背景: 在容易暴露于大量微生物的环境( 如传统的农场) 中成长的儿童, 不易患儿童哮喘和特应性体质。在既往的研究中, 微生物暴露的标志物与这些疾病呈负相关关系。方法: 在两项横断面研究中, 我们比较了居住于农场的儿童与参照组儿童哮喘和特应性体质的患病率以及微生物暴露的多样性。在一项PARSIFAL研究[ 变态反应的预防-与农业及特别信仰( Anthroposophic) 生活方式相关的儿童致敏作用的危险因素] 中, 研究者采用单链构型多态性( SSCP) 分析筛查了床垫灰尘样本的细菌DNA, 以检测出培养技术无法检测到的环境细菌。在另一项GABRIELA 研究[ 鉴定欧共体中哮喘的遗传和环境原因的多学科研究( GABRIEL) 高级研究] 中, 研究者采用培养技术对儿童房间落尘样本的细菌和真菌的分类进行了评估。结果: 在这两项研究中, 居住于农场的儿童哮喘与特应性体质的患病率较低, 并且他们比对照组儿童暴露于更多种类的环境微生物中。相反, 微生物暴露的多样性与哮喘发生危险呈负相关[ PARSIFAL 研究的比值比为0. 62; 95% 可信区间( CI) 为0. 44 ～0. 89; GABRIELA 研究的比值比为0. 86; 95% CI 为0. 75 ～0. 99] 。此外, 存在某种更为局限的暴露也与哮喘发生危险呈负相关; 这包括暴露于真菌中曲菌属中的某些物种( 经校正的比值比为0. 37; 95% CI 为0. 18 ～0. 76) , 以及暴露于多种细菌物种, 包括单核细胞增生李斯特菌、芽孢杆菌属物种、棒杆菌属物种和其他细菌( 经校正的比值比为0. 57,95% CI 为0. 38 ～0. 86) 。结论: 居住于农场的儿童比参照组儿童有更大范围的微生物暴露, 这种暴露解释了哮喘与成长在农场之间呈负相关关系的本质部分。【述评】哮喘发病机制的卫生学说认为在儿童时期接触大量的抗原能减少成年后哮喘的发病率, 主要机制是在人体免疫系统发育的过程中接触抗原可诱导免疫耐受, 此学说主要基于流行病学调查得出的结论。本研究采用分子生物学的方法研究儿童时期微生物暴露对哮喘发病率的影响, 结果证实微生物暴露的程度与哮喘发病呈负相关, 进一步证实了哮喘发病的卫生学说, 同时表明环境因素在哮喘发病中具有重要意义, 并提示儿童在发育过程中尽量接触多种抗原对减少成人过敏性疾病具有一定意义。
Objective To investigate the expression of RNP（alpha defensins） in guinea pigs with bronchial asthma and the influences of P2Y2 receptors on the expression. Methods Seventy-two adult male guinea pigs were randomly divided into a control group （group A） and an asthma group （group B）. The asthma model was established by sensitizing with ovalbumin injection intraperitoneally and challenging with ovalbumin inhalation. Then the A and B groups were divided into following subgroups,ie,the saline groups （A1/B1），ATP groups （A2/B2），and Suramin groups （A3/B3），in which the animals were intervented with saline，ATP，and suramin respectively. Total pulmonary resistance （RL） was measured.Total and differential cell counts in bronchoalveolar lavage fluid （BALF） were measured. Pathological changes of lung were observed under light microscope using HE staining. The plasma levels of RNP and IL-8 were measured by ELISA. The protein and mRNA expressions of RNP and P2Y2 were detected by immunohistochemistry and RT-PCR. Results The RL increased significantly as much as 10% in group B compared with group A. Pathological study revealed that luminal narrowing of bronchus and inflammatory cells infiltration in the asthma group. The total cell and polymorphonuclear neutrophil （PMN） counts in BALF in group B1 were significantly higher than group A1 and B3，but lower than group B2 （Plt;0.05）,but no significant difference among group A1，A2，or A3 was found. The RNP expression in plasma and lung tissue in group B1 was higher than group A1 and B3，but lower than group B2 （Plt;0.05）. The RNP expression in plasma and lung tissue was lower in group A1 than group A2，but higher than group A3（Plt;0.05）. The IL-8 expression in plasma in group B1 was significantly higher than group A and B3，but lower than group B2 （Plt;0.05） but no significant difference among group A1，A2，or A3 was found（Pgt;0.05）. RNP protein expressed predominantly in lung tissues，especially where the PMN infiltrated. The expression of RNP mRNA were consistent with the RNP protein expression in all groups. P2Y2 mRNA expression in group A1 was lower than group A2，and higher than group A3 （Plt;0.05）.P2Y2 mRNA expression in group B1 was lower than group B2 but higher than group B3 （Plt;0.05）. The linear correlation analysis showed that RNP had no significant correlation with PMN and IL-8 in group A，and was positively correlated with P2Y2 mRNA （Plt;0.05） while RNP was positively correlated with PMN，IL-8，and P2Y2 mRNA in group B. Conclusion RNP expression increases in bronchial asthma guinea pigs and may be related to P2Y2 receptors.
