支气管哮喘患者IgE水平与家族史相关

本文通过59例外源性支气管哮喘患者（以下简称哮喘）与36例健康对照者的家系调查及血清总IgE、特异性IgE阳性率的测定,发现哮喘组的血清总IgE平均值(714.0u/ml) 明显高于对照组(275.1u/ml),血清总IgE超常例数百分率（61.0%）也明显高于对照组（8.3%）,证明IgE参与了哮喘的发病。哮喘组阳性家族史患者与鹰性家族史患者比较,发现前者血清总IgE平均值（921.9u/ml）明显高于后者(410.6u/ml),血清总IgE超常例数百分率也是前者(80.0%)高于后者(33.3%);特异性IgE阳性率（前者为62.9%,后者为29.2%）也具有同样特点。数据表明血清总IgE及特异性IgE与哮喘的遗传与发病相关。血清总IgE升高与特异性IgE阳性呈不一致分布提示两者可能有不同的遗传调节方式。     

草原地区气传花粉可诱发应变性鼻炎

为探讨草原地区气传花粉与应变性鼻炎(AR)之间的关系,本研究选取临床诊断为AR的患者353例为研究对象,均接受16种吸入性过敏原皮肤点刺试验(SPT)。同时,采用重力沉降法对2015年当地花粉监测,显微镜下计数每日主要气传致敏花粉数量。研究表明,353例受试者中317例(89.80%)皮肤点刺试验阳性。吸入性过敏原阳性率前5位为:大籽蒿(74.99%)、葎草(61.93%)、灰黎草(58.53%)、豚草(56.25%)、榆树(47.15%)。夏秋花粉阳性率显著高于春季花粉(83.29%vs 63.46%,p0.001)。花粉监测显示锡林浩特地区气传致敏花粉主要为蒿属、藜科,分别占全年花粉总量的54.16%和30.71%。花粉分布的最高峰月份为7~8月份。本研究表明,草原地区AR常见致敏原为夏秋季花粉,为多重过敏原,且该草原地区主要气传花粉为蒿属与AR患者SPT主要致敏原一致。草原地区气传花粉在AR发病中的起着重要作用。     

PCR结合反向斑点杂交法检测石蜡包埋组织中的曲霉感染

目的评价PCR结合反向斑点杂交法检测福尔马林固定、石蜡包埋组织中曲霉感染的可行性。方法选取39例病理证实曲霉感染的患者活检标本（21例为鼻窦感染标本、18例为尸检标本）,以1对真菌特有的28SrRNA保守序列结构作为真菌通用引物,以临床常见的4个曲霉菌种：烟曲霉、黄曲霉、黑曲霉、土曲霉的种特异性序列为种特异性探针,与扩增产物进行反向斑点杂交。结果尸检标本阳性率为55．6％（10／18）,鼻窦标本阳性率为76．2％（16／21）,特异性均为100％。在这些曲霉所致的系统性感染中,烟曲霉是主要的致病真菌。结论该方法能对临床无法培养的石蜡组织块进行回顾性病原学研究,并可以鉴定常见的曲霉菌种,有良好的特异性和敏感性,适用于临床曲霉感染的检测。     

支气管哮喘患者血清IL-4、TNF-α 及IgE 水平变化及临床意义

目的:研究支气管哮喘患者白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)及免疫球蛋白E(IgE)水平变化及临床意义.方法:对78例支气管哮喘患者(急性发作期组39例、缓解期组39例)血清IL-4、TNF-α、IgE水平进行检测,并与正常对照组的40例健康受试者进行比较分析.结果:支气管哮喘患者组血清IL-4、TNF-α、IgE水平显著高于正常对照组,差异均有统计学意义(P＜0.05);急性发作期组血清IL-4、TNF-α、IgE水平均显著高于缓解期组,差异亦均有统计学意义(P＜0.05);支气管哮喘患者血清IL-4、TNF-α、IgE水平两两之间呈正性显著相关(P＜0.05).结论:检测支气管哮喘患者血清IL-4、TNF-α、IgE水平对患者疾病预测及治疗具有重要的临床意义.     

