婴幼儿喘息患儿呼出气一氧化氮的变化及临床意义

目的通过动态监测婴幼儿喘息患儿治疗前后呼出气一氧化氮(Fe NO)浓度变化,评价Fe NO在婴幼儿喘息性疾病中的临床作用。方法根据哮喘预测指数(API)将105例婴幼儿喘息患儿分为哮喘预测指数阳性组(APIP组)62例和哮喘预测指数阴性组(APIN组)43例,并设健康对照组20例。检测并比较APIP组和APIN组婴幼儿喘息患儿急性发作期、治疗后1个月、3个月Fe NO浓度变化趋势。结果 APIP组患儿在喘息发作期、治疗后1个月、3个月Fe NO值均显著高于APIN组(P均0.05)及对照组(P均0.05);而APIN组患儿在喘息发作期、治疗后1个月高于对照组(P均0.05),治疗后3个月降至正常水平。APIP组、APIN组患儿在治疗后1个月、3个月Fe NO值均低于喘息发作期(P均0.05)。结论 Fe NO可以反映婴幼儿喘息患儿气道炎症及程度,对婴幼儿喘息患儿抗炎药物的使用具有临床指导意义。     

Factors Associated With Severe Uncontrolled Asthma and the Perception of Control by Physicians and Patients

IntroductionDespite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control.MethodsMulticenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control.ResultsAccording to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥1 day/week), frequent use of rescue medication (≥5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1≤80% and a poorer understanding of the disease by the patient (physicians only).ConclusionsOnly 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.     

舒利迭联合孟鲁司特对咳嗽变异性哮喘患儿的疗效及其对IL-13、IgE的影响

【目的】探讨舒利迭联合孟鲁司特对咳嗽变异性哮喘（CVA）患儿的治疗作用及可能作用机制。【方法】选择80例CVA患儿按数字表法随机分为观察组和对照组,每组40例,观察组给予舒利迭联合孟鲁司特治疗,对照组给予舒利迭治疗,8周后观察两组患儿的临床疗效及治疗前后血清白介素-13（IL-13）、免疫球蛋白E（IgE）的含量变化。【结果】观察组临床总有效率为97．5％、对照组为80．0％,两组临床总有效率比较有统计学差异（P〈0．05）;治疗后观察组IL-13、IgE水平及对照组IgE水平均下降,与本组治疗前比较差异均有统计学意义（P〈0．05）,且观察组IL-13与对照组比较差异有显著性（P〈0．05）;治疗前两组血清IL-13、IgE水平间呈正相关（P〈O．05）。【结论】舒利迭联合孟鲁司特对CVA患儿的疗效显著,可调节其外周血IL-13、IgE的水平变化。     

支气管哮喘与免疫调节

支气管哮喘(哮喘)是由环境过敏原引起基因易感人群Th1/Th2免疫失衡,Th2功能亢进而引起的.产生Th2细胞因子的CD4+T细胞在哮喘发生过程中起了关键的作用[1].各种特异性致炎因子,调节性T细胞,抗原呈递细胞以及免疫球蛋白(Ig)都参与了哮喘的发生,本文就哮喘与免疫调节的关系以及免疫治疗的前景作一综述.     

Asthma mortality based on death certificates: A demographic survey in Kagawa,Japan

