小青龙汤对慢性支气管哮喘患者肺功能的影响

目的：探讨小青龙汤治疗慢性支气管哮喘的临床疗效。方法：选取2009年1月至2011年1月我院收治入院的哮喘患者84例,随机分为对照组和治疗纽,对照组采用西药对症治疗,治疗组在对照纽的基础上联合应用小青龙汤,治疗结束后对两组患者的临床疗效和肺功能进行分析。结果：临床疗效比较：治疗组总有效率显著高于对照组（95．42％VS80．95％,P〈0．05）;治疗结束后,两组患者肺功能FEV1占预计值％和PEF占预计值％均显著升高,肺功能明显好转（P〈0．05）,且治疗组肺功能改善更为明显（P〈0．05）。结论：小青龙汤作为中医经典方剂治疗慢性支气管哮喘,可显著改善肺功能,提高临床疗效。     

咳嗽变异性哮喘（CVA）与小气道功能相关性分析

目的：探讨咳嗽变异性哮喘（CVA）患者小气道功能检查对其诊断,治疗的意义。方法：对254例以慢性咳嗽为主的患者行肺功能检查并行支气管激发试验,回顾性分析小气道病变及气道高反应性检查结果与咳嗽变异性哮喘（CVA）的相关性。结果：有小气道功能障碍者接受吸入乙酰甲胆碱激发试验,气道反应性明显增高。有小气道功能障碍确诊咳嗽变异性哮喘（CVA）组起始阻力、反应阈值及阻力上升度与非哮喘组相比差异有统计学意义（P〈0.01）。结论：检查小气道功能障碍有助于哮喘的诊断,治疗及预后随访。     

维吾尔药神香草调节哮喘大鼠下丘脑-垂体-肾上腺轴功能紊乱的实验研究

目的：观察维吾尔药（维药）神香草对哮喘大鼠模型神经内分泌免疫网络若干组分的影响。方法：取雄性健康Wistar大鼠50只,随机分为正常对照组,哮喘模型组,神香草低、中、高剂量治疗组。采用致敏和雾化的方法制备哮喘模型。采用酶联免疫吸附试验（ELISA）方法检测血清中白介素-4（IL^4）、白介素-6（IL-6）、干扰素-γ（IFN-γ）、皮质酮（CORT）水平;放免法检测血浆中促肾上腺皮质激素（ACTH）的含量;采用实时定量-聚合酶链反应（RT—PCR）法测定下丘脑促肾上腺皮质激素释放激素（CRH）mRNA表达水平。结果：哮喘反复发作时,大鼠下丘脑-垂体-肾上腺（HPA）轴紊乱,哮喘大鼠下丘脑CRHmRNA表达和血浆ACTH无明显变化,实验各组血清CORT水平升高（P〈0．05）,神香草高剂量组血清CORT含量高于低剂量组（P〈0．05）。细胞因子IFN-γ无明显变化,IL-6、IL-4有下降趋势（P〈0．05）。结论：哮喘反复发作的大鼠存在NEI网络的紊乱;神香草可以增强下丘脑．垂体．肾上腺皮质（HPA）轴的功能,改善细胞因子的平衡。这些可能是其治疗哮喘的机制之一。     

支气管激发试验对咳嗽变异性哮喘诊断和治疗的新思考

目的:通过分析我院经行支气管激发试验明确诊断的咳嗽变异性哮喘(CVA)的临床和肺功能特点,为诊断和治疗CVA提供一些有益的参考。方法:临床资料采用回顾性分析,共收集142例支气管激发试验阳性而经临床诊断明确为咳嗽变异型哮喘的病例,将其按年龄分为5组,分别对不同年龄组在分布例数、症状特点、肺通气功能、激发剂量进行对比分析。结果:在142例CVA患者中,<30岁组病例42例(29.6%),30~40岁组30例(21.1%),40~50岁组28例(19.7%),50~60岁组26例(18.3%),>60岁组16例(11.3%)。在症状方面,除均有慢性咳嗽(>3周)外,随着年龄的增大,各组中出现胸闷、气促等症状的病例比例逐渐增多。在肺通气功能方面,<30岁组的肺通气功能测定明显好于>60岁组。而另外3组之间组与组之间无明显差异,但各组与<30岁组及>60岁组之间均有明显差异。结论:咳嗽变异型哮喘患者以中青年患者居多,老年患者较少,随着年龄的增长,其临床表现及肺通气功能越来越接近典型支气管哮喘,由此推想,若有条件的医院能广泛开展支气管激发试验,对咳嗽变异型哮喘患者进行早期诊断。     

Iron, Nitric Oxide, and Myeloperoxidase in Asthmatic Patients

Plasma nitric oxide (NO), myeloperoxidase (MPO), and iron (Fe) levels were determined in bronchial asthma. The relations among these parameters in different stages of asthma were interpreted. Their association with airway inflammation observed in patients with bronchial asthma as well as the roles and the contributions to the pathological processes were evaluated. A total of 62 individuals, 32 asthmatics and 30 controls, were included into the scope of this study. Plasma nitric oxide metabolites (NOx) and MPO and Fe levels were determined by the Griess reaction, ELISA, and the automated TPTZ (2,4,6-tri[2-pyridyl]-5-triazine) method, respectively. In the asthmatic individuals, plasma NOx, MPO, and Fe concentrations were 133 +/- 13 microM, 95 +/- 20 ng/ml, and 159 +/- 20 microg/dl, respectively; in the control group these values were 82 +/- 11 microM, 62 +/- 11 ng/ml, and 96 +/- 9 microg/dl. Increased values were detected for plasma MPO (p > 0.05), NOx (p < 0.01), and Fe (p < 0.01) concentrations in asthmatic individuals. Considering the facts that NO modulates the catalytic activity of MPO and induces the expression of heme oxygenase as important contributors to the mechanisms causing free Fe release, it is concluded that elevated NOx, MPO, and Fe levels observed in the asthmatic group act in a concerted manner and appear to be involved in the pathogenesis of asthma.     