【摘要】 目的 探讨系统规范的健康教育指导对哮喘患儿护理效果的影响。 方法 记录并分析2002年1月-2009年5月门诊或住院诊治的873例哮喘患儿的情况。将患儿分为健康教育组和对照组；健康教育组采用个体化管理的治疗护理方案进行系统的健康教育，对照组采用常规治疗和护理。 结果 对照组和健康教育组的总体有效率分别为77.3%和96.6%。健康教育组在临床控制率、显效率和总体有效率方面均明显优于对照组（Plt;0.05）。健康教育组在发作次数和缺课天数方面明显少于对照组（Plt;0.01）。 结论 健康教育对小儿哮喘的护理有重要意义。【Abstract】 Objective To investigate the effects of health education on nursing pediatric asthma. Methods A total of 873 asthma children got treatment from January 2002 to May 2009 were registered and analyzed. The children were divided into health education group and control group. The health education group was given education about asthma while the control group was given traditional nursing. Results The overall efficacy rate of the control group and health education group were 77.3% and 96.6%. The clinical control rate, show efficiency rate and overall efficiency rate in the health education group were higher than those in the control group (Plt;0.05).The attack frequency and absent days in the health education group were less than those in the control group (Plt;0.01). Conclusion The health education is important for nursing pediatric asthma.
Objective To explore the effects of prolonged inhalation of Aspergillus fumigatus ( Af)spores on epithelial cell injury and expression of epidermal growth factor receptor( EGFR) in airways of asthmatic rats. Methods 64 male Wistar rats were randomly divided into 8 groups, ie. chronic asthma group ( group A) , chronic asthma plus Af spores inhalation for 1 week ( group B) , 3 weeks ( group C) and 5 weeks ( group D) , chronic asthma plus saline inhalation for 5 weeks ( group E) , OVA-sensitized and salinechallenged group ( group F) , and OVA-sensitized and saline-challenged plus Af spores inhalation for 5 weeks ( group G) ( each n =8) . The airway resistance ( Raw) and change of Raw after acetylcholine provocation were detected using a computerized system. The concentrations of epidermal growth factor ( EGF) andtransforming growth factor alpha( TGF-α) in BALF were measured by ELISA. The extents of epithelial cell injury and goblet cell hyperplasia were evaluated on hematoxylin and eosin-stained( HE) and periodic acidschiff ( PAS) stained lung sections. The expression of EGFR in airway epithelia was demonstrated byimmunohistochemistry, and the level of EGFR protein in the rat lung tissues was measured by western blot.Results The concentration of EGF( pg/mL) ( 51. 72 ±8. 54, 68. 12 ±7. 85, 86. 24 ±9. 12, respectively)and TGF-α( pg/mL) ( 55. 26 ±9. 30, 75. 58 ±11. 56, 96. 75 ±14. 66, respectively) , detached/ inner perimeter of epithelium( % ) ( 11. 25 ±3. 12, 26. 45 ±5. 56, 28. 50 ±7. 50, respectively) , the ratio of goblet cell area to epithelial cell area ( % ) ( 16. 42 ±5. 24, 22. 64 ±6. 82, 36. 38 ±9. 21, respectively) , the integrated optical density ( IOD) of EGFR positive stain in airway epithelial cells ( 82 ±15,120 ±19, 165 ±21, respectively) , and the EGFR protein levels in lung tissues ( 0. 91 ±0. 26, 1. 61 ±0. 52, 2. 52 ±0. 78,respectively) in group B, C, and D were higher than those in group A, E, F and G( P lt; 0. 05 or P lt;0. 01) .The change rates of Raw( % ) ( 61. 91 ±5. 26, 84. 69 ±6. 38) in group C and D were higher than those in group A, E, F and G ( P lt; 0. 05 or P lt;0. 01) . The IOD of EGFR was positively correlated with detached/inner perimeter of epithelium( % ) and the ratio of goblet cell area to epithelial cell area( % ) ( r = 0. 692,P lt;0. 01; r = 0. 657, P lt; 0. 01, respectively) . Conclusion Prolonged inhalation of Aspergillus fumigatus spores can aggravate airway epithelial cell injury, up-regulate the expression of EGFR in airway epithelial cell and induce goblet cell hyperplasia, thus increase the airway responsiveness in rats with chronic asthma.