PCR结合反向斑点杂交法检测侵袭性曲霉感染的初步实验研究

目的评价PCR结合反向斑点杂交法检测动物模型和临床免疫抑制患者的侵袭性曲霉感染的可行性。方法建立侵袭性曲霉感染动物模型,收集动物血清和健康人群、免疫抑制患者的血清,进行PCR-种特异性探针检测。以1对真菌特有的28S rRNA保守序列结构作为真菌通用引物,以临床常见的4个曲霉菌种,即烟曲霉、黄曲霉、黑曲霉、土曲霉的种特异性序列为种特异性探针,与扩增产物进行反向斑点杂交。结果PCR-探针杂交检测动物接种后24h时阳性血清为16/24,48h为18/24,72h为19/24,96h为24/24。阳性率为80%,特异性为95.8%。同时取血行真菌培养,烟曲霉阳性率仅为5%。临床标本显示两例确诊IA患者血清均为阳性,且能鉴定菌种。健康对照人群标本检测显,阴性38例,假阳性2例。结论PCR-探针杂交法较传统血培养法能更快速、灵敏地检测动物模型的侵袭性曲霉感染,并可用于对IA高危患者的监测。     

支气管扩张合并支气管哮喘患者的病原菌检测及危险因素分析

目的分析支气管扩张合并支气管哮喘患者的病原菌及危险因素。方法选取湖州市中心医院115例支气管扩张合并支气管哮喘患者作为观察组,另选取同期110例健康体检者作为对照组。分析患者病原菌的组成、耐药性及发病危险因素。结果观察组患者送检痰样本经痰培养,阳性检出者68例,阳性率为59.13%(68/115)。全部样本共分离出104株病原菌,其中革兰阴性菌92株(以铜绿假单胞菌最多,占54.81%),革兰阳性菌8株,真菌4株。药敏试验结果表明革兰阴性菌对复方新诺明、头孢曲松、左旋左氧氟沙星和阿莫西林/克拉维酸等药物的耐药性均较高,对妥布霉素、亚胺培南、头孢哌酮/舒巴坦和哌拉西林的耐药性较低。Logistic回归分析显示,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎、哮喘、过敏性肺炎、慢性支气管炎及慢性阻塞性肺疾病均是支气管扩张伴支气管哮喘发生的危险因素。结论支气管扩张合并支气管哮喘患者其病原菌以革兰阴性菌为主,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎等是支气管扩张伴支气管哮喘发生的危险因素。     

深部真菌感染的微生物学诊断与防治研究

用简单、快速的念珠菌分类鉴定法对657例不同患者标本进行了鉴定,结果121例分得真菌,阳性率18.24％。分得真菌153株,其中酵母样真菌97株,占63.4％;曲霉23株,占15.03％.酵母样真菌97株中念珠菌83株,占酵母样真菌的85.57％。念珠菌中又以白色念珠菌为主,其次为热带念珠菌、克柔氏念珠菌。深部真菌感染∞％以上是由念珠菌引起的。用ELISA和GC法检测念珠菌感染患者血清中Mn—Ag,结果表明患者血清中Mn—Ag浓度明显高于正常人,用念珠菌感染动物后24h,在血清中可测到Mn—Ag,是一个早期快速、特异诊断念珠菌血行播散的方法。丁香、黄连、桂皮、木香对真菌有抑杀菌作用。真菌感染与应用抗生素、激素的数量及时间密切相关。     

西安地区儿童支气管哮喘吸入性过敏原的调查分析

目的:探讨西安地区儿童支气管哮喘吸入性过敏原的分布情况。方法:选择950例来自西安地区的支气管哮喘患儿为研究对象,采用过敏原皮肤点刺试验检测,以组胺作为阳性对照,生理盐水为阴性对照,分析不同年龄和性别的患儿过敏原的分布情况。结果:950例支气管哮喘患儿中,384例皮肤点刺过敏原检测呈阳性,占40.4%,男女患儿过敏原检测阳性分布无明显差异(P0.05);尘螨为主要的过敏原,其次为艾蒿和霉菌类;随着患儿年龄的增加,其过敏原检测的阳性率明显升高(P0.05),且大多数过敏原检测阳性患儿至少合并2-3种过敏原阳性。结论:西安地区支气管哮喘患儿吸入性过敏原阳性率与其性别无关,但与其年龄有关,过敏原以尘螨类为主,大多数检测阳性的患儿对至少一种以上的过敏原阳性。     

