“温药和之”在治疗支气管扩张缓解期中的应用

目的观察中药以＂温药和之＂之法与西药盐酸氨溴索口服治疗支气管扩张缓解期的作用。方法将46例支气管扩张患者随机分为治疗组（24例）和对照组（22例）,治疗组内服中药汤剂,1剂/d;对照组口服盐酸氨溴片,30 mg/次,3次/d。两组疗程均为30 d。结果治疗后治疗组中医症状积分明显减少（P〈0.05）;治疗组总有效率为91.7%,对照组为54.5%,两组比较差异有统计学意义（P〈0.05）。结论以温阳宣通之法治疗支扩缓解期对于减少痰液生成,缓解症状,增强体质,疗效确切,对减少复发有积极作用。     

Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications

Background

Bronchial dilation testing is an important tool to assess airway reversibility in adults with bronchiectasis. This study aims to investigate the association of bronchodilator response (BDR) and clinical parameters in bronchiectasis, and the utility of BDR to indicate lung function decline and risks of bronchiectasis exacerbations (BEs).

Methods

We recruited 129 patients with clinically stable bronchiectasis. Baseline measurements included assessment of sputum inflammation and matrix metalloproteinase-8 and -9, sputum bacterial culture, spirometry, bronchial dilation test (for baseline FEV₁ less than 80% predicted only) and chest high-resolution computed tomography (HRCT). Bronchiectasis patients were followed-up for 1 year to determine the incidence of BEs and lung function trajectories. Significant BDR was defined as FEV₁ improvement from pre-dose value by at least 200 mL and 12%. Clinical trial registry No.: {"type":"clinical-trial","attrs":{"text":"NCT01761214","term_id":"NCT01761214"}}NCT01761214; URL: www.clinicaltrials.gov.

Results

BDR was negatively correlated with baseline FEV₁ percentage predicted, but not blood or sputum eosinophil count. Significant BDR was not associated with greater proportion of never-smokers, poorer past history, greater HRCT scores, poorer diffusing capacity or increased sputum matrix metalloproteinases (all P>0.05). There was a trend towards higher bronchiectasis severity index (BSI) and greater proportion of patients with Pseudomonas aeruginosa isolation or infection. Significant BDR at baseline was linked to poorer spirometry, but not more rapid lung function decline, throughout follow-up. Patients with significant BDR demonstrated non-significantly lower risks of experiencing the first BEs than those without (P=0.09 for log-rank test).

Conclusions

Significant BDR is associated with poorer lung function compared with non-significant BDR. Whether BDR predicts future risks of BEs needs to be tested in a larger cohort.     

Roles of Staphylococcus aureus and sensitization to staphylococcal enterotoxin in bronchiectasis

Staphylococcus aureus (S. aureus) is an inducer of mucosal type 2 immune response. To test the hypothesis that airway colonization with S. aureus may reflect allergic predisposition with staphylococcal enterotoxin (SE) sensitization in bronchiectasis, we retrospectively examined the association between SE sensitization and S. aureus and Pseudomonas aeruginosa (P. aeruginosa) in sputum of patients with bronchiectasis (n = 35). Overall, 14 (40%) patients with bronchiectasis were sensitized to either staphylococcal enterotoxin A (SEA) or staphylococcal enterotoxin B (SEB). SEA sensitization was more frequently observed in patients with sputum S. aureus than those without it. Patients with sputum S. aureus but without P. aeruginosa exhibited the highest SEA sensitization frequency and serum total IgE levels. Patients with both S. aureus and P. aeruginosa exhibited the highest blood eosinophils. In conclusion, S. aureus in the lower airway may indicate an allergic predisposition with SE sensitization and blood eosinophilia in bronchiectasis.     

