36例阿司匹林哮喘回顾性分析

Aspirin Induced Asthma:A Retrospective Analysis about 36 Cases

目的了解我国阿司匹林哮喘(AIA)的流行情况、诱发原因及诊治特点。方法对近10年发表在国内的30篇AIA相关文献中的共36例AIA患者进行回顾性分析。结果我国AIA的诱发药物主要为乙酰水杨酸(阿司匹林)和丁苯丙酸(芬必得、布洛芬),诱发AIA的情况少见的药物为醋氨酚(扑热息痛、百服宁、泰诺)、甲氧萘丙酸(萘普生)、双氯芬酸。部分合并有鼻部疾病,占已明确是否患有鼻部疾病的28.6%(8/28)。本病可发生于各年龄段,尤以40岁以上多见(72.2%,26/36);女性病例(17例,47.22%)与男性病例(19例,52.78%)的性别差异无统计学意义(P>0.05)。AIA发作间隔时间以60 min以内居多(71.4%,20/28),>120 min的为28.6%(8/28)。主要给药途径为口服(83.3%,30/36),药物给药途径及方式与AIA间隔时间无明显关联。结论我国AIA发病主要原因为患者和医生对非处方非甾体类抗炎药认识不足,随意使用增加了AIA的发生。预防AIA发生最重要的就是避免使用解热镇痛抗炎药。如临床必须用非甾体类抗炎药(NSAIDs)且无禁忌证,建议使用甲氧萘丙酸(萘普生)和双氯芬酸。临床使用NSAIDs时应至少在60 min内密切关注病人呼吸变化的症状及体征,一旦发现AIA发生,应及时处理,防止其进一步恶化成致死型AIA。

Objective To improve the knowledge of epidemiology, diagnosis and treatment of aspirin induced asthma （AIA） in China. Methods Thirty-six cases with AIA who were reported in 30 papers in recent 10 years were analyzed retrospectively. Results The drugs which induced AIA in China mainly included acetylsalieylic acid （ aspirin）, ibuprofen （ Fenbid, ibuprofen ） , while acetaminophen （ paracetamol, Bufferin, Tylenol ） , phenylpropanoid thiazide （ Piroxieam ） , methoxy-naphthalene C acid （ naproxen ） , diclofenac in rare cases. 28.6% （8/28） of AIA patients were complicated with nasal disease . AIA could occur at all ages, especially for those over 40 years （72. 2% ,26/36）. No significant difference of prevalence in male and female. The onset time of AIA was less than 60min in 71.4% and 〉 120min in 38.6%. Most patients took the medications by oral （83.3% ,30/36） ,but the AIA onset time was not different by different administration route. Conclusions The incidence of AIA increases in recent years because of widely use of NSAIDs. However, no awareness of NSAIDs induced asthma is common in patients and physicians. For asthma patients it must be caution to take antipyretie analgesic anti-inflammatory drugs. If necessary, methoxy-naphthalene C acid （naproxen） and dielofenac could be better choice.