目的:探讨妊娠合并哮喘的临床表现及治疗方法。方法:对32 例妊娠合并支气管哮喘患者的临床资料进行回顾性分析。结果:经过适当的治疗,32例支气管哮喘合并妊娠患者症状缓解,随访至产后1 个月,婴儿和母亲均正常。结论:支气管哮喘合并妊娠时,妊娠早期可选用对胎儿无影响的药物如头孢菌素类抗生素、β2 受体激动剂、糖皮质激素(吸入布地奈德,强的松口服,短期甲强龙静滴),妊娠中晚期还可选用茶碱类药物及全身使用糖皮质激素等药物。
Objective To explore the relationship between nasopharyngeal microecology and diseases in children with bronchial asthma. Methods A total of 41 children with asthma who were treated in Hainan Provincial Hospital of Traditional Chinese Medicine between November 2020 and March 2023 were retrospectively included in the study, and 26 healthy children undergoing adenoid examination in the same period were selected as the control group. Samples of nasal mucosa were collected from the anterior and medial side of inferior turbinate, and the expression of DEFB2, IL17A, TSLP, IL13, IL5 and T1R3 genes was analyzed by polymerase chain reaction. Nasal swabs were collected from the children, and the bacterial composition was analyzed by 16S ribosomal RNA gene sequencing. Results Compared with the control group, the rate of atopy cases in the asthma group increased significantly (53.7% vs. 19.2%, P<0.05). At the phylum level, compared with the control group, the phylum Chloroflexi, the phylum Patescibacteria, the phylum Tenericutes and the phylum Nitrospirae in the asthma group increased significantly (P<0.05), and the phylum Elusimicrobia decreased significantly (P<0.05). At the genus level, compared with the control group, the members of Bacillus (Fimnicutes), Ruminococcus (Fimnicutes), Rhodococcus (Actinobacteria), Acinetobacter (Proteobacteria), Moraxella (Proteobacteria) and Asaia (Proteobacteria) in the asthma group increased significantly (P<0.05), and the members of Enterococcus (Fimnicutes), Alkanindiges (Proteobacteria), Rickettsia (Proteobacteria), and Rhizobium (Proteobacteria) in the asthma group decreased significantly (P<0.05). Compared with the control group, the Shannon index of the asthma group decreased significantly (2.63±1.45 vs. 3.90±1.44; t=2.708, P=0.010). According to receiver operating characteristic curve analysis, the optimal cut-off point of Shannon index was 3.10. In all study populations, compared with children whose Shannon index was higher than the cut-off point, children whose Shannon index was lower than the cut-off point were characterized by increased expression of IL17A and T1R3 (P<0.05) and decreased expression of TSLP (P<0.05). Conclusion The composition and abundance of nasopharyngeal microbiota are significantly different between children with asthma and healthy control children.
ObjectiveTo explore the application of pulmonary ventilation and perfusion imaging (V/P SPECT/CT) in quantitative evaluation of ventilation and perfusion function and its potential value in guiding local treatment of lung in patients with asthma.MethodsA total of 20 patients with asthma were included in this study. All patients underwent V/P SPECT/CT and pulmonary function test, and symptoms were assessed by the ACT questionnaire. Patients were graded for degree of airway obstruction according to V/ P SPECT/CT image visual scoring criteria. The comprehensive lung function (%) of the patients was quantitatively evaluated by combining the ventilation and perfusion defect of each lung segment in V/P imaging. The correlation between the degree of airway obstruction, comprehensive lung function, pulmonary function test and ACT score was analyzed.ResultsV/P SPECT/CT imaging can be used to grade the degree of airway obstruction in asthma patients (0-3 grade). Airway obstruction grading by V/P SPECT/CT visual score was associated with predictive forced expiratory volume in one second (FEV1%pred) of patients (r=–0.74, P<0.001). V/P SPECT/CT can also comprehensively evaluate ventilation and perfusion function in patients with asthma, and comprehensive lung function measured by this method was also correlated with FEV1%pred (r=0.629, P=0.003). V/P SPECT/CT can be used to quantitatively analyze the percentage of ventilation and perfusion function in each lung lobe. Compared with V/P SPECT/CT results, the CT volume overestimates the contribution in the upper lobes, and underestimates the lower lobes contribution to overall function.ConclusionsV/P SPECT/CT can be used as a new method to directly reflect the degree of airway obstruction in patients with asthma. Moreover, it can comprehensively and quantitatively evaluate the ventilation and perfusion function of asthma patients. V/P SPECT/CT can also be used to evaluate lobe function in patients with asthma, helping to identify the heterogeneity of changes in pulmonary function in patients with asthma, and has potential value for future treatment targeting specific areas of the lung.
