哮喘的炎症指标最新进展（医学ppt）

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1、哮喘炎症的非创伤性检测指标及临床意义AirwaysNarrowing哮喘的病理TriggerfactorMucuspluggingAirwaywalloedemaSmoothmusclespasm确定是否有气道阻塞:用肺功能仪Sensitivity=35%Smithetal.AJRCCM.,2004litresFEV1seconds123456NORMALOBSTRUCTEDGINA哮喘的定义…chronicinflammatorydisorderoftheairways……increaseinairwayhyper-responsiveness

2、……recurrentepisodesofrespiratorysymptoms……variableairflowobstruction……reversiblespontaneouslyorwithtreatment.GlobalINitiativeforAsthma2007ABCDSimpsonetalRespirology2006;11:54-61哮喘的炎症亚型A.NeutrophilicB.EosinophilicC.MixedcellularityD.PaucigranularIsairwayinflammationrelatedto…c

3、igarettesmoking…..activeorpassive?infection…..bronchiectasis?airpollution…..e.g.dieselfumes?allergic(IgE-mediated)asthma?…..e.g.ascarislumbricoides?-Dependingonthecause,thetypeofairwayinflammationmaybedifferent.-Thisisimportantbecauseitwillinfluencethepotentialresponsetoanti-

4、inflammatorytreatmentOnlyeosinophilicinflammationissteroidresponsiveRelationshipbetweensputumeosinophilsandresponsetoICStherapyN=120“Unstableasthma”RxTrialof:FLU500µg/dayORFLU2000µg/dayORoralprednisolone30mg/dayMeijeretal.Clin.Exp.Allergy2002;32:1096-1103Baselinesputumeosinop

5、hils%RelationshipbetweensputumneutrophilsandresponsetoICStherapyinasthmaGreenetal.Thorax2002PC20FEV1VASAllothersn=38Neutros>65%Eos<2%,n=11BUD800µg/dayfor2monthsEosinophilicinflammationissteroidresponsiveinflammationBrown,1958“Asthma”symptomsCo-existingpathologye.g.rhinitiswit

6、hpost-nasaldripAnxietyleadingtohyperventilationorvocalcorddysfunctionOtherpathologye.g.bronchiectasis,GErefluxPoorcompliance,inadequateanti-inflammatorytreatmentRespiratorysymptomsinpatientswith“asthma”“Asthma”symptomsCo-existingpathologye.g.rhinitiswithpost-nasaldripAnxietyl

7、eadingtohyperventilationorvocalcorddysfunctionOtherpathologye.g.bronchiectasis,GErefluxPoorcomplianceorinadequateICSdoseleadstouncontrolledairwayinflammationRespiratorysymptomsinpatientswith“asthma”炎症检测术（Inflammometry）Inflammometry标本采集方法有创技术经纤支镜支气管粘膜活检支气管肺泡灌洗（BAL）手术切除标本有创气道炎症

8、检测优点：可直接检测气道炎症是气道炎症的“金标准”缺点：属于侵入性检测可引起气道高反应不适用于哮喘发作期(特别是重症哮喘)结论：可作为研