支气管哮喘患者气道黏膜中肥大细胞雌激素受体表达变化的研究

目的探讨雌激素受体在女性支气管哮喘患者气道黏膜肥大细胞中表达水平的变化。方法12例女性支气管哮喘患者和9例对照亚急性或慢性咳嗽女性患者,经纤维支气管镜取3级支气管黏膜组织,采用抗人肥大细胞类胰酶单克隆抗体标记肥大细胞,抗人雌激素受体（ER）单克隆抗体检测ER的表达,同时采用双标免疫染色对ER在肥大细胞中的表达进行定位分析。结果女性支气管哮喘患者气道黏膜中肥大细胞和雌激素受体阳性细胞数明显高于对照组（P〈0．01）,雌激素受体阳性细胞在形态学上与肥大细胞相似;而且雌激素受体阳性细胞与肥大细胞的位置相吻合。结论提示雌激素可能通过气道黏膜中的肥大细胞雌激素受体表达的变化参与了女性患者哮喘发病机制中的作用过程。     

一氧化氮在哮喘大鼠气道炎症中的作用

为探讨一氧化氮在哮喘大鼠气道炎症中的作用,采用卵白蛋白作为致敏原制备哮喘大鼠模型,用Ｓ—Ｐ免疫组化染色方法对肺组织诱导型一氧化氮合酶ｉＮＯＳ的活性测定及定位分析。结果显示：哮喘大鼠肺组织（ｉＮＯＳ）的表达活性明显高于正常对照组（Ｐ＜０００１）。主要存在于支气管上皮细胞,支气管平滑肌细胞,肺泡上皮,血管内皮和平滑肌细胞,浸润的中性粒细胞和巨噬细胞,而淋巴细胞表达不明显。用甲基强的松龙处理后哮喘大鼠肺组织诱导型一氧化氮合酶表达明显降低。说明一氧化氮在哮喘气道炎症中起重要作用,甲基强的松龙治疗哮喘可以减轻气道炎症,使哮喘大鼠肺组织中诱导型一氧化氮合酶表达降低     

儿童支气管哮喘诊断与治疗新进展

支气管哮喘是由嗜酸性粒细胞,肥大细胞和淋巴细胞和其他细胞参与形成的气道炎症,气道狭窄患者,呼吸困难,咳嗽,哮喘复发症状。根据世界卫生组织的全球统计,近年来在支气管哮喘患者正在上升,尤其是在儿童支气管哮喘。近年来,随着对临床支气管哮喘疾病的认识程度的加深,许多专家和学者分别从病理学,生理学,免疫学,分子生物学,基因诊断,临床方面作了更全面,更深入的探索和研究。本文将侧重于综合近期在儿童支气管哮喘:诊断和治疗的新进展。     

Why does airway obstruction persist in asthma due to low-molecular-weight agents? A Pathologistís view

The pathology of occupational asthma, which is similar to that of nonoccupational asthma, is characterized by airway infiltration of eosinophils, mast cells, and T-lymphocytes associated with thickening of the subepithelial reticular basement membrane. Since occupational asthma is caused by exposure to a sensitizing agent present in the working environment, it might be expected that cessation of occupational exposure leads to complete recovery from the disease. Unfortunately, this fa orable prognosis is observed in only a small percentage of patients with occupational asthma; in most of them, symptoms and bronchial hyperresponsiveness persist, although often at a decreased level. The few longitudinal studies performed on airway pathology in subjects with occupational asthma have shown that, after cessation of exposure to the sensitizing agent, some of the pathologic alterations (such as the subepithelial collagen deposition) improve, whereas others (such as the airway eosinophilia) persist. This latter finding suggests a role for eosinophils in the persistence of symptoms and bronchial hyperresponsiveness in the majority of asthmatic subjects even several months after removal from exposure.     

How often is the diagnosis bronchial asthma correct?

BACKGROUND: There are studies indicating that bronchial asthma is often underdiagnosed, while only a little research has been conducted as concerns overdiagnosing asthma. OBJECTIVE: We aimed to estimate the number of patients who have been given the wrong diagnosis of asthma. METHODS: All patients aged above 18 years who had visited two GPs during 1994 or 1995, with the diagnosis of bronchial asthma confirmed in the medical register, were examined by a specialist in allergies. RESULTS: One hundred and twenty-three patients fulfilled the criteria for being included in the study. Eighty-six patients (70%) attended the examination. Of these, 51 (59%) had bronchial asthma, six (7%) asthma in combination with chronic obstructive pulmonary disease (COPD) and 29 (34%) no asthmatic disease. CONCLUSION: The study indicates that more accuracy is needed when diagnosing bronchial asthma.     