ObjectiveTo investigate the differences in self-perception level of asthma control and the factors affecting the ability of self-perception in patients with bronchial asthma. MethodsA total of 322 patients who were diagnosed with bronchial asthma at the First Affiliated Hospital of Harbin Medical University from March 2013 to February 2015 were recruited in the study. The clinical data were collected, including the demographic characteristics of the patients, the Asthma Control Test (ACT) and results of routine blood test and pulmonary function test on the same day that they were required to fill out the ACT. Then they were followed up at the 1st, 3rd, 6th, 12th months, and required to fill out the ACT again, and underwent the blood routine test and lung function test. In addition, health education about asthma was offered regularly during these visits. ResultsA total of 226 patients met the inclusion criteria of the study. The patients with asthma had significant differences between self-perception control level and real symptoms control level (P<0.05). The patients who were 65 years old or older perceived their symptoms of bronchial asthma rather poorly (P=0.000). The patients who received senior high school or higher education had a higher ability of self-perceived asthma control (P=0.005). The patients with allergic rhinitis combined were less likely to correctly perceive their illness compared with those who did not suffered from allergic rhinitis, and the difference was statistically significant (P=0.001). In addition, for those diagnosed with allergic rhinitis combined with bronchial asthma, regular treatment also made difference--longer treatment for rhinitis means a higher ability of self-perceived asthma control (P=0.000). The health education did play a constructive role in helping patients correctly perceive their illness (P=0.000). There was no correlation between the absolute value of peripheral blood eosinophils and the accuracy of self-perceived asthma control. Nevertheless,there was a noticeable correlation between the ability of peripheral blood eosinophils of patients with asthma and acute attack of bronchial asthma (P=0.003),which was a meaningful finding in assessing the risk of future acute attack of bronchial asthma (P=0.469). ConclusionsThere is a significant difference between self-perception control level and symptom control level in patients with asthma. The self-perception control level of asthma patients who are elderly, the low degree of educational level, merged allergic rhinitis, and lack of health education are associated with lower accuracy of self-perception control level. The absolute value of peripheral blood eosinophils of the patients with asthma can be used to assess the risk of asthma acute attack in the future, but has no significant correlation with the accuracy of self-perception control level.
Objective To investigate the expression of stromal cell derived factor-1 ( SDF-1) and the effects of budesonide suspension for inhalation ( Pulmicort Respules) in mice with asthma. Methods Thirty Kunming female mice were randomly divided into three groups, ie. a control group, an asthma group, and a pulmicort treatment group. The asthma group and the pulmicort treatment group were sensitized with ovalbumin ( OVA) by a combination of intraperitoneal injection and repeated OVA intranasal challenges to establish mouse asthma model. The pulmicort treatment group received 100μL pulmicort by intranasal administration before OVA challenge. The immunohistochemistry was used to estimate the expression of SDF-1 in lung tissues. HE staining and Wright-Giemsa staining method were used to assess inflammatory infiltration in the airway and bronchoalveolar lavage fluid ( BALF) respectively. Results The expression of SDF-1 in the asthma group increased significantly compared with the control group ( 0.48 ±0.03 vs. 0.21 ± 0.02, Plt;0.05) , and significantly decreased after the intervention with pulmicort ( 0.29 ±0.01 vs. 0.48 ± 0.03, Plt; 0.05 ) . Compared with control group, the infiltration of inflammatory cells in airway was significantly enhanced in the asthma group, and attenuated in the pulmicort treatment group. The total number of inflammatory cells and eosinophil, lymphocyte, neutrophil counts in BALF increased significantly in the asthma group compared with the control group, and decreased significantly after pulmicort intervention. Conclusion SDF-1 may play an important role in the recruitment of inflammatory cells in asthmatic airway and pulmicort may relieve airway inflammation by decreasing the expression of SDF-1.
Objective To investigate the expression of RNP（alpha defensins） in guinea pigs with bronchial asthma and the influences of P2Y2 receptors on the expression. Methods Seventy-two adult male guinea pigs were randomly divided into a control group （group A） and an asthma group （group B）. The asthma model was established by sensitizing with ovalbumin injection intraperitoneally and challenging with ovalbumin inhalation. Then the A and B groups were divided into following subgroups,ie,the saline groups （A1/B1），ATP groups （A2/B2），and Suramin groups （A3/B3），in which the animals were intervented with saline，ATP，and suramin respectively. Total pulmonary resistance （RL） was measured.Total and differential cell counts in bronchoalveolar lavage fluid （BALF） were measured. Pathological changes of lung were observed under light microscope using HE staining. The plasma levels of RNP and IL-8 were measured by ELISA. The protein and mRNA expressions of RNP and P2Y2 were detected by immunohistochemistry and RT-PCR. Results The RL increased significantly as much as 10% in group B compared with group A. Pathological study revealed that luminal narrowing of bronchus and inflammatory cells infiltration in the asthma group. The total cell and polymorphonuclear neutrophil （PMN） counts in BALF in group B1 were significantly higher than group A1 and B3，but lower than group B2 （Plt;0.05）,but no significant difference among group A1，A2，or A3 was found. The RNP expression in plasma and lung tissue in group B1 was higher than group A1 and B3，but lower than group B2 （Plt;0.05）. The RNP expression in plasma and lung tissue was lower in group A1 than group A2，but higher than group A3（Plt;0.05）. The IL-8 expression in plasma in group B1 was significantly higher than group A and B3，but lower than group B2 （Plt;0.05） but no significant difference among group A1，A2，or A3 was found（Pgt;0.05）. RNP protein expressed predominantly in lung tissues，especially where the PMN infiltrated. The expression of RNP mRNA were consistent with the RNP protein expression in all groups. P2Y2 mRNA expression in group A1 was lower than group A2，and higher than group A3 （Plt;0.05）.P2Y2 mRNA expression in group B1 was lower than group B2 but higher than group B3 （Plt;0.05）. The linear correlation analysis showed that RNP had no significant correlation with PMN and IL-8 in group A，and was positively correlated with P2Y2 mRNA （Plt;0.05） while RNP was positively correlated with PMN，IL-8，and P2Y2 mRNA in group B. Conclusion RNP expression increases in bronchial asthma guinea pigs and may be related to P2Y2 receptors.
