisticated sampling methods and quantification techniques, such as – omics and biomedical imaging, will enable detection of adequate biomarkers for both clinical and research applications.     

支气管哮喘患者合并变应性鼻炎的临床调查

目的调查支气管哮喘患者中变应性鼻炎的发生率,并对其临床诊治现状作初步分析。方法连续调查98例确诊的哮喘患者,详细了解其临床表现及诊治现状,并对所得数据进行统计学分析。结果 98例哮喘患者中63例（64.3%）并发变应性鼻炎,其中54例（85.7%）被误认为系反复感冒者。哮喘合并变应性鼻炎组（63例）和单纯哮喘组（35例）在年龄、病程等方面差异无显著性（P〉0.05）。仅在9例变应性鼻炎患者中有6例间断使用过鼻喷皮质类固醇激素治疗。结论较多的哮喘患者合并变应性鼻炎,及反复误诊提示应关注哮喘合并变应性鼻炎的诊治。当前对哮喘合并变应性鼻炎的诊治关注不足。     

Asthma exacerbations in patients with asthma and rhinitis: Factors associated with asthma exacerbation and its effect on QOL in patients with asthma and rhinitis

BackgroundThe comorbidity of asthma and allergic rhinitis is remarkably high, but not much is known about the effects of this combined condition on the quality of life. We aimed to evaluate the factors associated with asthma exacerbations and the effect of the exacerbations on the quality of life (QOL) through a one-year, large-scale, observational study in Japanese patients with asthma and rhinitis.MethodsA case survey by attending physicians and a patient survey was conducted at each assessment timepoint over a period of one year. Patients were divided into two groups according to the presence or absence of asthmatic attacks after enrollment and were matched using propensity scores to evaluate the factors associated with asthma exacerbations and the effect of the exacerbation on QOL.ResultsPotential factors associated with asthma exacerbations included high body mass index value, low forced expiratory flow 75% of forced vital capacity (FEF75%), severe rhinitis as determined based on ARIA (Allergic Rhinitis and its Impact on Asthma). Although patients with asthma exacerbations had significantly impaired quality of life at baseline as evidenced by the economic aspects, in addition to physical, mental, and social activities, no further reduction with the attacks was observed.ConclusionsThis study suggested that higher body mass index (BMI) and severe asthma as well as severe rhinitis were factors associated with asthma exacerbations. Although patients with asthma exacerbations had impaired QOL, attacks caused no further reduction.     

Occupational asthma and occupational rhinitis in hairdressers

BACKGROUND: Hairdressers are at risk for occupational respiratory diseases, but the risk factors, causal agents, and underlying mechanisms are not completely defined. AIM: To describe the features of a large group of hairdressers consecutively referred to our center for suspected occupational asthma (OA) over an 8-year period, the type of occupational respiratory diseases, the etiologic agents, and the diagnostic tests. RESULTS: Forty-seven hairdressers (mean age, 25 years; range, 17 to 52 years) were studied. On the basis of the response to the specific inhalation challenge (SIC), 24 patients received a diagnosis of OA (51.1%), which was due to persulfate salts in 21 patients (87.5%), permanent hair dyes in 2 patients (8.3%), and latex in 1 patient (4.2%). Thirteen of these 24 patients (54.2%) also received a diagnosis of occupational rhinitis, which was due to persulfate salts in 11 patients (84.6%) and to paraphenylenediamine in two patients (15.4%). Patients with persulfate asthma had a long period of exposure to bleaching agents, a long latent period between the start of exposure and the onset of symptoms, and a prevalent eosinophilic airway inflammation in induced sputum. The skin-prick test with ammonium persulfate performed in a subset of patients gave negative results CONCLUSIONS: In the present study, we confirmed that persulfate salts are the major agents involved in OA and occupational rhinitis in hairdressers. The positive response to the SIC in only a part of the population of symptomatic exposed workers, the period between the starting of exposure and the onset of symptoms, the type of response to the SIC, and the high frequency of association of asthma with other diseases such as dermatitis and rhinitis suggest an immunologic mechanism that remains to be elucidated.     