Defective Antibody Production in Patients with Rheumatoid Arthritis and Bronchiectasis

Bronchiectasis (BR) occurs in about 3% of patients with rheumatoid arthritis (RA). Defective antibody production is a rare but well-recognised cause of both BR and inflammatory arthritis. We examined the hypothesis that subtle specific antibody defects might play a role in the pathogenesis of BR associated with RA. Identification of defects in antibody production is important because substantial benefits may be gained from immunoglobulin replacement. Specific antibody production was assessed in 20 patients with RA and BR, 20 with BR alone, 20 with RA alone and 20 healthy controls (all groups matched for age and sex). All had normal total IgG, IgA and IgM and IgG subclass levels. Specific antibody production was assessed by assay of antibodies to representative polysaccharide and protein antigens. Subjects with subprotective titres were challenged with the appropriate vaccine. Defective antibody production was defined as a subprotective level despite immunisation. Three out of 20 patients with RA and BR had a defective IgG₂ response to the polysaccharide antigen, but normal responses to the protein antigen. All of the subjects in the BR alone or healthy control group had normal antibody production. Two out of 20 patients with RA alone had defective production of antibodies against both protein and polysaccharide antigens; both were receiving gold therapy, a recognised cause of functional antibody defects. It was concluded that some patients with RA and BR have functional antibody defects and may benefit from antibody replacement. An unexpectedly high proportion of patients with RA alone also have functional antibody defects, possibly secondary to gold therapy. Received: 7 April 1998 / Accepted: 22 October 1998     

类风湿关节炎合并支气管扩张临床及危险因素分析

目的 回顾性分析类风湿关节炎(RA)合并支气管扩张病例资料,探讨其临床特点及相关危险因素.方法 分析自2008年5月至2013年5月入住.北京同仁医院RA合并支气管扩张病例的一般临床特征、肺功能、高分辨率CT等,与同期收治的单一RA病例进行对照分析,并应用Logistic回归探讨相关危险因素.结果 RA患者共计66例,其中RA合并支气管扩张19例,单一RA 47例.RA合并支气管扩张组有呼吸道症状者8例(42.1％),有呼吸系统体征者8例(42.1％),RA病程(16.6±9.1)年,呼吸病程(4.6±11.7)年,14例(73.7％)为RA先于支气管扩张发病,平均提前12年.支气管扩张好发于右肺中及下叶,分别为52.6％及36.8％.与单纯RA组相比,RA病程(P=0.045)、PEF(P=0.000)、FEV1.0(P=0.032)、FEF25-75(P=0.002)、DLCO(P=0.008)有显著统计学差异,RA相关免疫指标(RF、APF、CCP)、炎症指标(ESR、CRP)、治疗等方面无差别.多因素分析显示RA病程(P=0.018)及应用来氟米特(P=0.006)具有显著统计学差异.结论 RA人群中支气管扩张并不少见,好发于右肺中下叶,多伴有肺功能异常,RA病程及应用来氟米特为其独立危险因素.     

Analysis of factors associated with bronchial hyperreactivity to methacholine in bronchiectasis

Nonspecific bronchial hyperreactivity (BHR) has been reported to occur in patients with bronchiectasis. To evaluate this further, we studied 77 patients with stable bronchiectasis (noncystic fibrosis) with special reference to the prevalence of BHR to methacholine (MCh), and its relation to lung function, sputum characteristics, concommitant asthma, and atopy. The concentration of MCh required to produce a fall of 20% in forced expiratory volume in 1 s (FEV₁), PC₂₀, was determined by Wright’s nebulization tidal breathing method. BHR defined by a PC₂₀ ≤ 8 mg/ml was found in 21 of 47 (45%) subjects who underwent bronchial challenge. Presence of BHR was positively associated with low baseline spirometric values, diagnosis of asthma, long duration of disease, and elevated total IgE on univariant analysis, and was significantly related to FEV₁/forced vital capacity (FVC) ratio and asthma on multiple regression analysis. Ten of the 21 hyperreactive subjects did not have clinical asthma, whereas all 11 of 22 subjects with clinical asthma who underwent bronchial challenge were hyperreactive. Among those with BHR, there was a positive correlation between PC₂₀ and baseline FEV₁. When patients were further classified into asthmatic and nonasthmatic subjects, a positive correlation between PC₂₀ and FEV₁ was seen only in those without asthma. Frequency of infective episodes and inflammatory score of sputum assessed by average daily volume, purulence, and leukocyte count did not differ significantly in the groups with and without BHR. These results suggest that BHR in patients with bronchiectasis is associated with coexistent asthma and worse spriometric values, and not with the severity of bronchial sepsis. An erratum to this article is available at .     