Objective To study the effects of anxious condition on asthma symptom burden and asthma control in elderly asthma patients in primary care settings. Methods Totally 128 elderly asthma patients were recruited in this study. The patients were required to fill in the questionnaire，then the score of asthma control test （ACT） and Hamilton anxious meter（HAMA） were calculated. Risk factors of anxious condition were analyzed by logistic analysis. Results The ACT scores in the anxious patients were significantly lower than those of the non-anxious patients [17.45±3.14 vs. 21.45±2.37，Plt;0.05）. The patients with lower incoming and more complications had more severe anxious condition，lower asthma control level，and more asthmatic medications. Meanwhile the latter conditions also increased the incidence of anxiety in the elderly asthma patients significantly （Plt;0.05）. Conclusions The elderly asthma patients in primary care settings are also complicated with anxiety，and the anxious condition can significantly increase asthma symptom burden and decrease asthma control level.
支气管哮喘防治全球创议(GINA)将哮喘的严重程度分为三度四级，其中三级和四级属于中度和重度哮喘。在整个哮喘人群当中，中重度哮喘大约只占1／3，但在临床上轻度哮喘患者很少就诊，中重度哮喘大约占就诊患者的2／3甚至更多。中重度哮喘患者由于症状明显，频繁就诊，因为哮喘控制不良，经常出现急性发作，需要住院治疗，虽然人数不是很多，但占用了大部分的医疗资源。无论是从提高哮喘防治的整体水平的角度，还是从减少哮喘疾病负担的角度，都应当将中重度哮喘作为哮喘长期管理的主要的目标人群。
【摘要翻译】 胸腺基质淋巴生成素( TSLP) 触发树突状细胞介导的Th2 型炎症反应。一个位于TSLP 基因启动子区域的rs3806933 位点的单核苷酸多态性能产生转录因子激活蛋白( AP) -1 的结合位点。这种变异增强了AP-1 结合到调控元件的能力, 并增强聚肌苷酸胞苷酸刺激人类正常支气管上皮细胞时TSLP 启动子-报告子反应活性。我们研究了这种包括rs3806933 位点的多态性是否影响支气管哮喘的易感性和临床表型。我们选择了三个具有代表性的单核苷酸多态位点进行TSLP 基因相关性研究, 对象为两个独立的人群( 其中一个为693 例儿童特应性哮喘患者和838 例对照者, 另一个为641 例成年哮喘患者和376 名对照者) 。我们进一步检测了糖皮质激素和长效β2 受体激动剂( 沙美特罗) 对聚肌苷酸胞苷酸刺激的人类正常支气管上皮细胞TSLP 基因表达的影响。我们发现启动子多态性位点rs3806933、rs2289276 与儿童特应性哮喘和成人哮喘的易感性均显著相关。功能单核苷酸多态性位点rs3806933 与哮喘相关( Meta 分析, P = 0. 000056; 比值比, 1. 29; 95% 可信区间, 1. 14 ～1. 47) 。Rs2289278 的基因型和肺功能相关。并且, 糖皮质激素和沙美特罗可协同性地抑制聚肌苷酸胞苷酸刺激导致人类正常支气管上皮细胞TSLP mRNA 及蛋白的上调表达。TSLP 多态性变异与支气管哮喘和肺功能显著相关。因此, TSLP可能作为联合治疗的分子靶点。【述评】 越来越多的研究表明哮喘是一种环境和遗传因素相互作用的疾病。本研究不但发现TSLP 启动子多态rs3806933、rs2289276 与儿童特应性哮喘和成人哮喘的易感性均显著相关, 并研究了其导致哮喘炎症反应可能与该多态性位点产生激活蛋白( AP) -1 的转录因子的结合位点。这种变异增强了AP-1 结合到调控元件从而导致基因表达异常。同时, 作者还发现临床常用的哮喘治疗药物ICS 与LABA 的联合制剂可调节TSLP 表达。这些数据表明TSLP在哮喘发病中起重要作用, 并进一步阐明ICS 与LABA 联合治疗的分子机制。该研究不但从分子遗传和分子生物学的角度阐明TSLP多态性在哮喘发病中的分子机制, 并从分子药理层面进一步证实目前常用哮喘治疗方案的合理性, 研究较为深入。
Objective To investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.