单纯支气哮喘和支气管哮喘合并支气管扩张症患者呼出气一氧化氮水平的差异比较

目的探讨单纯支气哮喘和支气管哮喘合并支气管扩张症患者呼出气NO(FeNO)水平的差异对比。方法选择2017年1月~2018年4月收治的单纯支气哮喘患者50例为对象,作为A组,另选取同时间段收治的支气管哮喘合并支气管扩张症患者50例为对象,作为B组;比较分析两组FeNO水平差异、第1秒用力呼气容积(FEV1)水平差异、最大呼气峰流速(PEF)水平差异、外周血清白介素-4(IL-4)水平差异、γ干扰素(IFN-γ)水平差异。结果单纯支气哮喘患者的FeNO水平[(26.45±10.30)ppb]明显低于支气管哮喘合并支气管扩张症患者,第1秒用力呼气容积水平[(2.86±0.31)L]明显高于支气管哮喘合并支气管扩张症患者,最大呼气峰流速水平[(3.95±0.25)L/min]明显高于支气管哮喘合并支气管扩张症患者,IL-4水平[(367.55±45.20)ng/L]明显高于支气管哮喘合并支气管扩张症患者,IFN-γ水平[(153.75±26.70)ng/L]明显低于支气管哮喘合并支气管扩张症患者,P <0.05。ROC曲线AUC=0.808,95%可信区间=0.840~0.968,截断点临界值=36.60ppb,敏感度为80.60%,特异度为72.10%。结论与单纯支气哮喘患者FeNO水平比较,支气管哮喘合并支气管扩张症患者FeNO水平更高,有重要临床应用价值。

中医药治疗支气管哮喘的概况

支气管哮喘是一种慢性呼吸道疾患 ,控制发作及预防越来越受到重视 ,其疗效与药物副作用也受到广泛关注。本文就近几年中医药治疗支气管哮喘的概况进行综述。

血脂对儿童支气管哮喘发病的影响

目的 :探讨血脂水平对儿童支气管哮喘发病的影响。方法 :选取94例支气管哮喘患儿作为观察组,另外选取同期接受体检的98例健康儿童作为对照组。根据临床哮喘分期标准将观察组患儿分为急性发作期和慢性持续期亚组,比较对照组和观察组、对照组与哮喘急性发作期组和慢性持续期组血脂水平的差异。采用Spearman相关分析探讨血脂与支气管哮喘发病的相关性。结果 :观察组血低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯(TG)、总胆固醇(TC)水平与对照组比较,差异均无统计学意义(P> 0.05)。血HDL水平,对照组明显高于哮喘急性发作期组和慢性持续期组(P <0.05),以急性发作期组最低;血TC水平,哮喘慢性持续期组明显高于对照组和哮喘急性发作期组(P <0.05),以急性发作期组最低;血LDL、TG水平在各组间比较,差异均无统计学意义(P> 0.05)。TG、TC水平与支气管哮喘发病率无相关性(P> 0.05),LDL(r=0.365,P=0.031)、HDL(r=0.236,P=0.024)与支气管哮喘发病呈显著正相关。结论 :血脂水平与儿童支气管哮喘发病有密切关系,其中血LDL、HDL水平与支气管哮喘发病相关性较大。

加味麻杏甘石汤治疗支气管哮喘48例的临床疗效研究

目的研究加味麻杏甘石汤治疗支气管哮喘病临床疗效。方法将48例支气管哮喘病变患者分为治疗组和对照组。对照组按常规西药治疗,治疗组在此基础上用加味麻杏甘石汤,比较两组的疗效。结果治疗组总有效率为96.4%,对照组总有效率为95%,治疗组总有效率高于对照组。结论加味麻杏甘石汤治疗支气管哮喘疗效理想,可在临床上推广使用。