Changes in the symptoms of bronchial asthma and associated allergic disorders from childhood to adult age

The aim of the study was to determine the prognosis of bronchial asthma. 145 adults (96 men, 49 women) with bronchial asthma during childhood were examined above age of 28 years (mean age was 37.6, SD: 5.9 years). The patients filled out questionnaires about the asthmatic and accompanying allergic symptoms in their childhood, age at 18 years and at present. They all were physically examined and prick tested with 12 inhalant allergens. 43% of the patients became symptom-free but 57% still had intermittent or persisting asthmatic symptoms while growing up. More patients had intermittent asthmatic day (59%) and night (67%) symptoms than persisting ones (41 and 33%). The accompanying allergic diseases in childhood did not definitely affect the prognosis of bronchial asthma. These are more frequent in the females, regarding before all the atopic skin disorders. At the age of 18, the occurrence of allergic rhinitis was more frequent than in childhood. The frequency of other allergic disorders did not change significantly. Among patients with asthmatic symptoms, moulds and cat hair allergies were more frequent than in the symptom-free group. The long-term prognosis of childhood bronchial asthma is relatively good, however only less than 50% of the patients has become symptom-free. In most of the adult patients the complaints are relatively mild. The indoor allergens may contribute to the occurrence of asthmatic symptoms.     

Inhaled corticosteroids for COPD

Over 60% of patients with COPD are treated with inhaled corticosteroids (ICS), even though their use is still subject to debate. The inflammatory process in the lungs of patients with COPD is dominated by macrophages, CD8+ T-lymphocytes, neutrophilic granulocytes and mast cells, as well as an increased production and/or concentration of IL-8, TNF-alpha and leucotrine B4. This inflammatory process is less sensitive to the effect of corticosteroids than that in asthma. Placebo-controlled clinical studies show a beneficial effect of ICS on the number and severity of exacerbations, symptoms and quality of life, but not on the accelerated decline in lung function. Exacerbations occurred in a subgroup of patients in whom ICS were discontinued. A trial treatment with ICS should be considered in all COPD patients who have previously exhibited signs of asthma or allergy, or who have marked bronchial hyperresponsiveness, considerable reversibility, and recurrent exacerbations. In patients with moderate and severe COPD, a one-year trial with ICS should be considered, with exacerbations and symptoms as primary efficacy parameters and lung function decline as a secondary parameter. The combined use of ICS and long-acting beta-2 agonists may be considered in view of an additional effect on these parameters compared to administering the individual components.     

The study of the inflammation of the airway in bronchial asthma by cytological and chemical analysis in the fluid phase of samples taken by sputum induction

In recent years the study of samples of bronchial biopsies and bronchoalveolar lavage fluid has made it possible to show the existence of significant airway mucosal inflammation, even in cases of mild bronchial asthma. This has led to a renewed interest in the use of sputum to assess airway inflammation non-invasively. Sputum induction has recently been proposed as a non-invasive alternative to bronchoscopy for the collection of airway secretions from asthmatic subjects. Sputum induction yields satisfactory samples of sputum in the great majority of asthmatic subjects, and both differential cell counts and the measurement of molecular markers of inflammation in the sputum fluid phase are feasible. In this paper we review studies where these measurements have been taken from subjects who were asthmatic, affected by other respiratory pathologies or healthy, and we assess their validity. Finally, we consider possible future clinical applications of sputum measurement of airway inflammation in asthma.     

肠易激综合征回盲部肥大细胞的实验观察

目的观察肠易激综合征(IBS)患者肠黏膜回盲部肥大细胞的分布及变化,探讨其在IBS中的可能作用。方法符合入选标准IBS患者30例,按临床症状分为腹泻型、便秘型。与15例正常人经结肠镜钳取回盲部结肠黏膜,检测肥大细胞及脱颗粒肥大细胞的数目,进行比较。结果IBS患者回盲部肥大细胞的数目增多,与正常对照组比较,有高度统计学意义,腹泻型与便秘型之间差异无统计学意义;腹泻型、便秘型患者回盲部脱颗粒肥大细胞数明显多于正常组,差异有统计学意义;便秘型与腹泻型之间比较P<0.01,有高度统计学意义。结论肠易激综合征患者回盲部肥大细胞增多,提示与IBS临床症状有相关性;腹泻型肠易激综合征回盲部脱颗粒肥大细胞增多,提示肥大细胞活化是产生IBS腹泻的原因。     

实验性大鼠矽肺肥大细胞表型的观察

目的研究矽肺病灶内肥大细胞的表型。方法非暴露式气管内注入石英粉尘悬液复制大鼠矽肺模型。用甲苯胺蓝、阿新兰－沙红Ｏ染色及图像分析等方法，观察、分析矽肺组织中肥大细胞数量及表型的变化。结果（１）实验组染尘后１、４、１２、２４、３６、４８周单位面积肥大细胞数量增加，与对照组比较，差异有显著性（Ｐ＜０．０５）。（２）增生的肥大细胞主要是结缔组织表型肥大细胞。（３）肺实质中结缔组织型肥大细胞的增加与矽肺病程呈直线正相关。结论肥大细胞，特别是结缔组织型肥大细胞，在矽肺的发生发展中可能具有一定作用。     

Why has the utilization of antiasthmatics increased in Finland?

