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关注哮喘、过敏性鼻炎的个体化治疗

2015-04-09 佚名 中国医学论坛报

重症哮喘管理最新进展    来自英国伦敦帝国理工学院实验医学、国家心肺研究所钟建桓教授,其对2014年欧洲呼吸协会(ERS)/美国胸科协会(ATS)国际指南关于重症哮喘管理方面的重点信息进行介绍。 ①进一步优化吸入型糖皮质激素(ICS)/长效β2受体激动剂(LABA)的剂量,可考虑更高剂量的治疗性试验。②考虑应用低剂量口服糖皮质激素进行维持治疗,但需监测

重症哮喘管理最新进展   

来自英国伦敦帝国理工学院实验医学、国家心肺研究所钟建桓教授,其对2014年欧洲呼吸协会(ERS)/美国胸科协会(ATS)国际指南关于重症哮喘管理方面的重点信息进行介绍。

①进一步优化吸入型糖皮质激素(ICS)/长效β2受体激动剂(LABA)的剂量,可考虑更高剂量的治疗性试验。②考虑应用低剂量口服糖皮质激素进行维持治疗,但需监测并管理副作用,包括骨质疏松症等。③根据痰液样本检测所示表型指导治疗以降低哮喘发作次数和(或)减少激素用量,重度过敏性哮喘患者建议添加IgE治疗,对于服用阿司匹林后呼吸系统疾病加重者,可考虑添加白三烯受体拮抗剂(LTRA)。④对于无表型患者的添加治疗,指南指出,茶碱类、LTRA的获益有限。⑤关于非药物介入治疗,指南指出,对于特定患者,可考虑支气管热成形术。对于此疗法,证据仍较少,其确切的获益与风险尚有待进一步确定。

亚太地区对哮喘的认知与治疗现状


为了解哮喘的流行病学和患者对这一疾病的认知情况,研究者在全球范围内的多个地区进行了问卷调查。台中荣民总医院许正园教授对亚太地区的调查结果进行了介绍,主要有以下几个方面。

1.在亚太地区各国家之间,由哮喘带来的整体疾病负担,包括哮喘控制率、发作率及疾病管理的方法、资源利用率等方面均存在较大差异。以哮喘控制为例,中国大陆自觉过去4周哮喘已完全控制或控制良好的患者比例为69%,中国台湾为84%,而韩国仅为27%。

2.患者对哮喘治疗药物的副作用心存顾虑,40%~50%的患者担心必须使用ICS治疗。另外,研究还显示,患者对哮喘治疗的期望不高。这使得哮喘控制目标与患者自觉哮喘控制相关性极低。

3.哮喘患者存在较重的身体及心理负担,25%的哮喘患者认为自己在急性发作时有生命危险。

总体而言,哮喘控制不佳对患者个人、家庭及社会都带来了负担,改善哮喘控制刻不容缓。

我国儿童哮喘诊治现状及指南修订要点探讨

上海第一人民医院洪建国教授介绍,流行病学调查研究显示,近年来我国儿童哮喘患病率呈明显上升趋势,且哮喘控制现状也不容乐观,我国一项门诊调查显示,2~16岁儿童哮喘控制不佳的比例为25.6%。因此,我国儿童哮喘的管理仍有较大改善空间。

哮喘防治指南的发布对规范临床诊疗、提高哮喘控制率有重要作用。目前,我国正在酝酿新一轮指南的修订与更新。会上,洪建国教授也提前透露这次指南更新的要点。①正确诊断和评估儿童哮喘。目前,儿童哮喘的诊断尚缺乏足够的客观指标,主要依据临床症状诊断。②与成人哮喘不同,儿童哮喘有较高的缓解率。对于其治疗,应在功能和炎症评估的基础上,采用阶梯式治疗原则指导下的个体化治疗。此外,多数患儿无需终生用药,可根据现有指南选择停药时机。

鼻部干预对哮喘防控的意义

研究表明,80%的哮喘患者伴有过敏性鼻炎,事实上,过敏性鼻炎与哮喘有共同的诱发因素,且由相同的炎症细胞与介质所致。南京军区总医院王秋萍教授指出,过敏性鼻炎可使哮喘发生风险增加,而规范治疗鼻部炎症,可有效减轻下气道炎症,降低哮喘发生风险。而哮喘患者应高度关注鼻部疾病,早期积极联合鼻用激素治疗可有效缓解下气道炎症,有利于哮喘控制。此外,研究还提示,鼻用激素或可作为哮喘尤其是重症哮喘的辅助或协同治疗药物,与下气道治疗药物同时应用,或可帮助哮喘得到更好的控制。

