课件：哮喘的小气道炎症(科内稿).ppt

Nikander, 1997 * Berry M,et al.Alveolar nitric oxide in adults with asthma: evidence of distal lung inflammation in refractory asthma. Eur Respir J 2005;25:986-991. Berry 等证实了对哮喘患者的持续性小气道炎症进行治疗的必要性。该研究发现，尽管已经根据哮喘治疗指南的 4 步治疗法，优化了哮喘患者的雾化吸入治疗，但这些患者的肺泡一氧化氮水平，及其支气管肺泡灌洗（BAL）液内的嗜酸性粒细胞水平，仍呈增高状态。而且，在这些患者接受了为期 1 个月的加倍剂量 ICS 吸入治疗后，其肺泡一氧化氮水平并无减少。因此，研究者认为，在治疗持续性的小气道炎症时，传统的吸入装置并不能有效地将药物输送到位。然而，上述患者在接受了为其 2 周的口服糖皮质激素治疗后，其肺泡一氧化氮水平则明显降低。 入组难治性、轻中度哮喘患者和健康受试者。哮喘患者具有哮喘症状和至少1项气道高反应和/或气流阻塞症状。 Patients with refractory asthma, who on clinical grounds required an increase in anti-inflammatory medication, defined as a juniper asthma control score . 1.57 and/or a sputum eosinophil count 3%, had either oral corticosteroid treatment initiated or a doubling of their inhaled corticosteroid and were invited for repeat measurement of their alveolar NO concentration after ≥2 weeks. FIGURE 3.Changes in alveolar nitric oxide (NO) concentration in patients who received a doubling of their inhaled steroid dose (n=10) and those who received oral corticosteroids (n=11).#:p=0.034; ?p=0.002; NS: nonsignificant The baseline concentration of alveolar NO was not significantly different in the patients who were started on oral corticosteroids (mean 7.9 ppb) than those who received a doubling dose of their inhaled corticosteroid (mean 7.5 ppb,mean difference 0.4 (95% CI: -3.9–2.5); p=0.65). Other baseline characteristics were similar (table 2). Treatment with oral corticosteroids led to a significant reduction in alveolar NO concentration (7.9–3.6 ppb, mean difference 4.3 (95% CI: 1.3–7.4); p=0.002), whereas a doubling of the dose of inhaled corticosteroids did not lead to a reduction (7.5–8.0 ppb, mean difference -0.6 (95% CI: -3.2–2); p=0.62; fig. 3). The differencein the change in alveolar NO concentration between the two treatment groups was significant (mean difference 5.0 (95% CI:1.0–5.0); p=0.034). * 白三烯1型受体（红色）在呼吸性支气管和肺泡中都有表达。 * Mechiche H, et al. Effects of cysteinyl leukotrienes in small human bron