Burden of rhinitis in children with asthma

Although the clinical association of allergic rhinitis and asthma has been recognized for centuries, in recent years the association appears to be stronger than was reported previously. However, data for children are less clear, and some studies indicate that results observed in developing countries may differ from those observed in Western populations. We therefore intended to document the association of rhinitis with pediatric asthma in terms of caregivers' perception, physician practice, and file records. Asthmatic children aged 3-16 years with at least 1-year follow-up in an allergy-asthma outpatient clinic were invited to participate in the study during a 10-month interval. In addition to a face-to-face questionnaire-based interview, file records were evaluated retrospectively to obtain information relating to asthma and rhinitis. Of 396 patients included in the study, 369 with consistent replies were included in the analyses. The mean age of the study group was 10.6 +/- 0.2 (mean +/- SEM) years, and a greater proportion of the respondents were male (63.7%), atopic (78.3%), and mildly asthmatic (50.7%). House dust mite and grass pollens were the most commonly sensitized allergens (50.7% and 46.9%, respectively). Although only 5.4% of our study population regarded themselves as rhinitic and 23.8% had been diagnosed with allergic rhinitis according to the file records, almost 57.7% of patients had required medications for rhinitis within the last year, and 68.8% had findings consistent with allergic rhinitis. Furthermore, 41.2% and 58.8% reported that their rhinitis symptoms caused a significant burden in their daily life and exacerbated their asthma, respectively, and almost 50% felt that their rhinitis had not been given significant consideration by their physician. In conclusion, although we report a large discrepancy between caregivers' perception of rhinitis, documentation in file records, and treatments for rhinitis, the allergic rhinitis prevalence determined in the survey and the medication use for rhinitis appeared to be in agreement. We recommend a greater effort be made to identify, label, and educate children with rhinitis and their families in asthma outpatient clinics.     

THl／TH2对HBV特异性抗原HBcAg和HBeAg应答的研究

为研究HBcAg和HBeAg对慢性乙型肝炎病毒感染者外周血单个核细胞 (PBMC)中TH1/TH2类细胞分化的影响。将 6 4例慢性HBV感染者根据免疫状态不同分为ATL正常组 (ATL <40u/L)和ATL异常组 (ATL>6 0u/L) ;HBeAg阳性组和抗 -HBe阳性组。分别用重组HBcAg和HBeAg诱导感染者PBMC体外增殖。并设 2 0例健康人群做正常对照组 ,用双抗体夹心ELISA法检测培养上清液中TH1类细胞因子 (IL - 2、IFN -γ)和TH2类细胞因子 (IL - 4、IL - 10 )发现无论何组 ,在HBcAg诱导下产生TH1类细胞因子量明显高于HBeAg诱导下产生的量 ,TH2类细胞因子量低于HBeAg诱导下产生的量 ,正常对照组也得出类似的结果。提示 :对于慢性HBV感染者在不同的免疫状态下 ,均表现为HBcAg倾向诱导TH1类细胞分化 ,而HBeAg倾向诱导TH2类细胞分化。     

Effect of atorvastatin on TH1 and TH2 cytokine secreting cells during T cell activation and differentiation

Statins, which are 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, are the most effective agents for the lowering of cholesterol in clinical practice. In addition to their lipid-lowering properties, statins also have immunomodulatory activities. Animal studies have shown that statins promote a T helper 2 (T(H)2) bias and suppress the secretion of T helper 1 (T(H)1) cytokines. We therefore examine whether atorvastatin modulates the T(H)1/T(H)2 responses in human T cells. Using primary T cells as well as differentiated T(H)1 and T(H)2 cells, the immunomodulatory effect of atorvastatin on cells secreting IFN-gamma (T(H)1 response) and IL-4 (T(H)2 response) was investigated. Atorvastatin had no effect on cells secreting IFN-gamma and IL-4 in primary T cells stimulated with anti-CD3 and -CD28 antibodies. Similarly, cells producing IFN-gamma and IL-4 in stable differentiated T(H)1 and T(H)2 cells were unaffected by atorvastatin. Furthermore, atorvastatin had no effect on the ratio of IFN-gamma+/IL-4+ cells during the differentiation of T(H)0 cells to T(H)1 and T(H)2 cells in long-term cultures. These data suggest that atorvastatin does not have any immunomodulatory effect on the T(H)1/T(H)2 balance in human T cells in vitro.     

Local ige synthesis in allergic rhinitis and asthma

Local IgE production has been a contentious concept for over 40 years. Although a host of clinical observations suggested a local source of IgE, co-localization of IgE to B cells in the nasal mucosa could not be demonstrated. In contrast, igE-producing B cells were observed in local lymphoid tissue. Definitive proof of local IgE synthesis in the nasal mucosa has now become available. Here, we review the recent developments in local IgE research in allergic rhinitis and asthma within their historical context, and speculate on the implications of both local IgE synthesis and ongoing research into local immunoglobulin isotype switching for patient therapy.