目的:探討妊娠合并哮喘的臨床表現及治療方法。方法:對32 例妊娠合并支氣管哮喘患者的臨床資料進行回顧性分析。結果:經過適當的治療,32例支氣管哮喘合并妊娠患者癥狀緩解,隨訪至產后1 個月,嬰兒和母親均正常。結論:支氣管哮喘合并妊娠時,妊娠早期可選用對胎兒無影響的藥物如頭孢菌素類抗生素、β2 受體激動劑、糖皮質激素(吸入布地奈德,強的松口服,短期甲強龍靜滴),妊娠中晚期還可選用茶堿類藥物及全身使用糖皮質激素等藥物。
Objective To investigate the expression of stromal cell derived factor-1 ( SDF-1) and the effects of budesonide suspension for inhalation ( Pulmicort Respules) in mice with asthma. Methods Thirty Kunming female mice were randomly divided into three groups, ie. a control group, an asthma group, and a pulmicort treatment group. The asthma group and the pulmicort treatment group were sensitized with ovalbumin ( OVA) by a combination of intraperitoneal injection and repeated OVA intranasal challenges to establish mouse asthma model. The pulmicort treatment group received 100μL pulmicort by intranasal administration before OVA challenge. The immunohistochemistry was used to estimate the expression of SDF-1 in lung tissues. HE staining and Wright-Giemsa staining method were used to assess inflammatory infiltration in the airway and bronchoalveolar lavage fluid ( BALF) respectively. Results The expression of SDF-1 in the asthma group increased significantly compared with the control group ( 0.48 ±0.03 vs. 0.21 ± 0.02, Plt;0.05) , and significantly decreased after the intervention with pulmicort ( 0.29 ±0.01 vs. 0.48 ± 0.03, Plt; 0.05 ) . Compared with control group, the infiltration of inflammatory cells in airway was significantly enhanced in the asthma group, and attenuated in the pulmicort treatment group. The total number of inflammatory cells and eosinophil, lymphocyte, neutrophil counts in BALF increased significantly in the asthma group compared with the control group, and decreased significantly after pulmicort intervention. Conclusion SDF-1 may play an important role in the recruitment of inflammatory cells in asthmatic airway and pulmicort may relieve airway inflammation by decreasing the expression of SDF-1.
Objective To investigate the effect of myeloid derived suppressor cells ( MDSCs) on airway inflammation of asthmatic mice. Methods Five male BALB/ c mice aged 6 weeks were used for preparing 4T1 tumor bearing mice. Thirty female BALB/ c mice aged six weeks were randomly divided into a normal control group, an athmatic model group, and a cell transplantation group. The MDSCs were separated frommyeloid tissue of tumor-bearing mice using amagnetic cell sorting systemand cultured in RPMI medium 1640 containing GM-CSF. The morphologic characteristics of these cells were observed under lightmicroscope and the phenotypic figures were analyzed with flow cytometry. The mice in the model group and the cell transplantation group were sensitized by ovalbumin and then stimulated with nebulized ovalbumin. The mice in the cell transplantation group were intravenously administered MDSCs which purified by magnetic cell sorting system at 10 days after sensitization. The airway inflammation was evaluated by HE staining. The total and differential cell counts in bronchoalveolar lavage fluid ( BALF) were measured.Results The neutrophil and eosinophil infiltration in pulmonary tissue was dramatically increased in the model group, but not observed in the normal control group and was much milder in the cell transplantation group. The total cell count, the eosinophil and lymphocyte counts in BALF of the model group and the cell transplantation group were significantly higher than those of the normal control group( P lt; 0. 05) , and the number of eosinophils in BALF of the cell transplantation group was decreased when compared with that of the model group( P lt;0. 05) . Conclusion MDSCs via intravenous infusion can effectively suppress airway inflammation in a mouse asthma model.
ObjectivesTo detect expressions of trefoil factor 1 (TFF1) and TFF3 in the mice with acute allergic airway disease (AAD) after different interventions, and explore primitively the effect of recombinant TFF3 on airway inflammation and mucous secretion.MethodsForty BALB/c mice were randomly divided into 5 groups, each group with 8 mice, ie. a normal saline control group (group A), an AAD group (group B), a budesonide intervention group (group C), a recombinant TFF3 intervention group (group D), and a budesonide+recombinant TFF3 intervention group (group D). The BALB/c mice were sensitized and challenged with ovalbumin to induce AAD. Lung tissue sections were stained with hematoxylin-eosin staining for assessment of airway inflammation, and immunohistochemistry was used for detecting TFF1/TFF3 expression in the airway. Alcian blue stain was applied to determine mucous secretion.ResultsAirway inflammation score and airway mucous secretion: Group B was significantly more than group A (P<0.01); Group C was less than group B (P<0.05), and there was no significant difference between group D and group B (P>0.05); There was no significant difference between group C and group E (P>0.05). Expression of TFFs: TFF1 and TFF3 were expressed in epithelial cells, goblet cells and submucosal gland cells of bronchi and bronchioles in all groups; The expressions of TFF1 and TFF3 in group B were significantly higher than those in group A (P<0.01), while the expressions of TFF1 and TFF3 in group C were lower than those in group B (P<0.05). TFF1 expression in airway epithelium was positively correlated with inflammatory score (r=0.876, P=0.000) and mucin expression (r=0.807, P=0.000). TFF3 level was positively correlated with inflammatory score (r=0.654, P=0.006) and mucin expression (r=0.666, P=0.005).ConclusionsOvalbumin-induced acute allergic airway inflammation significantly increases TFF1/TFF3 expression. Intranasal TFF3 treatment may not influence airway inflammation and mucus secretion. Inhaled corticosteroids to some extent inhibit expressions of TFF1 and TFF3, simultaneously suppress airway inflammation and mucus secretion in the mouse model of acute AAD .