伴哮喘慢性鼻窦炎外科治疗的意义

流行病学调查表明,鼻窦炎和哮喘常相伴发生,鼻窦炎患者中哮喘患病率为34%~58%,明显高于哮喘5%~10%的总体患病率。首都医科大学附属北京同仁医院周兵教授指出,哮喘伴鼻窦炎、鼻息肉患者经鼻内镜手术可有效改善鼻腔和下呼吸道功能,显著提高患者生活质量。一项纳入50例慢性鼻-鼻窦炎(CRS)伴哮喘患者的研究结果显示,以鼻内镜手术为主的综合治疗在有效改善患者症状的同时,与保守治疗相比,还可使第1秒呼气容积(FEV1)、FEV1/用力肺活量(FVC)及最大呼气流量(PEF)均显著增加(P<0.05)。

此外,周教授还指出,手术可减少伴哮喘慢性鼻窦炎的药物需求。

临床医生应了解的鼻部知识

与其他讲者不同,台湾大学医学院附设医院叶德辉教授从鼻、鼻窦的进化过程深入介绍了两者的结构与功能,他指出,鼻和鼻窦不仅是呼吸和感觉器官,还是一个免疫器官。2013年发表的一项研究证实,人鼻黏膜上皮细胞(hNEC)可对外周血单个核细胞(PBMC)产生的特异性抗原抗体反应发挥免疫调节作用。同时,研究还表明,在特定抗原刺激下,hNEC还在介导天然和获得性免疫反应方面具有多能作用。事实上,早在2000年即有学者总结了呼吸道上皮细胞的天然免疫功能,其包括以下几个方面:①纤毛细胞的物理清除;②上皮覆盖的黏液中含广谱的抗菌物质如溶菌酶、乳铁蛋白、补体蛋白、IgA、SPLUNC1等;③可招募吞噬细胞及诱导免疫反应。

叶德辉教授强调,鼻及鼻窦的生理功能远比我们想像得多且重要,因此,当鼻腔发生阻塞需用口腔替代呼吸时,应引起大家重视,并尽早纠正这一异常。鼻用激素及LTRA是治疗过敏性鼻炎的有效药物。

哮喘治疗最成功的方法是预防和坚持

广州呼吸疾病研究所荣誉所长、中国工程院院士钟南山


与心血管病、高血压病、糖尿病等一样,哮喘也是一种慢性疾病,但不同的是,目前并没有发现明确的生物学指标可提示哪些患者需要治疗,因此,哮喘的治疗指征仍为症状,即在出现初期症状的时候开始治疗。

对哮喘而言,事实上,发作治疗是下策,不让它发作是上策。患者哮喘发作时表明炎症已经积累到了一定程度,“冰山”已经露出来了。而哮喘作为一种长期慢性疾病,如果确诊后坚持规范用药,即可使症状不发作,用药量也可逐渐减少,甚至间歇用药,如隔天一用。研究显示,仅有少部分患者能实现停药。事实上,严格来说,哮喘是不能“断根”的,部分患者在症状消失后则自行停止药物治疗,这是不正确的做法,不利于哮喘的长期控制。此外,还需强调的是,哮喘是一种可以控制的慢性疾病,长期规范地治疗使疾病得到控制后,患者的日常生活可与正常人一样。因此,哮喘治疗最成功的方法是预防和坚持,用药慢慢减少。这里的“预防”是指在症状出现的初期即用药,目前尚不能普及在患者未出现症状即用药预防。

对于哮喘控制不佳的患者,应考虑合并疾病的可能性。临床实践证明,相当一部分患者鼻炎和哮喘常合并存在,对于合并鼻炎的哮喘患者,采用LTRA同时控制哮喘和鼻炎,或其他药物同时用于鼻部和下呼吸道,可有效提高哮喘控制率。因此,临床医生在诊断哮喘时,应仔细询问患者是否有鼻塞或打喷嚏等,鉴别其合并鼻炎的可能性。

我国哮喘控制现状及患者存在的误区

中日友好医院呼吸内科林江涛


根据2010~2011年在我国30个省市的90家医院做的调查显示,在调查的4650例成人哮喘患者中,57%的患者哮喘控制不佳,超过70%的患者在近4周内有哮喘症状。而研究数据表明,哮喘患者在观察1年后,近80%是可以得到控制的,由此可以看出,我国哮喘控制还存在较大的改善空间。