BackgroundWe aimed to determine the reasons for the high rate of asthma mortality in Kagawa Prefecture, Japan, by analyzing death certificates.MethodsWe analyzed the death certificates between 2009 and 2011 in a demographic survey. Of 1187 patients with documented disease names suggesting bronchial asthma, analysis was performed on 103 patients in whom the cause of death was classified as asthma based on ICD-10 Codes. The patients were then classified into the following 4 groups: asthma death, asthma-related death, non-asthma death, and indistinguishable death. Based on this classification, consistency between ICD-10-based asthma death and asthma/asthma-related deaths was examined for each age group as well as for the site of death.ResultsOf 103 asthma deaths based on the ICD-10 classification, 30 (29%) were classified as asthma death, 44 (43%) as asthma-related death, 16 (16%) as non-asthma death, and 13 (13%) as indistinguishable death. Asthma death based on our classification correlated with that of ICD-10-based classification as a cause of death in patients younger than the median age (87 years), but correlation was not observed in patients aged older than 87 years. Deaths occurred outside the hospital in 45% of patients, and many ICD-10-based deaths reported at nursing homes and geriatric health care facilities were classified as non-asthma deaths in this survey.ConclusionRe-examination of the death certificate revealed that asthma deaths were reported incorrectly on the death certificates of elderly patients who died outside the hospital.     

哮喘大鼠静脉血和支气管肺泡灌洗液中降钙素基因相关肽的研究

目的 观察大鼠哮喘模型静脉血和支气管肺泡灌洗液（BALF）中降钙素基因相关肽（CGRP）的变化及其在哮喘发病机制中的作用。方法 用卵蛋白（OVA）致敏SD大鼠并雾化吸入刺激,制作大鼠哮喘模型。10只大鼠作为哮喘组,7只大鼠作为正常对照组,收集静脉血和BALF。肺组织做病理切片,BALF进行HE染色并细胞分类计数,采用ELISA法检测静脉血和BALF中CGRP的浓度。结果 哮喘组BALF中可见大量嗜酸粒细胞,与对照组比较,有极显著性差异（P〈0．01）。哮喘组静脉血中CGRP水平与对照组比较有极显著性差异（P〈0．01）;哮喘组BALF中CGRP水平与对照组比较,有显著性差异（P〈0．05）。结论 哮喘大鼠静脉血和BALF中CGRP均明显升高,CGRP在哮喘的发病机制中可能起着重要的作用。     

支气管哮喘患者应对方式与人格类型社会支持的关系

目的 研究支气管哮喘患者应对方式的特点及其与人格类型、社会支持的关系.方法 使用医学应对问卷(MCMQ)、艾森克人格问卷简式量表中国版 (EPQ-RSC)及社会支持评定量表(SSRS)对769名支气管哮喘患者进行了调查研究.结果 与其他慢性病患者相比,支气管哮喘患者较多地采用屈服[(10.17±3.39)分,(8.81±3.17)分]( t =10.99,P ＜0.01)及回避[(15.04±2.98)分,(14.44±2.97)分]的应对策略( t =5.51,P ＜0.01).面对、屈服及回避的应对方式均与人格的不同维度及社会支持存在一定程度的相关,相关分析具有统计学意义(均P ＜0.05).人格特征及社会支持能够显著地预测应对方式的变化.结论 人格类型和社会支持的水平是影响哮喘患者应对方式的重要因素.     

关合雾化吸入异丙托溴铵溶液治疗婴幼儿喘息性疾病108例临床分析

目的探讨异丙托溴铵雾化溶液在婴幼儿喘息性疾病中的治疗意义。方法将我院收治的108例患有喘息性疾病的1～36个月婴幼儿按随机数字表法分为治疗组和对照组。每组54例;对照组均给予布地奈德联合特布他林雾化吸人治疗,治疗组在给予布地奈德和特布他林的同时加入异丙托溴铵联合雾化吸入,比较两组婴幼儿临床症状、体征及住院时间。结果治疗组1～12个月的患儿总有效率最高（94．11％）;治疗组13～24个月及25-36个月患儿总有效率均高于对照组（P〈0．05）：治疗组患儿喘息缓解时间、哮鸣音消失时间及住院时间均短于对照组（P均〈0．05）。结论异丙托溴铵联合布地奈德、特布他林雾化吸人治疗患有喘息性疾病的患儿具有良好的疗效,尤其是1～12个月患儿,较单纯布地奈德联合特布他林雾化吸人治疗更加有效。