Objective To explore the influencing factors of inhalation medication compliance in Chinese asthma patients, and to provide evidence for improving the compliance of patients with inhalation therapy. Methods PubMed, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for literature on factors influencing inhalation medication compliance in Chinese asthma patients from the establishment of databases to December 2021. Meta-analysis was performed using RevMan 5.2 software. Results A total of 16 studies were included, with a sample size of 2 600 cases, 1 084 cases of good compliance with inhalation administration, 1 516 cases of poor compliance with inhalation administration, and good compliance with inhalation administration accounted for 41.69%. The literature quality evaluation scores were all ≥4 points, all of which were of medium quality and above. Meta-analysis showed that the factors affecting inhalation compliance of asthma patients included age [odds ratio (OR)=0.54, 95% confidence interval (CI) (0.32, 0.91), P=0.02], educational level [OR=0.57, 95%CI (0.36, 0.90), P=0.02], doctor-patient relationship [OR=0.42, 95%CI (0.19, 0.93), P=0.03], disease severity [OR=0.25, 95%CI (0.11, 0.58), P=0.001], degree of mastery of asthma knowledge [OR=2.51, 95%CI (1.11, 5.65), P=0.03], degree of mastery of inhalation technique [OR=8.66, 95%CI (3.20, 23.40), P<0.0001], adverse drug reaction [OR=0.23, 95%CI (0.13, 0.41), P<0.00001]. Conclusion The compliance of inhaled dosing in Chinese asthma patients needs to be improved urgently. Age, education level, doctor-patient relationship, disease severity, mastery of asthma knowledge, mastery of inhalation technology, and adverse drug reactions are the important influencing factors of inhaled medication compliance.
Objective Using nerve growth factor ( NGF) and anti-NGF microspheres injected directly into the asthmatic rat adrenal gland, to explore the possible role of anti-NGF microsphere treatment in asthma.Methods 32 male SD rats were randomly divided into a normal control group, an asthma group, a NGF microspheres group, and an anti-NGF microspheres group. The behavior of rats, lung function testing, light microscopy of lung biopsy, electron microscopy of adrenal medulla cell ultrastructure changes, NGF and phenylethanolamine N-methyltransferase ( PNMT) expressions in the adrenal gland were assayed by immunohistochemistry method, and serum NGF, cortisol, corticosterone, epinephrine and norepinephrine concentrations were detected by ELISA. Results Behavior in the asthma rats showed varying degrees of sneezing, runny nose, wheezing, scratching the head and face, irritability holes, incontinence, increased aggression and other acts, while in the anti-NGF rats showed relatively slighter symptoms. The rats in the asthma, anti-NGF and NGF groups showed significant airway hyperresponsiveness, while RL value reduced and Cdyn value increased in the anti-NGF group compared with the asthma group. HE staining of lung tissue revealed obvious bronchoconstriction, inflammatory cell infiltration around small vessels and alveolar spaces and in interstitum, bronchial epithelial cells desquamation in the asthma group. In anti-NGF group, tracheal epithelium was relatively complete, inflammatory exudation, bronchoconstriction and inflammatory cell infiltration were milder compared to the asthma group. Electron microscopy showed vacuolated changes of adrenal medulla cells, uneven distribution of chromaffin granules in the asthma group and the NGFgroup, and the quantity and concentration of chromaffin granules were significantly lower than normal. There were villous clubbing processes on the adrenal medulla cell membrane in the NGF group. While the anti-NGF group had no significant vacuolar changes in chromaffin granules and the concentration was close to normal. Image analysis showed that mean gray values of PNMT and NGF in the anti-NGF group were significantly different fromthe asthma group. The ELISA results showed that: ( 1) The average concentrations of epinephrine in each group were as follows, ie. the control group gt; anti-NGF group gt; asthma group gt; NGF group. ( 2) The average concentrations of norepinephrine in each group were as follows, ie. the NGF group gt; asthma group gt; anti-NGF group gt; control group. ( 3) There was no significant difference among the groups in the average concentration of cortisol. ( 4) The average concentrations of norepinephrine in each group were as follows, ie. , the control group gt; anti-NGF group gt; asthma group gt; NGF group. Conclusions Local embedding of anti-NGF microspheres can alleviate inflammatory infiltration in lung tissue and improve lung function of rat model with asthma. The mechanismmay be the anti-NGF antagonists the NGF receptor and reverse adrenal medulla cell transdifferentiation process primined by NGF.