分析我国哮喘患者控制率不佳的原因,主要有以下几点。首先,患者对哮喘这一疾病的认知程度仍较低,多数患者不知道哮喘是一个慢性疾病,应坚持长期治疗。更多患者在症状缓解后,未坚持长期用药。患者对治疗依从性不佳是影响哮喘控制率的一个非常重要的因素。其次,在用药方面,患者倾向于应用快速缓解症状的药物,较少用控制药物。但事实上,轻度哮喘患者应选择合适的控制性药物如LTRA和ICS,长期应用。症状缓解性药物则是在患者症状加重时按需使用。再其次,哮喘患者认为长期应用西药容易上瘾或产生依赖性。实际上,目前临床应用的西药不具有依赖性,按需用药,不过量使用就不会产生依赖。控制好时还可减少用量。此外,西药还可以实现靶向治疗,直接作用于病变位置,起到事半功倍的治疗效果。

由此可以看出,较好的患者教育,加强其对哮喘的认识,提高治疗依从性对哮喘控制的改善至关重要。目前,国内外指南均明确指出,患者教育是改善哮喘控制水平的有效方法之一。因此,临床医生应与政府相关部门及媒体等一道,共同做我国哮喘患者的知识普及工作。

我国儿童哮喘指南修订要点解析

上海第一人民医院儿内科洪建国

自2008年我国儿童哮喘诊疗指南发布以来已有6年时间,今年,基于一些临床进展,我们将对原版指南进行一定的修订与更新,其要点主要体现在以下几个方面。

1.强调儿童哮喘诊断的准确性。哮喘是一个异质性的慢性炎症性疾病,其临床表现是多样的,年龄越小,诊断哮喘越要慎重,要尽可能及早诊断,也要尽可能避免过度诊断。

2.强调儿童哮喘的临床特殊性。与成人哮喘不同,部分儿童哮喘是可以临床治愈的。临床医生要充分认识到这一点,并使患者家长也清楚这一点,这不仅可增加患者及其家属对治疗的信心,也会使患者对治疗的依从性提高。

3.强调个体化治疗。哮喘是一个异质性疾病,在患者治疗过程中,需个体化选择治疗方案。目前,临床上主要根据患者哮喘表型制定治疗方案,如阿司匹林相关性哮喘患者应用LTRA的效果优于ICS。对于难治性哮喘,研究显示,患者对相同治疗方案的反应不同,这引导我们思考,是否可以探索发现一些可预测患者对治疗反应的生物学标志物,从而早期预测患者对相应治疗方案的反应,基于此,为患者制定更多有效的个体化治疗方案。这是哮喘治疗的理想目标,也是临床研究者努力的方向。

从药物选择考虑,目前,LTRA在儿童哮喘中的应用具有优势。首先,LTRA口服后对鼻炎和哮喘均有效,且控制鼻炎后更有利于哮喘的控制。其次,相较于激素,LTRA的安全性高,患者及其家属容易接受。从剂型上讲,其有颗粒剂和咀嚼片,患者依从性佳。

过敏性鼻炎合并哮喘的治疗应注重多学科协作与个体化

北京同仁医院耳鼻喉头颈外科周兵


在临床上,有相当一部分(20%~40%)过敏性鼻炎患者会发生哮喘,因此,作为一个耳鼻喉科医生应提高对过敏性鼻炎合并哮喘的认识。众所周知,鼻腔和气管共属气道,分别为上气道和下气道,两者在结构和功能上有共性,也有区别。因此,过敏性鼻炎与哮喘在发病机制及治疗上应是紧密相关的,但不能完全等同。

对于过敏性鼻炎合并哮喘患者,在临床上首先要强调共治,两者不能孤立。但目前,耳鼻喉科医生治疗哮喘的水平还不能与呼吸科医生齐平,因此,我们更多的是讲求协作,两个科室甚至与包括颅底外科在内的其他科室紧密协作,即多学科协作,各施所长,这是使患者最大获益的有效策略。对于各科协作的方式,我们也正在积极地探索,相信未来一定会越来越好。

在用药方面,LTRA、经鼻吸入激素和抗组胺药是目前临床常用治疗过敏性鼻炎及哮喘的药物。对缓解由组胺释放引发的鼻痒甚至刺激性咳嗽,抗组胺药较为有效。近年来,鼻用抗组胺药也得到了更多关注,其可快速缓解患者症状。对于鼻用激素的应用,大家最关注的还是安全性问题,但研究表明,吸入激素的安全性风险与剂量相关,目前,临床用药的剂量是较为安全的。

