顺尔宁病例-分析报告.ppt

英国胸科学会推荐的CVA的治疗方案包括短效β2受体激动剂、吸入糖皮质激素，以及白三烯受体拮抗剂1 美国胸科医师学会（ACCP）指南2建议，经吸入糖皮质激素和支气管舒张剂疗效不佳的CVA患者，在排除依从性差等影响因素后，可以在升级到口服激素治疗前先增加白三烯受体拮抗剂治疗 Demeester积分:24 h食管pH值＜4的次数、反流时间大于5min的次数、最长反流时间、食管pH值＜4占监测时间百分比 SAP：检查时实时记录反流相关症状，以获得反流与咳嗽症状的相关概率 Slide *：白三烯是气道炎症的重要介质 半胱氨酰白三烯是引起哮喘炎症和反复发作的重要炎症介质。GINA指南（2011）明确指出半胱氨酰白三烯是强效的支气管收缩剂和促炎反应介质，主要由肥大细胞与嗜酸性粒细胞产生。抑制其作用可以增加肺功能并改善哮喘症状，它们是唯一的此类介质。 SGA 2003-W-6701-SS MS* Slide 12: Central Role of Cysteinyl Leukotrienes in Asthma First identified in the late 1970s, the CysLTs, including LTD4, are key mediators in asthma. Early evidence of the importance of LTs in asthma was provided by their recovery in the blood, bronchoalveolar lavage fluid, and urine of patients after spontaneous or induced bronchospasm. The ability of specific LT receptor antagonists to increase airflow and reduce symptoms further supports LT involvement in this disease.1 CysLTs, including LTD4, are generated by inflammatory cells such as mast cells and eosinophils. Through multiple mechanisms, CysLTs and LT receptor occupation have been correlated with1: Increased vascular permeability and edema formation Increased mucus production with decreased mucociliary transport Recruitment of inflammatory cells, such as eosinophils, from bloodstream to airway. Eosinophil influx is a component in the inflammatory process that underlies asthma Eosinophils in the airway releasing inflammatory mediators, including cationic proteins, that can damage the epithelium. Epithelial damage can then expose sensory fibers to allow stimulation of cough or other bronchial reflexes Continued… SGA 2003-W-6701-SS MS* Slide 4 半胱氨酰白三烯和糖皮质激素敏感的介质是哮喘炎症中两个重要通道。5 糖皮质激素不能阻断白三烯介导的炎症通道。5,6 因此治疗双通道与单一治疗糖皮质激素敏感通道相比，能够提供附加疗效 – 更好的炎症控制和有效的哮喘控制。5,6 References 5. Peters-Golden M, Sampson AP. Cysteinyl leukotriene interactions with other medications and with glucocorticosteroids during airway inflammation. J Allergy Clin Immunol 2003;111(1 suppl):S37-S42 6.Bisgaard H. Pathophysiology of t