支气管扩张合并支气管哮喘患者支气管肺泡灌洗液病原菌培养及药敏状况研究

目的:对支气管扩张合并支气管哮喘患者支气管肺泡灌洗液病原菌培养及药敏状况展开分析,实现多药耐药医院感染的有效预防与控制。方法:随机选取2010年9月~2013年8月期间收治的50例支气管扩张症合并支气管哮喘患者,对50例患者支气管肺泡灌洗液标本进行病原学检测及药敏试验,并对临床感染资料及病原菌耐药性进行统计学分析。结果:50例支气管扩张症合并支气管哮喘患者支气管肺泡灌洗液培养阳性率为30例,60.0%,共分离出48株细菌。其中,革兰阳性球菌5株,占分离菌的10.4%;革兰阴性杆菌41株,占分离菌的85.4%;真菌2株,占分离菌的4.2%。41株革兰阴性杆菌对抗菌药物的耐药性分别为:复方新诺明73.1%,阿米卡星22.0%,环丙沙星14.6%,头孢曲松48.8%,头孢噻肟41.5%,头孢哌酮19.5%,头孢他啶20.7%,头孢他啶/舒巴坦12.1%,头孢吡肟22.0%,庆大霉素17.1%,阿莫西林/克拉维酸41.5%,哌拉西林/他唑巴坦19.5%。结论:铜绿假单胞菌是支气管扩张合并哮喘患者感染中的常见病原菌,医务人员要结合病原菌高耐药率、高分离阳性率的特征,合理运用抗菌药物控制传播。     

广州地区70例儿童头癣病原学分析

目的 了解6a来广州地区头癣类型及病原菌分布特点.方法 采用病例回顾性分析,对2007年7月～2013年9月来广州市中山大学附属第三医院皮肤科门诊就诊的头癣患儿（平均为6.0±3.6岁）真菌直接镜检、培养及分离鉴定的结果进行分析.结果 70例头癣患儿真菌镜检阳性为69例,阳性率为99％,真菌培养阳性为47例,阳性率为81％.白癣为52例,占74％.病原菌包括犬小孢子菌19例（40％）、须癣毛癣菌13例（28％）、紫色毛癣菌5例（11％）,石膏样小孢子菌3例（6％）,其他病原菌为7例（15％）.其中,4～7岁的头癣患儿为35例,占50％.结论 儿童头癣的主要临床类型为白癣.致病菌以亲动物性犬小孢子菌为主.患儿的主要年龄段为4～7岁.     

Indoor airborne fungi as risk factors in IgE-mediated respiratory allergy

The purpose of this epidemiological study was to assess respiratory allergy in relation to the presence of indoor airborne fungi. The relationship between IgE-mediated respiratory allergy (skin test positivity) and the presence of fungi (CFU/m³) in the indoor environments of 104 subjects was assessed in a cross-sectional study by controlling for extraneous variables (age, gender, predisposition, asthma, rhinitis, skin positivity to ragweed and mite, and smoking). The qualitative and quantitative measurements of airborne seasonal fungi (Alternaria spp. andCladosporium spp.) and non-seasonal airborne fungi (Penicillium spp. andAspergillus spp.) were taken in the subjects’ indoor environments twice in a 2-year period by volumetric methods (Burkard Personal Sampler). There was a significant association between skin test positivity to seasonal fungi and to ragweed (Adj. OR=3.42, CI=1.76–6.66). There was no association between skin test positivity to seasonal fungi and asthma (Adj. OR=0.52, CI=0.28–0.98), but a significant association was found between skin test positivity to seasonal fungi and rhinitis (Adj. OR=5, CI=2.03–12.32). In a logistic regression analysis (maximum likelihood estimates—model A), no statistical association was found indoors between skin prick test positivity to seasonal fungi (Alternaria and/orCladosporium) and airborneAlternaria and/orCladosporium concentrations (Adj. OR=1.18, CI=0.66–2.07). There was a significant association between skin prick test positivity to seasonal fungi and to non-seasonal fungi (Adj. OR=12.81, CI=1.67–98.34). There was no association between asthma and airbornePenicillium concentrations (Adj. OR=1.86, CI=0.47–7.33) nor between rhinitis and airbornePenicillium concentrations (Adj. OR=0.18, CI=0.03–1.19). In another logistic regression analysis (maximum likelihood estimates — model B) using non-seasonal fungi (Aspergillus andPenicillium), no statistical association was found indoors between skin prick test positivity to non-seasonal fungi and airbornePenicillium concentrations (Adj. OR=0.33, CI=0.07–1.69). These findings suggest an association between rhinitis and seasonal fungi. In the rhinitis stratum, subjects who had skin test positivity to ragweed had a higher risk of being sensitive to seasonal airborne fungal allergens. Subjects with non-seasonal fungal allergy had a high relative risk if they were also allergic to seasonal fungi. There was no association between asthma and airborne fungi, as the epidemiological study (cross-sectional design), by definition, does not allow an etiological evaluation of chronic disease. This would require a longitudinal study, i.e. the measurement of repeated exposure as an independent variable (allergen) and repeated measurement as a function of the disease as outcome in humans as a dependent variable.     

