Warrell D A, Fawcett I W, Harrison B D, Agamah A J, Ibu J O, Pope H M, Maberly D J
Q J Med. 1975 Apr;44(174):325-47.
One hundred and six asthma patients were studied in Zaria in the Nigerian savanna region. This group resembled hospital attenders in general in containing a disproportionately large number of immigrants from southern Nigeria and students undergoing higher education. Childhood asthma was rare. Asthma started after the age of 19 years in 69 per cent of patients. Twenty-seven per cent gave a history of rhinitis but none had had eczema. Twenty-two per cent gave a family history of asthma. Cutaneous hypersensitivity to house dust supported by a history of attacks being precipitated by dust was found in 41 per cent of patients. Asthma was worst in the rainy season in 45 per cent of patients. Mites were found in mattress dust samples; the mean count was 243 mites per g dust; Dermatophagoides farinae formed 86-6 per cent of the total mite population. The variability of airways obstruction averaged 50 per cent of maximum values for forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF). The median severity of airways obstruction measured as FEV1/VC per cent was four standard deviations below predicted normal. Eighty-seven per cent of patients were positive to prick skin tests with one or more allergens. The commonest reactions were to house dust (58 per cent), house dust mite (45 per cent) and Dermatophagoides farinae (44 per cent). Fifty-one per cent of a group of controls were also positive on skin testing but the pattern of responses was different from the asthmatic patients. This high proportion of reactors is explained by high allergen load. Serum IgE levels were lower in the asthmatics than in a group of healthy controls who showed the very high levels characteristic of some African populations. We suggest that the controls were protected from atopic disease by developing high blocking levels of non-specific IgE, perhaps in response to gut helminths. The clinical pattern of asthma in Zaria is compared with other countries in the tropical and temperate zones. The particular problems of treating asthma in developing tropical countries are discussed.
在尼日利亚稀树草原地区的扎里亚，对106名哮喘患者进行了研究。该组患者与一般的医院就诊者相似，来自尼日利亚南部的移民和接受高等教育的学生比例过高。儿童哮喘很少见。69%的患者哮喘始于19岁以后。27%的患者有鼻炎病史，但无人有湿疹病史。22%的患者有哮喘家族史。41%的患者有皮肤对屋尘过敏且有因灰尘诱发发作的病史。45%的患者哮喘在雨季最为严重。在床垫灰尘样本中发现了螨虫；平均计数为每克灰尘243只螨虫；粉尘螨占螨虫总数的86.6%。气道阻塞的变异性平均为第一秒用力呼气量（FEV1）和呼气峰值流速（PEF）最大值的50%。以FEV1/VC百分比衡量的气道阻塞严重程度中位数比预测正常值低4个标准差。87%的患者对一种或多种过敏原的皮肤点刺试验呈阳性。最常见的反应是对屋尘（58%）、屋尘螨（45%）和粉尘螨（44%）。一组对照组中有51%的人皮肤试验也呈阳性，但反应模式与哮喘患者不同。这种高比例的反应者是由高过敏原负荷所解释的。哮喘患者的血清IgE水平低于一组健康对照组，后者表现出一些非洲人群特有的非常高的水平。我们认为对照组通过产生高水平的非特异性IgE阻断来预防特应性疾病，这可能是对肠道蠕虫的反应。将扎里亚哮喘的临床模式与热带和温带地区的其他国家进行了比较。讨论了在热带发展中国家治疗哮喘的特殊问题。