中西医结合治疗支气管哮喘41例临床观察

目的观察中西医结合对支气管哮喘的治疗效果。方法将患者随机分为两组,均给予常规抗生素及解痉平喘药,治疗组加服用中药自拟哮喘方;治疗10 d。结果治疗组总有效率高于对照组。结论中西医结合治疗支气管哮喘可明显提高临床疗效。

中药治疗小儿支气管哮喘80例

本文报告自拟方胆龙散治疗小儿支气管哮喘80例,总有效率95%。提示本方对风热犯肺、痰热壅肺、热毒伤肺等实喘疗效较好。

布地奈德 沙丁胺醇雾化治疗小儿哮喘急性发作

目的探讨布地奈德混悬液和沙丁胺醇溶液联合雾化对儿童哮喘急性发作的治疗效果。方法自2006年6月～2007年10月本院急性发作期患儿120例,分为治疗组60例,对照组60例,年龄、性别、病程、病情程度等差别无显著性。两组均采用常规治疗的基础上,对照组给予0.5%沙丁胺醇溶液+生理盐水5ml雾化吸入1～3次/d,10～15min/分。治疗组给予布地奈德混悬液1ml(0.5mg)+0.5%沙丁胺醇溶液+生理盐水2ml雾化吸入1～3次/d,10～15min/次,雾化采用空气压缩泵喷射吸入,疗程5～7d。结果治疗组60例中,显效50例,有效10例,对照组60例中显效34例,有效26例,在喘息呼吸困难改善心率恢复正常两肺改善方面,治疗组与对照组比较差别有高度显著性,P<0.01。结论雾化吸入布地奈德混悬液可取得与静脉用药相同的疗效而减少患儿的痛苦和不良反应,在缓解临床症状及改善肺功能方面治疗组明显优于对照组,效果满意。

浅析肺鼻同治法

“肺鼻同治法”是龙江医学流派高仲山教授经过数十年的临证经验创立的肺系疾病治法,高仲山教授的学术传承人高雪、曲敬来教授经过多年的探索及不断创新,将“肺鼻同治法”用于治疗哮病患者。高、曲两位教授认为“宿痰伏肺”是哮病的病因,认为哮病之“宿痰”伏于“肺系”与“肺经”,并在“肺系伏邪论”的基础上,将“肺鼻同治”法广泛应用于肺系疾病的防治,收效显著。

Respiratory Distress Resulting from Gastroesophageal Reflux Is not Asthma,but Laryngotracheal Irritation,Spasm,even Suffocation

ESPITE the strong association between gastroesophageal reflux disease （GERD） and asthma has been undisputedly established and widely recognized by experts in advanced countries. Yet few topics in medicine are as controversial as the causal relationship between GERD and asthma： some argue that GERD causes asthma, while others think the other way around is true, still quite a few believe that bronchodilator medications are to blame. This controversy continues to be a conundrum or more piece of the puzzle.1 We would like to share two thoughts which might be a belated revelation with scholars and experts and invite them for further cooperative studies： the GERD-derived respiratory distress is not asthma, but GERD pure and simple; and the pathogenesis of respiratory distress is not asthma, but laryngotracheal irritation/spasm/suffocation.

Remission of bronchial asthma after viral clearance in chronic hepatitis C

A 53-year-old man with a history of blood transfusion at the age of 20 was admitted to our hospital because of liver dysfunction. He had bronchial asthma when he was 18 years old, which naturally resolved within 2 years. However, his bronchial asthma recurred at the age of 45 and was treated with oral theophylline. He was diagnosed as having chronic hepatitis C based on the histological and clinical findings, and then interferon (IFN) therapy was administered. The frequency of bronchial asthma attack was gradually decreasing after IFN therapy with marked improvement of hypereosinophilia. He achieved sustained viral response (SVR) and his bronchial asthma did not worsen even after the cessation of IFN. Hepatitis C virus (HCV) infection and IFN therapy were considered in the remission of asthma in this case. HCV infection could be the cause of bronchial asthma, especially in patients with late appearance of asthma.

