孟鲁司特纳片联合沙美特罗替卡松粉吸入剂对儿童支气管哮喘的临床疗效

目的:探究孟鲁司特纳片联合沙美特罗替卡松粉吸入剂治疗儿童支气管哮喘的临床疗效并分析复发情况。方法:选取2011年9月至2012年12月在本院就诊并住院治疗的100例支气管哮喘患儿,随机分成的对照组以及研究组,各50例。对照组吸入沙美特罗替卡松粉吸入剂,研究组给予孟鲁司特纳片联用沙美特罗替卡松粉吸入剂,观察哮喘的复发和控制情况。结果:用药治疗后两组肺功能指标均有改善(P<0.05);研究组用药第3、6个月和停药6个月时患儿肺功能较对照组改善更明显,差异均有统计学意义(P<0.05);两组患儿治疗后临床控制率均有显著的改善,但仅研究组差异有统计学意义(P<0.05);研究组在用药3个月、6个月以及停药6个月三个阶段临床控制率均高于对照组,而在用药6个月以及停药6个月两个阶段复发率均低于对照组,差异均有统计学意义(P<0.05)。结论:孟鲁司特纳片联合沙美特罗替卡松粉吸入剂治疗儿童支气管哮喘疗效较单用沙美特罗替卡松粉吸入剂治疗效果更好,复发率低。     

儿童哮喘急性发作期不同吸入给药方法的疗效对比

目的：通过比较儿童哮喘急性发作期不同吸入给药方式的疗效。为临床寻求科学高效的给药方法。方法：选取90名儿童哮喘急性发作期病例,随机、均衡分3组,A组使用沙丁胺醇（万托林）、普米克气雾剂用手控式定量型雾化器（MDI）吸入治疗。B、C两组均使用相同剂量的万托林溶液和普米克令舒溶液治疗,B组将药物加入空气压缩泵雾化器后雾化吸入。C组将药物加入氧驱雾化器后雾化吸入,比较三组病人哮喘急性发作缓解速度。结果：吸入治疗15分钟B、C两组临床疗效评价明显优于A组（P〈0．05）,而B、C两纽间无明显差异（P〉0．05）。咳嗽、气喘、哮鸣音持续时间比较,三组间有显著性差异（P〈0．01）。其两两比较,B、C两组较A组显著缩短（P〈0．01）。B、C两组间差异无统计学意义（P〉0．05）。结论：药物加入氧驱雾化器和空气压缩泵后雾化吸入缓解儿童哮喘急性发作都是较理想的给药方法,各医疗单位可以根据自身情况选用。     

沙丁胺醇雾化吸入辅助治疗小儿支气管哮喘急性发作的疗效观察

目的:观察沙丁胺醇雾化吸入辅助治疗小儿支气管哮喘急性发作的疗效。方法:将纳入研究的170例处于支气管哮喘急性发作期的患儿随机分为A组和B组,各85例。A组给予常规西医治疗,B组在常规治疗的基础上给予沙丁胺醇雾化吸入治疗。治疗1周后观察疗效,并复查肺功能。结果:B组总有效率90.59%显著优于A组总有效率69.41%,比较有显著性差异(x2=11.912P0.05);治疗后,B组各肺功能指标改善幅度明显优于A组,比较均有显著性差异(P0.05)。结论:沙丁胺醇雾化吸入辅助治疗可迅速缓解小儿哮喘急性发作,且有助于改善肺功能,临床效果满意。     

