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吸入糖皮质激素对哮喘儿童支气管高反应性的改善作用:支气管高反应性家族史的重要性

Improvement in bronchial hyperresponsiveness with inhaled corticosteroids in children with asthma: importance of family history of bronchial hyperresponsiveness.

作者信息

Koh Young Yull, Lee Myung Hyun, Sun Yong Han, Park Yang, Kim Chang Keun

机构信息

Department of Pediatrics and Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chiongno-gu, Seoul 110-744, Republic of Korea.

出版信息

Am J Respir Crit Care Med. 2002 Aug 1;166(3):340-5. doi: 10.1164/rccm.2101158.

Abstract

The extent of improvement in bronchial hyperresponsiveness (BHR) with corticosteroids varies considerably among patients with asthma, although predictive factors for improvement are largely unknown. We tested the hypothesis that the improvement may vary according to family history of BHR. Children with atopic asthma (n = 121) received inhaled budesonide (800 micro g per day) regularly for 6 months. Methacholine provocative concentration causing a 20% fall in FEV(1) was measured before treatment and again after 3 and 6 months of treatment. A methacholine challenge test was also performed in each patient's parents, and the results were analyzed with regard to their children's response to corticosteroid therapy. When the children were classified into large (n = 40) and small (n = 40) improvement groups after 6 months of treatment, the prevalence of BHR and the bronchial responsiveness index were higher in parents of the small improvement group (28.8%, 1.145 +/- 0.104) than in parents of the large improvement group (6.3%, 1.095 +/- 0.064; both, p < 0.01). The magnitude of improvement in BHR at 6 months was lower in children with at least one parent with BHR (n = 45; 1.666 +/- 1.244 doubling doses) than in children with non-BHR parents (n = 76; 2.531 +/- 1.726, p < 0.01). Our results suggest that a family history of BHR may be an important factor in the sensitivity of BHR of individuals with asthma to inhaled corticosteroids.

摘要

支气管高反应性(BHR)经皮质类固醇治疗后的改善程度在哮喘患者中差异很大,尽管改善的预测因素 largely unknown。我们检验了这样一个假设,即改善情况可能因BHR家族史而异。患有特应性哮喘的儿童(n = 121)每天规律吸入布地奈德(800微克),持续6个月。在治疗前以及治疗3个月和6个月后测量引起FEV(1)下降20%的乙酰甲胆碱激发浓度。还对每位患者的父母进行了乙酰甲胆碱激发试验,并根据他们孩子对皮质类固醇治疗的反应分析结果。当将这些儿童在治疗6个月后分为改善程度大(n = 40)和改善程度小(n = 40)两组时,改善程度小的组的父母中BHR的患病率和支气管反应性指数(28.8%,1.145±0.104)高于改善程度大的组的父母(6.3%,1.095±0.064;两者均p < 0.01)。至少有一位父母患有BHR的儿童(n = 45;1.666±1.244倍剂量)在6个月时BHR的改善幅度低于父母无BHR的儿童(n = 76;2.531±1.726,p < 0.01)。我们的结果表明,BHR家族史可能是哮喘患者BHR对吸入性皮质类固醇敏感性的一个重要因素。

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