支气管哮喘患者疾病认知状况调查及控制水平的影响因素分析

目的:调查支气管哮喘患者疾病认知状况,并分析控制水平的影响因素。方法:选取2018年7月~2020年7月期间贵州医科大学附属医院诊治的支气管哮喘患者100例,采用面对面问卷调查的方式调查所有患者疾病认知状况。采用哮喘控制测试(ACT)对患者哮喘控制水平进行评估。根据ACT结果将患者分为哮喘未控制组(n=57)和哮喘控制组(n=43)。分析哮喘控制水平的影响因素。结果:支气管哮喘患者对疾病认知相关问题的回答正确率均在60%以上,但仅有12%的患者使用过峰流速仪。本研究中100例患者均完成ACT,其中完全控制17例,控制良好26例,未控制57例,分别占比17.00%、26.00%、57.00%,哮喘控制率为43.00%。由单因素分析显示,支气管哮喘患者的哮喘控制水平与性别、家庭月收入、文化程度、家族史、吸烟史、居住处是否空气污染、病程、哮喘用药依从性、使用吸入性糖皮质激素治疗、抑郁情况、焦虑情况有关(P<0.05)。多因素Logistic回归分析显示:焦虑情况、抑郁情况、居住处空气污染、吸烟史是支气管哮喘患者哮喘控制水平的危险因素,而哮喘用药依从性、使用吸入性糖皮质激素治疗是支气管哮喘患者哮喘控制水平的保护因素(P<0.05)。结论:支气管哮喘患者对疾病有一定的正确认知,但仍未达到理想状态。哮喘控制水平受多种因素影响,可根据相关影响因素做出针对性的干预措施,以改善支气管哮喘控制水平。     

Quantitative linkage genome scan for atopy in a large collection of Caucasian families

Quantitative phenotypes correlated with a complex disorder offer increased power to detect linkage in comparison to affected-unaffected classifications. Asthma is a complex disorder characterized by periods of bronchial obstruction and increased bronchial hyper reactivity. In childhood and early adulthood, asthma is frequently associated also with quantitative measures of atopy. Genome wide quantitative multipoint linkage analysis was conducted for serum IgE levels and percentage of positive skin prick test (SPT(per)) using three large groups of families originally ascertained for asthma. In this report, 438 and 429 asthma families were informative for linkage using IgE and SPT(per) which represents 690 independent families. Suggestive linkage (LOD > or = 2) was found on chromosomes 1, 3, and 8q with maximum LODs of 2.34 (IgE), 2.03 (SPT(per)), and 2.25 (IgE) near markers D1S1653, D3S2322-D3S1764, and D8S2324, respectively. The results from chromosomes 1 and 3 replicate previous reports of linkage. We also replicate linkage to 5q with peak LODs of 1.96 (SPT(per)) and 1.77 (IgE) at or near marker D5S1480. Our results provide further evidence implicating chromosomes 1, 3, and 5q. The current report represents one of the biggest genome scans so far reported for asthma related phenotypes. This study also demonstrates the utility of increased sample sizes and quantitative phenotypes in linkage analysis of complex disorders.     

miR-1165-3p、miR-145水平在支气管哮喘患者中的表达及其临床意义

摘要 目的：探讨微小RNA（MicroRNA,miR）-1165-3p、miR-145水平在支气管哮喘患者中的表达及其临床意义。方法：收集2021年1月-2022年3月中国人民解放军总医院第六医学中心62例支气管哮喘患者作为研究组,其中轻度急性发作27例,中度急性发作22例,重度急性发作13例。另收集同时期、同年龄段30例健康体检者作为对照组。采用实时荧光定量PCR（RT-PCR）检测各组血清miR-1165-3p、miR-145表达水平。采用Spearman相关分析不同程度支气管哮喘患者与血清miR-1165-3p、miR-145之间的相关性。通过受试者工作特征（ROC）分析血清miR-1165-3p、miR-145表达水平对不同程度支气管哮喘的诊断效能。结果：与对照组相比,研究组中白细胞介素-6（IL-6）、嗜酸性粒细胞、总免疫球蛋白E（IgE）水平显著升高,第1秒用力呼气容积（FEV₁）占预测值百分比（FEV₁%）则显著降低,差异均有统计学意义（P＜0.05）。不同严重程度支气管哮喘患者（轻度、中度、重度）血清miR-1165-3p、miR-145表达水平均高于健康对照组,支气管哮喘越严重,其表达水平越高,且组间、组内比较差异均有统计学意义（P＜0.05）。Spearman相关分析显示,miR-1165-3p、miR-145、IL-6表达水平与哮喘严重程度呈正相关（P＜0.05）,FEV₁%与哮喘严重程度呈负相关（P＜0.05）,嗜酸性粒细胞、总IgE与哮喘严重程度无相关性（P＞0.05）。对轻度、中度、重度急性支气管哮喘发作的诊断效能显示：血清miR-1165-3p的曲线下面积（AUC）（0.95CI）分别为3.085（0.326～29.221）、0.712（0.611～0.829）、0.755（0.602～0.948）。血清miR-145的AUC（0.95CI）分别为0.833（0.708～0.979）、0.754（0.590～0.964）、0.816（0.671～0.993）。结论：血清miR-1165-3p、miR-145表达水平具有较高的诊断效能,支气管哮喘越严重,诊断的特异性越高,可作为支气管哮喘严重程度的无创诊断指标。     