成人非囊性纤维化性支气管扩张的诊治进展

支气管扩张是慢性气道损伤引起支气管管壁肌肉和弹力支撑组织破坏所导致的一组支气管不可逆性扩张.其发病率在3.9/10万到52/10万左右,不发达国家发病率相对较高.在我国,支气管扩张被当做气道的一般化脓性炎症来治疗,但其病因、发病机制、针对性的治疗手段均研究甚少.文中结合目前的文献及2010年英国胸科学会的支气管扩张诊治指南,对非囊性纤维化性支气管扩张的诊治最新进展作简要述评。     

吸入沙美特罗替卡松治疗支气管扩张合并不可逆气流受限患者的疗效与安全性研究

目的 评价吸入沙美特罗替卡松治疗支气管扩张症合并不可逆的气流受限患者的疗效和安全性.方法 这项临床试验是一项6个月的随机、对照、前瞻性研究,收集的患者从2010年6月至2012年6月.80例支气管扩张症伴有不可逆的气流受限患者都要经过高分辨率CT、肺功能检查确诊.随机分为两组:治疗组接受沙美特罗替卡松治疗(50/250 μg吸入,2次/d)+常规治疗;对照组接受常规治疗.分别于治疗3个月、6个月观察临床状况、健康相关生活质量、急性发作次数、肺功能、β2肾上腺素能激动剂(沙丁胺醇)使用量、病原微生物的菌株、药物不良反应等.结果 ①治疗组在呼吸困难评分、咳嗽次数、使用β2肾上腺素受体激动剂的剂量方面与对照组差异有统计学意义.②HRQL的改善方面差异有统计学意义.③治疗组急性发作次数明显少于对照组.④两组肺功能、可能的致病微生物的分离差异无统计学意义,虽然治疗组在肺功能方面有一定的改善.⑤两组不良反应差异无统计学意义.结论 对支气管扩张合并不可逆的气流受限患者联合吸入沙美特罗替卡松治疗是有效和安全的.     

Bronchiectasis exacerbations: The role of atypical bacteria and respiratory syncytial virus

BACKGROUND:

Aside from the known role of common bacteria, there is a paucity of data regarding the possible role of atypical bacteria and viruses in exacerbations of non-cystic fibrosis bronchiectasis.

OBJECTIVE:

To explore the possible role of atypical bacteria (namely, Mycoplasma pneumoniae and Chlamydophila pneumoniae) and respiratory syncytial virus (RSV) as causative agents of bronchiectasis exacerbations.

METHODS:

A cohort of 33 patients was studied over a two-year period (one year follow-up for each patient). Polymerase chain reaction for the detection of M pneumoniae, C pneumoniae and RSV in bronchoalveolar lavage samples were performed during all visits. Antibody titres (immunoglobulin [Ig]M and IgG) against the aforementioned pathogens were also measured. In addition, cultures for common bacteria and mycobacteria were performed from the bronchoalveolar lavage samples.

RESULTS:

Fifteen patients experienced a total of 19 exacerbations during the study period. Although RSV was detected by polymerase chain reaction during stable visits in four patients, it was never detected during an exacerbation. M pneumoniae and C pneumoniae were never detected at stable visits or during exacerbations. IgM antibody titres for these three pathogens were negative in all patient visits.

CONCLUSIONS:

Atypical pathogens and RSV did not appear to be causative agents of bronchiectasis exacerbations.