沙美特罗替卡松联合布地格福吸入气雾剂对支气管哮喘的应用效果及对 Treg T细胞亚群的影响

摘要 目的：探讨沙美特罗替卡松联合布地格福吸入气雾剂对支气管哮喘的应用效果及对 Treg T细胞亚群的影响。方法：选2021年6月到2023年4月收治的80例支气管哮喘患者,分为观察组与对照组,各40例。对照组应用沙美特罗替卡松吸入治疗,观察组应用沙美特罗替卡松联合布地格福吸入气雾剂吸入治疗,对比两组患者体征和症状消失时间,治疗前与治疗1个月后肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）、白细胞介素-6（Interleukin-4,IL-6）及T细胞亚群表达水平,并对比两组患者不良反应发生率。结果：观察组患者湿啰音消失时间、咳嗽消失时间等体征及症状消失时间较对照组短（P＜0.05）;治疗前,两组患者TNF-α、IFN-γ、IL-6水平对比无差异（P＞0.05）,治疗后均降低,且与对照组相比,观察组较低（P＜0.05）;治疗前两组患者CD4⁺、CD3⁺和CD4⁺/CD8⁺数值对比无差异（P＞0.05）,治疗后观察组患者CD4⁺、CD3⁺和CD4⁺/ CD8⁺数值均升高,且观察组高于对照组（P＜0.05）;两组患者不良反应发生率对比无差异（P＞0.05）。结论：沙美特罗替卡松联合布地格福吸入气雾剂对支气管哮喘的应用效果显著,能够缩短患者症状与体征持续时间,降低机体炎症因子反应,提升T细胞亚群比率,安全性较高。     

Cost-Effectiveness of Bronchial Thermoplasty,Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma

Background

Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently include omalizumab and standard therapy.

Objective

To evaluate the cost-effectiveness of standard therapy, BT, and omalizumab for moderate-to-severe allergic asthma in the USA.

Methods

A probabilistic Markov model with weekly cycles was developed to reflect the course of asthma progression over a 5-year time horizon. The study population was adults with moderate-to-severe allergic asthma whose asthma remained uncontrolled despite using high-dose inhaled corticosteroids (ICS, with or without long-acting beta-agonists [LABA]). A perspective of the health-care system was adopted with asthma-related costs as well as quality-adjusted life years (QALYs) and exacerbations as the outcomes.

Results

For standard therapy, BT, and omalizumab, the discounted 5-year costs and QALYs were $15,400 and 3.08, $28,100 and 3.24, and $117,000 and 3.26, respectively. The incremental cost-effectiveness ratio (ICER) of BT versus standard therapy and omalizumab versus BT was $78,700/QALY and $3.86 million/QALY, respectively. At the willingness-to-pay (WTP) of $50,000/QALY and $100,000/QALY, the probability of BT being cost-effective was 9%, and 67%, respectively. The corresponding expected value of perfect information (EVPI) was $155 and $1,530 per individual at these thresholds. In sensitivity analyses, increasing the costs of BT from $14,900 to $30,000 increased its ICER relative to standard therapy to $178,000/QALY, and decreased the ICER of omalizumab relative to BT to $3.06 million/QALY. Reducing the costs of omalizumab by 25% decreased its ICER relative to BT by 29%.

Conclusions

Based on the available evidence, our study suggests that there is more than 60% chance that BT becomes cost-effective relative to omalizumab and standard therapy at the WTP of $100,000/QALY in patients with moderate-to-severe allergic asthma. However, there is a substantial uncertainty in the underlying evidence, indicating the need for future research towards reducing such uncertainty.     

支气管哮喘遗传因子研究

研究谷胱甘肽-S-转移酶 （glutathione S-transferase, GST）M1和T1基因多态性与支气管哮喘（asthma bronchial）的关系。采取聚合酶链反应对60名支气管哮喘患者和60名正常对照进行了GSTM1和GSTT1基因非缺失（+）和缺失（0）等位基因分布频率研究。结果表明,与对照组相比,支气管哮喘患者GSTM1基因缺失的纯合子（0/0）频率（81.2%）显著升高（χ2=32.46,P<0.001;wχ2=28.75,P<0.001）。对于GSTT1也得到类似资料。而支气管哮喘患者GSTT1基因缺失等位基因（0/0）频率（71.7%）比对照组（11.7%）显著升高（χ2=26.72,P<0.001;wχ2=35.75,P<0.001）。表明GSTM1、GSTT1缺失等位基因纯合性在哮喘患者中最有特征性的。GSTM1 0/0、GSTT1 0/0结合的频率患者组为61.7%,对照组仅为1.7%（χ2=27.3,P<0.001）。提示GSTM1和GSTT1基因多态性与哮喘有显著性关联,两个基因的突变可以被视为发生支气管哮喘遗传风险因子。     