Analysis of lymphocyte response to chironomid midge antigens in asthmatic and non-asthmatic individuals

Chironomid antigens are currently one of the important allergens for bronchial asthma in Japan. We evaluated in vitro responses of peripheral blood lymphocytes (PBLs) to chironomid antigens and compared these responses with serum IgE levels. PBLs from adult asthmatic patients showed stronger proliferation in response to the extract of adult midges of Chironomus yoshimatsui compared with healthy adults. On the other hand, elevated PBL responses of child asthmatic patients to chironomid antigens were not observed. There was no significant correlation between PBL proliferation and the serum IgE level. Our results might suggest that elevated PBL proliferation in response to chironomid allergens has somehow important pathogenic roles in adult cases although this does not correlate directly with specific IgE production.     

Allergy against chironomids (non biting midges) in adult atopic patients

Summary The aim of this investigation was to evaluate the prevalence of atopic sensitization to chironomids (CHI) in patients with asthma and/or rhinitis (A/R), and to study concomitant sensitization to CHI and other allergens. Skin prick tests were performed with 3 different CHI extracts as well as with common inhalant allergens in 600 consecutive patients, 495 of which had A/R. Allergen specific IgE antibodies in the sera against CHI, shell fish and cockroaches were analyzed with Magic Lite.59 (12%) of the patients with A/R had a positive skin test with CHI. Positive skin tests with house dust mites and a storage mite were more common in CHI allergic patients than in other atopic patients. Nasal or conjunctival provocation tests, performed on 23 of the patients with positive skin test with CHI, were clearly positive in 7 cases (30%), questionable in 8 (35%) and negative in 8 cases (35%).Magic Lite, performed on sera from 50 of the patients with positive skin test against CHI, was positive with CHI in 39 cases (78%), with crayfish in 33 (66%), shrimp 20 (40%), cockroach 21 (40%) and with crab in 3 cases (6%).It is concluded that sensitization against CHI is common in patients with A/R. The clinical relevance of the positive test results is, however, unknown. Concomitant sensitization with CHI, crustaceans and cockroach is common.     

Serum levels of total IgE and soluble CD23 in bronchial asthma

The aim of the present study was to compare, during the pollen season, serum levels of total IgE and soluble CD23 (sCD23) from patients with allergic bronchial asthma, with those from healthy subjects. Significantly higher levels of total IgE and sCD23 were found in patients with asthma compared to the control group. Both in normal controls and in asthmatic patients, a significant correlation was shown between the levels of these two molecules. In asthmatic patients, significant correlations were found for both total IgE and sCD23, with lung function measured as bronchial responsiveness to inhaled methacholine. These results suggest that in asthmatic patients, in addition to the study of total serum IgE levels, the assessment of sCD23 serum levels may be helpful in the evaluation of disease activity.     

Diagnostic significance of immunoglobulins in infectious allergic bronchial asthma

In 100 patients with infectious allergic bronchial asthma the levels of IgM. IgG and IgA were determined by Mancini's method and the levels of IgE, tissue and microbial antibodies by the Prausnitz - Küstner test before and after combined treatment carried out under conditions of the microclimate of the salt mines in the village of Solotvino. The data on the content of immunoglobulins in the blood serum allowed the authors to establish 3 types of immediate hypersensitivity. THe decreased content of IgM in the blood serum indirectly revealed the role of immune complexes in the pathogenesis of infectious allergic bronchial asthma. The high content of IgE suggested that atopy could take some part in the infectious process.