支气管哮喘的研究治疗进展

1、支气管哮喘的研究治疗进展支气管哮喘的研究治疗进展global initiative for asthma 2003global initiative for asthma 2003global initiative for asthma 2003哮喘免疫组织病理学改变哮喘免疫组织病理学改变嗜酸性粒细胞嗜酸性粒细胞哮喘的变态反应性炎症哮喘的变态反应性炎症.关于细胞因子的平衡（关于细胞因子的平衡（th1/th2）asthmacopdairflowlimitationsmoothmuscledysfunctionairwayinflamationairwayremodellingmuco-cilli

2、arydysfunctionstructuralchangeairway inflamationsystemiccomponent 急性炎症慢性炎症气道重塑 asthma 粘液分泌过多嗜酸性细胞肥大细胞 抗原th2 细胞血管扩张新血管形成血浆渗出水肿形成中性粒细胞粘粘 液液 栓栓巨噬细胞/树突状细胞平滑肌收缩肥大 / 增生胆碱能反射上皮脱落上皮纤维化感觉神经激活神经激活barnes pj 0 2 4 6 24（m）100无夜间症状无夜间症状fev1mpef不用不用saba气道高反应性气道高反应性woolcock aj, et.al. academic press 2001douwes j, e

3、t.al. thorax 2002慢慢 性性 炎炎 症症结结 构构 改改 变变急性炎症急性炎症发作发作激素疗效激素疗效反应反应时间时间barnes pj短效b2激动剂激素吸入型激素吸入激素长效b2激动剂reliever:rapid-acting inhaled 2-agonist prncontroller:daily inhaledcorticosteroid controller:daily inhaled corticosteroid daily long-acting inhaled b2-agonistcontroller:daily inhaled corticosteroid d

4、aily long acting inhaled b2-agonistplus (if needed) when asthma is controlled, reduce therapymonitorstep 1:intermittentstep 2:mild persistentoutcome: asthma controloutcome: best possible resultscontroller:none -theophylline-sr -leukotriene -long-acting inhaled b2- agonist -oral corticosteroidstepwis

5、e approach to asthma therapypde4抑制抑制camp代谢代谢pde4通过增加通过增加camp浓度，抑制嗜酸细胞炎症浓度，抑制嗜酸细胞炎症ed bateman, et.al. oralpresentation 157. ers 2003m aubier oral presentation 157 ers 2003tiotropium化学合成过程化学合成过程tiotropium vs ipratropium boulet lp et.al ajrccm 1997 milgrom h et.al nejm 1999胞降低;ige细胞染色阳性细胞降低；t细胞亚群降低；b细胞降低；il-4染色阳性细胞降低。lousi r, et.al. ajrccm 2000green rh, et.al. lancet 2002 ayres jg,et. al. jaci 2003 holga