滨蒿内酯对哮喘豚鼠气管平滑肌细胞RyR2 mRNA表达影响

研究哮喘豚鼠气管平滑肌细胞Ryanodine受体亚型的变化及滨蒿内酯对其的影响。将动物分为3组:正常组、哮喘组和滨蒿内酯组,采用卵蛋白致敏复制豚鼠哮喘模型,滨蒿内酯组雾化吸入滨蒿内酯。应用RT-PCR鉴定豚鼠气管平滑肌细胞(TSMC)中RyR亚型分布并观察各组豚鼠气管平滑肌细胞RyR2 mRNA表达的变化。豚鼠TSMC表达RyR2和RyR3两个亚型;哮喘时豚鼠TSMC中RyR2 mRNA表达量(以RyR2区带与-βactin区带的密度百分比表示)为47.15%±15.30%,明显低于对照组(77.12%±6.16%)(P<0.01);滨蒿内酯组豚鼠TSMC中RyR2 mRNA量为63.77%±9.09%,较哮喘组增强(P<0.05)。豚鼠TSMC表达RyR2和RyR3两个亚型;哮喘时TSMC RyR2 mRNA表达下调;滨蒿内酯可使哮喘豚鼠TSMC RyR2表达水平得以恢复。     

Effects of Th-2 type cytokines on human airway epithelial cells: interleukins-4, -5, and -13.

Proliferation and death of airway epithelial cells may be of importance in the pathogenesis of asthma. T-helper (Th)-2 response interleukins (IL)-4, -5, and -13 have the ability to induce proliferation of airway epithelial cells.     

Is low dose inhaled corticosteroid therapy as effective for inflammation and remodeling in asthma? A randomized,parallel group study

Background

While most of the clinical benefits of inhaled corticosteroid (ICS) therapy may occur at low doses, results of dose-ranging studies are inconsistent. Although symptom/lung function response to low and high dose ICS medication is comparable, it is uncertain whether low dose ICSs are as effective as high dose in the treatment of inflammation and remodeling.

Methods

22 mild or moderate asthmatic adult subjects (corticosteroid free for > 2 months) participated in a randomized, parallel group study to compare effects of fluticasone propionate (FP) 200 mcg/day and 1000 mcg/day. Alveolar macrophage (AM)-derived cytokines and basement membrane thickness (BMT) were measured at baseline and after 7 weeks treatment while symptoms, spirometry, exhaled nitric oxide (eNO) and airway hyperresponsiveness (AHR) to mannitol at baseline and 6 weeks.

Results

FP improved spirometry, eNO, symptoms and AHR with no difference between low and high dose FP. Both high and low dose FP reduced GM-CSF, TNF-alpha and IL-1ra, with no change in BMT and with no differences between low and high dose FP.

Conclusions

200 μg/day of FP was as effective as 1000 μg/day in improving asthma control, airway inflammation, lung function and AHR in adults in the short term. Future studies should examine potential differential effects between low and high dose combination therapy (ICS/long acting beta agonist) on inflammation and airway remodeling over longer treatment periods.     

Transformation of adrenal medullary chromaffin cells increases asthmatic susceptibility in pups from allergen-sensitized rats

Background

Studies have shown that epinephrine release is impaired in patients with asthma. The pregnancy of female rats (dams) with asthma promotes in their pups the differentiation of adrenal medulla chromaffin cells (AMCCs) into sympathetic neurons, mediated by nerve growth factor, which leads to a reduction in epinephrine secretion. However, the relatedness between the alteration of AMCCs and increased asthma susceptibility in such offspring has not been established.

Methods

In this study, we observed the effects of allergization via ovalbumin on rat pups born of asthmatic dams.

Results

Compared to the offspring of untreated controls, bronchial hyperreactivity and airway inflammation were more severe in the pups from sensitized (asthmatic) dams. In pups exposed to nerve growth factor (NGF) in utero these effects were aggravated further, but the effects were blocked in pups whose dams had been treated with anti-NGF. Furthermore, alterations in AMCC phenotype corresponded to the degree of bronchial hyperreactivity and lung lesions of the different treatment groups. Such AMCC alterations included degranulation of chromaffin granules, reduction of epinephrine and phenylethanolamine-n-methyl transferase, and elevation of NGF and peripherin levels.

Conclusions

Our results present evidence that asthma during the pregnancy of rat dams promotes asthma susceptibility in their offspring, and that the transformation of AMCCs to neurons induced by NGF plays an important role in this process.