维生素D血浆浓度与氟替卡松对COPD患者肺功能的影响

目的探讨25-羟维生素D血浆浓度与吸人性糖皮质激素对COPD患者肺功能影响的关系。方法120例重度COPD患者于初人院时进行气量测定以及清晨禁食采集血样标本，用高效液相色谱法检测25（OH）D水平；而后每日2次，每次使用500μg氟替卡松，50μg沙美特罗，疗程4周。4周后再检测第1秒用力通气量及其改变，抽取血样，检测25（OH）D水平。治疗前后测量第1秒用力呼气容积（FEV1），与25（OH）D血浆水平进行相关性分析。结果25（OH）D血浆浓度水平平均为（23．3±9．3）ng/mL．在COPD患者中普遍维生素D缺乏，约占40％。对氟替卡松起效的患者体内25（OH）D水平偏高，在使用氟替卡松4周后，第1秒用力通气量有明显改善。结论25（OH）D血浆水平与患者对氟替卡松的敏感性有关，并可提高第1秒用力通气量，提高1秒率，改善肺功能。     

Role of cysteinyl leukotrienes in airway inflammation and responsiveness following RSV infection in BALB/c mice

Cysteinyl leukotrienes (CysLTs) contribute to the development of airway obstruction and inflammation in asthma; however little information is available on the role of these molecules in the pathophysiology of respiratory syncytial virus (RSV) bronchiolitis. This study was designed to evaluate the effects of RSV infection on CysLTs production in a well-established mouse infection model. Furthermore, we assessed the effect of anti-inflammatory agents (a leukotriene receptor antagonist, MK-571, and dexamethasone) on the functional and immune changes induced by RSV infection. Six to 8-wk-old BALB/c mice were infected with human RSV (strain A2). Measurements of airway function were performed using whole body plethysmography. Lung inflammation was assessed by cell counts, measurement of cytokines and CysLTs in bronchoalveolar lavage fluid (BALF) in the absence and presence of treatment with MK-571 or dexamethasone. RSV infection produced a marked increase in CysLTs in the BALF and lung tissue, recruitment of neutrophils and lymphocytes into the airways, increased IFN-gamma levels and airway hyperresponsiveness (AHR). Treatment with MK-571 decreased RSV-induced AHR without affecting the cellular and inflammatory responses to RSV. Dexamethasone decreased AHR and markedly reduced the recruitment of inflammatory cells and production of IFN-gamma. Our findings suggest CysLTs play an important role in the pathogenesis of RSV-induced airway dysfunction. Treatment with MK-571 decreases RSV-induced AHR but does not appear to alter the lung inflammatory responses to RSV. In contrast, dexamethasone decreases RSV-induced AHR but interferes with recruitment of inflammatory cells, resulting in decreased Th1 cytokines (a potentially Th2-prone environment) in this model. These studies support recent reports on the beneficial effects of CysLT receptor antagonist in human trials and provide a model for investigating the role of CysLTs in RSV bronchiolitis.     

急性重症哮喘的诊治体会(附52例报告)

目的：总结重症哮喘的诊治经验。方法：通过对52例重症哮喘病人的住院资料作回顾性分析总结。结果：48例治愈，治愈率：92．3％(48／52)；4例死亡，占同期住院哮喘患者的3．92％(4／102)；其中13例进行了机械通气治疗，9例在3d内脱机，2例并发纵隔气肿2周后症状改善脱机拔管，2例死于多器官功能衰竭；另2例拒行机械通气者3d内死于呼吸衰竭。结论：及时准确评估病情，合理应用皮盾激素等药物及机械通气支持等综合治疗措施是提高抢救成功率的关键。     

Corticosteroid cross-reactions: an alternative view

An alternative view of corticosteroid cross-reactivity is proposed, based on 2 immune recognition sites on the corticosteroid molecule, 1 influenced by C 6/9 substitution and 1 by C 16/17 substitution. A case report is adduced in support of such a hypothesis.     

吸入激素联合缓释茶碱与β_2-受体激动剂治疗儿童哮喘比较

目的比较吸入糖皮质激素(ICS)联合缓释茶碱(SRT)与ICS联合长效β2-受体激动剂(LABA)治疗中、重度儿童哮喘的疗效和安全性。方法141例4—14岁中、重度哮喘患者随机分成两组。A组73例,吸入丙酸氟替卡松气雾剂(FP),同时口服茶碱缓释片舒弗美。B组68例,沙美特罗/丙酸氟替卡松(SM／FP)干粉剂吸入治疗,疗程12周。比较A、B两组的临床疗效及安全性。结果治疗后两组患者晨间最大呼气峰流速(PEFam)与第1秒时间肺活量(FEV1)占预计值的百分比明显升高(P<0．01),两组间比较无显著性差异(P>0．05)。日、夜间症状评分较治疗前均显著降低(P<0．01),两组间比较无显著性差异(P> 0．05)。两组患者使用快速缓解药物(沙丁胺醇气雾剂)的揿数较治疗前均明湿减少(P<0．01),两组间比较无显著性差异(P>0．05)。结论ICS联合SRT治疗中、重度儿童哮喘,其疗效相似于ICS联合LABA,无严重不良反应。     

High single-dose alternate-day corticosteroid regimens in treatment of polymyositis

Summary High single-dose alternate-day prednisolone therapy (ADT) was compared with daily-dose prednisolone therapy (DDT) for treatment of polymyositis. Thirty patients with polymositis were treated with ADT for an average of 33.9 months. The combined number of improvements was 21 out of 30, a response rate of 70%. Side-effects were very rare and mild. On the other hand, 9 of 17 patients treated with DDT for an average 18.5 months improved, a response rate of 53%. The incidence of side-effects was strikingly higher than with ADT. ADT is therefore strongly advocated for treatment of polymyositis to avoid infectious complications and lessen cushingoid side-effects.