The sales of antiasthmatics have increased rapidly in the Nordic countries during the 1980s. The causes for this growth in Finland were studied. Four nationwide population surveys show that the prevalence of self-reported asthma has risen, a larger proportion of asthmatic patients are under medication, the number of antiasthmatics per patient has increased, and the dosage recommendations of inhalation glucocorticoids and beta-agonists have grown. The average cost of medical treatment of an asthmatic patient was FIM 1848 (approximately U.S. $510.00) in 1990. The highest average expenses in the 21 districts studied were FIM 2171 and the lowest FIM 1535. To identify the consequences of these variations, the frequency of symptomatic periods as well as the quality of life of the asthmatic patients should be studied.     

信必可都保治疗支气管哮喘50例临床分析

目的观察信必可都保治疗支气管哮喘的临床疗效。方法选择我院50例哮喘患者，吸入信必可都保治疗，观察患者的症状、最大呼气峰流速值（PEF）、哮喘控制水平分级的变化及不良反应情况。结果经过3个月的治疗，患者的临床症状、肺功能均有明显改善。结论吸入信必可都保可有效控制中～重度哮喘发作，改善肺功能和生活质量，具有良好的依从性和安全性。     

The management of bronchial asthma during pregnancy--Hungarian experiences

INTRODUCTION: The prevalence of bronchial asthma is 4-8% among pregnant women. The complications, which threaten the asthmatic pregnancies according to the literature, are the following: spontaneous abortion, diabetes mellitus, caesarean delivery, pre-eclampsia, low gestational weight, neonatal icterus. OBJECTIVE: The aim of the study was a retrospective analysis of the data of asthmatic pregnant patients managed between 2000 and 2004, with a special consideration on the treatment and gynecologic complications. METHODS: The data of 53 persistent asthmatic patients--who had already undergone delivery--were collected. All of them were treated according to the guidelines issued in 2000 by the American College of Allergy, Asthma and Immunology and the American College of Obstetricians and Gynecologists: the inhalative corticosteroid budesonide, the long-acting beta-agonist formoterol or salmeterol and the short-acting beta-agonist terbutaline were used. RESULTS: The mean peak expiratory flow of the asthmatic pregnant patients was 71 +/- 16% of predicted, and the mean partial arterial oxygen tension 96 +/- 9 mmHg (means +/- SE). 10 of the 53 patients had cesarean delivery, 3 developed pre-eclampsia, 1 diabetes mellitus. The mean gestational age was 38.84 +/- 2.17 weeks and the weight of newborns 3132 +/- 604 g. The hospitalization was prolonged due to the infants' hyperbilirubinaemia in 3 cases. No congenital malformations or spontaneous abortions were detected. CONCLUSION: Based on the results of this retrospective study it can be concluded, that bronchial asthma slightly decreases the weight of newborns. The appropriate treatment of asthma during pregnancy resulted that the prevalence of gynecologic complications did not exceed the prevalence observed in the normal population--without increasing the risk of congenital malformations.     

Environmentally relevant metal and transition metal ions enhance Fc epsilon RI-mediated mast cell activation

Upon contact with allergen, sensitized mast cells release highly active proinflammatory mediators. Allergen-mediated mast cell activation is an important mechanism in the pathogenesis of atopic asthma. Asthmatic patients are especially susceptible to air pollution. Epidemiologic studies found a positive correlation between severity of symptoms among asthmatic patients and the level of particulate matter (PM) in the air. Among the constituents of PM are metals and transition metals, which could mediate some of its adverse effects on human health. We sought to determine the effect of metal and transition metal ions on allergen-mediated mast cell activation. We observed that several metal and transition metal ions activated mast cells and enhanced allergen-mediated mast cell activation. Thus, Al(3+), Cd(2+), and Sr(2+) induced release of granule-associated N-acetyl-ss-d-hexosaminidase, and Al(3+) and Ni(2+) enhanced antigen-mediated release. Metal and transition metal ions also induced significant secretion of interleukin (IL)-4 and increased antigen-mediated IL-4 secretion in mast cells. These effects of metal and transition metal ions on mast cells were observed at concentrations that do not result in direct cytotoxicity and might be relevant for environmental exposure. Thus, metals and transition metals could increase the level of allergen-mediated mast cell activation, which might be one of the mechanisms mediating exacerbation of allergen-driven asthma symptoms by air pollution.     