支氣管哮喘防治全球創議(GINA)將哮喘的嚴重程度分為三度四級，其中三級和四級屬于中度和重度哮喘。在整個哮喘人群當中，中重度哮喘大約只占1／3，但在臨床上輕度哮喘患者很少就診，中重度哮喘大約占就診患者的2／3甚至更多。中重度哮喘患者由于癥狀明顯，頻繁就診，因為哮喘控制不良，經常出現急性發作，需要住院治療，雖然人數不是很多，但占用了大部分的醫療資源。無論是從提高哮喘防治的整體水平的角度，還是從減少哮喘疾病負擔的角度，都應當將中重度哮喘作為哮喘長期管理的主要的目標人群。
ObjectiveTo analyze the causes of death of patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). MethodsA total of 493 patients admitted between January 2006 and Octomber 2015 were respectively analyzed, including 348 asthma patients and 145 ACOS patients. The patients was divided into a survival group and a death group based on the outcome. The ACOS patients were divided into three subgroups based on FEV1% pred level (≥80%, 50%-80%, and < 50%, respectively). The basic characteristics and causes of death were analyzed using χ2-test, t-test and Fish-test based on data type. ResultsThe age (t=3.457, P < 0.001), male proportion (χ2=15.394, P < 0.001) and smoking history (χ2=12.418, P=0.002) had significant differences between the survival group and the death group. The proportion of ACOS patients was higher in the death group (42% vs. 27%, χ2=7.033, P=0.008), and the mortality was also higher in the ACOS patients (21% vs. 12%). The proportion of male patients was higher in the ACOS patients than that in the asthma patients (86% vs. 38%, P < 0.001). The leading three causes of death in the ACOS patients were malignant diseases (45%), pneumonia (26%), and cardiovascular diseases (16%). Malignant diseases were the main cause of death in the ACOS patients with FEV1% pred≥50%, while pneumonia was the main cause of death in those with FEV1% pred≥50%. There was no significant difference in cause of death distribution between three subgroups with different FEV1% pred (P=0.318). ConclusionThe main cause of death of ACOS patients is malignant diseases, the followed are pneumonia and cardiovascular diseases.
ICS/LABA聯合治療的提出和推廣，是近十年來哮喘治療領域的一個革命性進展。然而，從LABA問世之初，圍繞LABA的爭議就始終沒有平息過。在2010年2月18日，FDA再次發出關于LABA安全性的公告。美國FDA申明LABA絕不應當（should never）單獨用于治療兒童或成人哮喘。制造商須在這類藥物產品的標簽上加入這一警示，同時采取其他步驟以減少這類藥物的過度使用。這些藥物包括單獨的LABA制劑，如施立穩（Serevent，沙美特羅）和 Foradil（福莫特羅），也包括和ICS的復合制劑如Advair（沙美特羅/氟替卡松）及信必可（布地奈德/福莫特羅）。FDA要求產品標簽反映以下信息：●如果沒有使用其他哮喘控制性藥物，如ICS，則不應當使 用LABA。LABA只能與其他控制性藥物聯合使用，不應當單獨使用。只有對那些其他哮喘控制性藥物不能取得充分控制的患者，才能夠長期使用 LABA。●使用LABA治療應當采用取得哮喘癥狀控制的最短的療程，一旦哮喘取得控制，只要有可能就應當停用。患者應當用其他的控制性藥物維持。●需要使用LABA和ICS治療的兒童和青少年患者，應當使用一種既含有ICS也含有LABA的復合制劑，以保證治療的依從性。
ObjectiveTo investigate and compare the clinical characteristics of chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). MethodsA case-control study was conducted in 139 patients with COPD who admitted between March 2013 and September 2013. The patients were divided into a COPD-only group and an ACOS group. Clinical data were collected and compared between two groups. ResultsOf all 139 patients, 93 patients were diagnosed with COPD only (66.9%) and 46 patients were diagnosed with ACOS (33.1%). Compared with the COPD-only group, the ACOS group had a lower ratio of exposure to cigarette smoking (80.4% vs. 93.5%), but high possibility of a history of asthma (89.1% vs. 4.3%), allergies (60.9% vs. 9.6%) and airway hyperreactivity (80.4% vs. 6.5%) (P < 0.05). In clinical symptoms, the ACOS group had a higher ratio of breathless as the first complaint of symptom (26.1% vs. 8.6%) and dry and moist rales in lung by auscultation (67.4% vs. 31.2%) (P < 0.05). In laboratory examination, the ACOS group had increased levels of peripheral blood eosinophils and IgE than those of the COPD-only group (21.7% vs. 5.4%, 18.3% vs. 4.3%, P < 0.05). In treatment, the ACOS group was more likely to use systemic glucocorticoid (58.7% vs. 24.7%) and be treated with higher dosage of glucocorticoid (80 mg, P < 0.05). ConclusionsACOS and COPD-only are two subtypes of COPD. Compared with COPD-only patients, ACOS patients might be more likely to be breathless and have dry and moist rales in clinical symptoms, more likely to have increased levels of peripheral blood eosinophils and IgE in blood test, and more inclined to receive systemic glucocorticoid treatment.