CIRCULATING INTERCELLULAR ADHESION MOLECULE 1 LEVELS IN SERA OF BRONCHIAL ASTHMA

Objective The aim of the study was to determine whether bronchial asthma was associated with increased levels of soluble intercellular adhesion molecule 1(sICAM 1) in serum, which might be valuble data for the effective therapy of these patients Patients and methods The concentrations of sICAM 1 were determined in sera of healthy donors and asthmatic patients using a sensitive enzyme immunoassay Results The mean(±SD) levels of serum sICAM 1 of 26 asthmatic patients (205±72 0 μg/L)was significantly higher than that of the 30 healthy volunteers (154±63 9 μg/L,P<0 01) There was no much difference between the serum levels in 12 patients suffering from atopic asthma and the levels in 14 patients with nonatopic asthma The serum concentrations of sICAM 1 were higher during asthma attacks than that during remissions in the same patients (P<0 05) Conclusion These results suggest that sICAM 1 may play a certain role in the pathophysiology of bronchial asthma,and might be signals for successful treatment

DEVELOPMENT OF RESEARCHES ON THE TREATMENT OF BRONCHIAL ASTHMA WITH ACUPUNCTURE AND MOXIBUSTION

Acu-moxibustion therapy is one of the commonly-used remedies for the prevention and treatmerit of asthma. In the present article, the authors review development of clinical studies on acu-moxibustion treatment of asthma in recent 5 years from ① changes of pulmonary function as forced expiratory volume in 1 second （FEV1）, forced vital capacity （FVC）, FEV1%, peak expiratory flow （PEF）, maximum mid expiratory flow （MMEF）, etc., ② changes of immune function as serum IgE, IgG, subgroups of T lymphocytes, inflammatory mediators, cytokines, etc, and ③ changes of the nervous system and related receptors including nitric oxide （NO）, vasoactive intestinal peptide （VIP）, substance P （SP）, and cAMP/cGMP. Additionally, the authors also introduce the development of experimental researches from the effects of acu-moxibustion on ① inflammatory cells, ② nervous system and receptors, ③ patho-morphological changes of the lung tissue, and ④serology of acupuncture.

Association of Xenobiotic Detoxification Enzymes Gene Polymorphism in Predisposition of Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Glutathione-S-transferase （GST） family enzymes are implicated in the pathopbysiology of bronchial asthma （BA） and chronic obstructive pulmonary disease （COPD）. In some cases both illnesses exhibit similar pathomorphologic and clinical features, indicating common genetic basis of predisposing to development of disease. To assess genetic susceptibility we conducted association analysis of glutathione-S-transferases Mu （M）, Theta （T） and Pi （P） gene polymorphism with disease development in 85 adult asthma, 60 COPD subjects and 64 control subjects. Present investigation of GST gene polymorphisms indicates that GSTM1 and GSTT null alleles are associated with predisposition for COPD and they do not appear to play a substantial role in susceptibility to BA. However, homozygote ＋/＋ and heterozygote ＋/0 genotypes of GSTT1 revealed to be associated with increasing of IgE level in serum in BA patients. Our findings suggest that the 105 Val variant of GSTP1 contributed to the increasing risk of developing of both diseases, and more likely for COPD.

CLINICAL OBSERVATION ON TREATMENT OF ALLERGIC BRONCHIAL ASTHMA WITH ACUPOINT APPLICATION THERAPY

In the present paper, the therapeutic effect of acupoint application of Chinese Materia Medica in the treatment of allergic asthma was observed. The results revealed that topical application of drug paste [mixture of powder of Mahuang (Herba Ephedrae), Xixin (Herba Asari), Baijiezi (Semen Sinapis Albae), etc.] at the acupuncture points could improve symptoms and signs of allergic asthma patients, with the total effective rate being 69.57% (16/23) for the short term effect, and 52.17%(12/23) for the long term effect. In medication (Aminophylline) group, of the 25 cases of allergic asthma, 16 (64.0%) were effective after 4 weeks of treatment, while 6 (24.0%) were still effective that was shown by 6 months’ follow up. The therapeutic effect of acupoint application group was significantly better than that of medication group in the long term effect. Results also showed that no obvious interrelation between the short term therapeutic effect and the duration or the severity of the disease. Results also display that acupoint application therapy is an effective, safe and handy method with fewer side effects for asthma.