呼吸道炎症无创检测技术在儿童支气管哮喘应用的研究进展

儿童呼吸道炎症评估和监测,对于支气管哮喘的病情评价,治疗反应效果、预测急性发作和预后检测均具有重要意义。目前,对于呼吸道炎症检测相关技术,包括无创和有创二类。其中,呼吸道炎症无创检测技术,已成为哮喘管理的重要手段之一,主要包括呼吸道反应性测定、呼出气一氧化氮(FeNO)水平检测、诱导痰技术、血液与尿液白三烯(LT)水平检测,以及呼出气冷凝物(EBC)成分试验等。对呼吸道炎症无创检测技术和判定指标的标准化,是目前影响这些技术在儿童支气管哮喘临床应用的主要问题。     

小儿喘息性疾病病因及流行病学分析

目的:探讨小儿喘息性疾病的病因和流行病学特征。方法:选择185例小儿喘息性疾病患儿,根据出院诊断分为支气管哮喘组、毛细支气管炎组和喘息性肺炎组,对其流行病学及辅助检查特点进行分析。结果:此类疾病冬季高发,3岁以下男孩多见;支气管哮喘组过敏史和家族史发生率较高,与其他两组比较差异有统计学意义(P<0.05);支气管哮喘组、喘息性肺炎组白细胞计数(WBC)和C-反应蛋白(CRP)增高较多,但3组总体比较差异无统计学意义(P>0.05);支气管哮喘组嗜酸性粒细胞增高率为47.5%,与其他两组比较,差异有统计学意义(P<0.05);喘息性肺炎组和支气管哮喘组肺炎支原体抗体阳性率较高,依次为49.2%和34.6%,与毛细支气管炎组比较,差异有统计学意义(P<0.05)。结论:小儿喘息性疾病具有自己的病因和流行病学特征,且不同性质的疾病各有不同,临床上要正确认识、合理治疗。     

持续正压通气对重度支气管哮喘患儿肺功能的影响

[目的]观察持续正压通气对重度支气管哮喘患儿肺功能的影响. [方法]将重度支气管哮喘患儿168例随机分为治疗组[持续正压通气(continious positive airway pressure,CPAP)]和对照组(面罩吸氧),两组均给予常规治疗.3 d后监测喘息缓解情况、哮鸣音消失时间、最大呼气峰流速(PEFR)、第1秒最大呼气率(FEV1%)、用力肺活量(FVC)、血气分析(PaO2)等指标的变化.[结果]治疗组在哮喘缓解时间、哮鸣音消失时间、PEFR、FEV1%、PaO2等方面与对照组间差异有统计学意义(P<0.05).[结论]持续正压通气可以明显改善重度支气管哮喘患儿的症状和肺功能.     

RNA干扰技术在支气管哮喘研究中的应用

支气管哮喘(Bronchial Asthma,简称哮喘),是由多种细胞特别是肥大细胞、嗜酸性粒细胞和T淋巴细胞参与的慢性气道炎症。目前已知这些细胞都可产生炎症介质,其包括组胺、前列腺素、白三烯、内皮素-1等。如果我们能利用RNA干扰技术从源头上让致病基因"沉默",减轻甚至阻断多种炎症细胞、炎症介质和细胞因子的产生及其相互作用,以减轻气道慢性炎症,从而达到缓解哮喘症状甚至治疗哮喘的目的。本文就RNA干扰技术在哮喘研究中的应用的综述。     

支气管哮喘与胃食管返流之间关系的探讨

目的探讨胃食管返流(GER)与支气管哮喘之间的关系及制酸药物对GER的作用.方法采用便携式24hpH值自动记录仪对20例哮喘恶者进行六项返流指标监测,10例正常人作对照,并随机抽10例哮喘合并GER患者进行抗返流治疗.结果哮喘组六项返流指标均明显高于对照组,哮喘合并GER的发生率为70%,用H2拮抗剂对l0例合并GER者抗返流治疗,,治疗后各项返流指标明显降低.结论哮喘与胃食管返流之间有密切关系,GER是诱发哮喘发作的一个重要因素,H2拮抗剂对哮喘合并GER者有良好的治疗作用.     

Mononuclear cell activation in status asthmaticus

Evidence was provided by the authors, that the activity of circulating mononuclear cells is increased in status asthmaticus. An increased spontaneous secretion of chemotactic cytokin was found into the culture medium. There was no further increase in neutrophil chemotactic activity after 24 hours. In all patients a reduction was observed in the amount of neutrophil chemotactic activity after one week therapy, which is probably due to steroid treatment. No eosinophil chemotactic activity could be detected in the mononuclear cell supernatant derived from patients with acute severe asthma. The chemotactic activity was measured using a 48-well microchemotactic chamber. This mononuclear cell derived cytokin may play a role in genesis of asthmatic bronchial inflammation and provides further evidence that mononuclear cell activation is a feature of status asthmaticus.