雾化吸入治疗婴幼儿重度哮喘的研究

目的:比较婴幼儿哮喘重度发作时,采用布地奈德混悬液吸入治疗和全身用甲基强的松龙的效果。方法:将78例哮喘重度发作婴幼儿按就诊顺序分为2组,分别采用布地奈德混悬液+万托林雾化(布地奈德组,35例)、万托林雾化+静脉用甲泼尼龙(甲泼尼龙组,43例)治疗,对其临床症状进行比较。结果:组内不同治疗时间患儿呼吸频率、心率、哮鸣音及自我感觉评分均随时间延长而逐渐降低,与治疗前比较差异有统计学意义(q=2.89~143.87,P<0.05或0.01);组间比较,各组指标无显著性差异。结论:提示婴幼儿哮喘重度发作时,采用布地奈德混悬液吸入治疗可达到与静脉用甲泼尼龙基本相同的效果;联合吸入治疗在一定程度上可代替全身用激素。     

Trial of Disodium Cromoglycate in Bronchial Asthma

In a double-blind cross-over trial of disodium cromoglycate on 11 patients nine were symptomatically improved, and in all of these daily measurements of peak expiratory flow increased. The forced expiratory volume in the first second and specific airway conductance did not increase in all patients. In most cases the average values for residual volume and functional residual capacity fell; exercise capacity and ventilation did not change, but the pulse rate on exercise was lower. It is suggested that the changes produced by disodium cromoglycate are worth while.     

Genetic Determinants of Predisposition to Bronchial Asthma

The ratio between the normal (+) and null (0) alleles of the genes encoding glutatione S-transferases M1 (GSTM1) and T1 (GSTT1) were studied in normal individuals from northwestern Russia (control group) and in patients with bronchial asthma (BA). The frequency of the GSTM1 0/0 genotype in the population sample was statistically significantly lower (37.8%) than in the BA patients (82.1%; ² = 16.8;P< 0.001; _W² = 15.7; = 0.01). For the GSTT1 gene, similar data were obtained. The frequency of the GSTT1 0/0 genotype in healthy donors was statistically significantly higher (16.3%) than in the BA patients (73.7%; ² = 28.5;P < 0.001; _W² = 23.22; = 0.01). A significant preponderance of the compound homozygotes for the GSTM1 and GSTT1 null alleles among the BA patients was observed. The frequency of the GSTM1 0/0, GSTT10/0 individuals among the patients was 57.9%, while it was only 4.7% among the controls (² = 27.4; P < 0.001).     

家族性支气管哮喘的遗传方式分析

为研究家族性支气管哮喘的遗传方式, 进一步确定在群体中的传递规律,用群体研究法调查邯郸地区有家族史的支气管哮喘家系。采用家系分析法和Smith无偏差校正法, 进行理论值与观察值符合程度的卡方检验分析。72个家族性支气管哮喘的家系, 包括109个核心家系, 其亲属的患病率为0.46。分析结果表明, 有单基因遗传的倾向。用家系法分析, 符合常染色体显性遗传。对D-× dd婚配家系用Smith法分析, χ² = 3.181, P > 0.05, 所得结果支持常染色体显性遗传(Autosomal domiant inheritance, AD), 并提示不同的婚 配类型, 遗传方式可能不同, 存在着遗传异质性, 研究结果可为家族性支气管哮喘的预防、诊断和治疗提供参考依据。