MEDICINAL VESICULATION THERAPY AND ITS CLINICAL APPLICATION

In this paper, the authors introduce medicinal vesiculation therapy from its origin, points for attention in clinical application, and their individual experiences. In clinical application, the authors advocate: ① avoid using drugs that are over-irritating in the property, and strictly controlling the dose of drugs and the duration of application, ② in selection of drugs, some factors as patients’ conditions, the season, the geographic location, etc. should be taken into account. In the present paper, 3 typical cases of bronchial asthma, tonsil swelling and facial paralysis treated with medicinal vesiculation therapy are introduced. Clinical practice demonstrates that this therapy is economical, simple and convenient and fairly effective in treatment of some chronic diseases.

嗜酸粒细胞性气道炎症和慢性咳嗽

嗜酸粒细胞性气道炎症是以气管和支气管壁存在明显嗜酸粒细胞浸润为特征的一种病理状态。哮喘、咳嗽变异性哮喘及非哮喘性嗜酸粒细胞性支气管炎是慢性咳嗽的常见病因，嗜酸粒细胞性气道炎症是其共同病理过程，提示嗜酸粒细胞性气道炎症与慢性咳嗽的发生可能有密切联系，并呈现不同的临床表型。

Role of β-adrenoceptor at different stages of bronchial asthma

Objective To investigate the changes of β-adrenergic receptor (βAR) in peripheral lymphocytes and β2AR mRNA levels at different stages of bronchial asthma. Methods β2AR density and β2AR mRNA level in peripheral lymphocytes, cAMP and cGMP levels in blood plasma were estimated by radioligand binding assay, radioimmunoassay and RT-PCR.Results (1) Maximum bound volume (Bmax) and equilibrium dissociation constant (Kd) of β2AR of lymphocyte in asthma patients at remission stage were markedly higher than that in normal subjects, while cAMP levels in blood plasma showed no difference. Bmax of β2AR and cAMP levels in asthma patients at acute exacerbation stage were significantly lower than that in normal subjects, and Kds between these two groups were not much different. (2) Expression of β2ARmRNA in peripheral lymphocytes of asthmatics at remission stage was not significantly different compared with that in normals. Conclusions Amount and function of βAR and β2ARmRNA levels are related to asthmatic conditions. Changes of βAR and β2ARmRNA in asthma might rather be a pathological change accompanied by the course of the disease than a primary defect.

Analysis of the T cell receptor Vδ region gene repertoire in bronchoalveolar lavage fluid (BALF) and peripheral blood of asthmatics

Objective To explore the role of γδT cells in the airway of asthmatics and to identify the forces which induce and maintain the inflammatory processMethods Peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) were obtained from7 asthmatic subjects and 7 nonsmoker control subjects The percentage of γδT cells in the PB and BALF was measured by immunofluorescent staining and flow cytometry The frequency of usage and the clonality of Vδ subfamilies (Vδ 1-Vδ 3) were assessed by RTPCR and gene scanning Results A higher proportion of γδT cell was detected in the BALF of asthmatic subjects (7.8%±4.7%) than that from control subjects (3.3%±3.0%, P=0.04) No selective usage for a particular Vδ subfamily was found, but the relative expression level of Vδ 1 was significantly higher in the asthmatic airway (44%±13%) than in the control (19%±5%, P=0.0002) In asthmatic subjects, the monoclonal or oligoclonal expansion of γδT lymphocytes was predominant in the BALF, especially Vδ 1+ T lymphocytes Conclusions Antigenic specific γδT cells might play an important role in the inducement and maintenance of airway inflammation Persistent antigenic stimulation may be the key factor that maintains chronic airway inflammation in asthma