总的来说,对于过敏性鼻炎合并哮喘患者的治疗,还应注重以患者为中心的个体化治疗。

除上述内容外,各分场的专家报告内容同样精彩,如特殊类型哮喘的个性化治疗、真实世界的哮喘控制、哮喘急性期治疗、儿童哮喘的长期治疗、过敏性鼻炎的起源与进展等,较为全面地解析了哮喘及过敏性鼻炎诊疗要点及最新进展,拓宽了与会医生的视野,增长了知识。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2046793, encodeId=9c022046e9361, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Aug 21 01:22:00 CST 2015, time=2015-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21314, encodeId=8e9021314d6, content=学习了,很厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=202, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Fri Apr 17 15:32:00 CST 2015, time=2015-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21131, encodeId=467c2113102, content=个体化治疗必须来自中医呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=208, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:12:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21125, encodeId=a64e2112572, content=这样的环境,哮喘是越来越多, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:09:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20173, encodeId=3172201e3b3, content=不错的课程, beContent=null, objectType=article, channel=null, level=null, likeNumber=219, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 13:06:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1379741, encodeId=428c13e974171, content=<a href='/topic/show?id=193721289ea' target=_blank style='color:#2F92EE;'>#个体化治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21289, encryptionId=193721289ea, topicName=个体化治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11b4465, createdName=ying_wu, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435301, encodeId=8b9914353018c, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20032, encodeId=3be4200324e, content=哮喘的机制不同,确实需要个体化, beContent=null, objectType=article, channel=null, level=null, likeNumber=257, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12781609448, createdName=wu2734033, createdTime=Thu Apr 09 22:02:00 CST 2015, time=2015-04-09, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2046793, encodeId=9c022046e9361, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Aug 21 01:22:00 CST 2015, time=2015-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21314, encodeId=8e9021314d6, content=学习了,很厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=202, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Fri Apr 17 15:32:00 CST 2015, time=2015-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21131, encodeId=467c2113102, content=个体化治疗必须来自中医呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=208, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:12:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21125, encodeId=a64e2112572, content=这样的环境,哮喘是越来越多, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:09:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20173, encodeId=3172201e3b3, content=不错的课程, beContent=null, objectType=article, channel=null, level=null, likeNumber=219, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 13:06:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1379741, encodeId=428c13e974171, content=<a href='/topic/show?id=193721289ea' target=_blank style='color:#2F92EE;'>#个体化治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21289, encryptionId=193721289ea, topicName=个体化治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11b4465, createdName=ying_wu, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435301, encodeId=8b9914353018c, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20032, encodeId=3be4200324e, content=哮喘的机制不同,确实需要个体化, beContent=null, objectType=article, channel=null, level=null, likeNumber=257, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12781609448, createdName=wu2734033, createdTime=Thu Apr 09 22:02:00 CST 2015, time=2015-04-09, status=1, ipAttribution=)]
    2015-04-17 吴颖

    学习了,很厉害

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2046793, encodeId=9c022046e9361, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Aug 21 01:22:00 CST 2015, time=2015-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21314, encodeId=8e9021314d6, content=学习了,很厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=202, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Fri Apr 17 15:32:00 CST 2015, time=2015-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21131, encodeId=467c2113102, content=个体化治疗必须来自中医呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=208, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:12:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21125, encodeId=a64e2112572, content=这样的环境,哮喘是越来越多, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:09:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20173, encodeId=3172201e3b3, content=不错的课程, beContent=null, objectType=article, channel=null, level=null, likeNumber=219, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 13:06:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1379741, encodeId=428c13e974171, content=<a href='/topic/show?id=193721289ea' target=_blank style='color:#2F92EE;'>#个体化治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21289, encryptionId=193721289ea, topicName=个体化治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11b4465, createdName=ying_wu, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435301, encodeId=8b9914353018c, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20032, encodeId=3be4200324e, content=哮喘的机制不同,确实需要个体化, beContent=null, objectType=article, channel=null, level=null, likeNumber=257, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12781609448, createdName=wu2734033, createdTime=Thu Apr 09 22:02:00 CST 2015, time=2015-04-09, status=1, ipAttribution=)]
    2015-04-14 吴颖

    个体化治疗必须来自中医呀

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2046793, encodeId=9c022046e9361, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Aug 21 01:22:00 CST 2015, time=2015-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21314, encodeId=8e9021314d6, content=学习了,很厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=202, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Fri Apr 17 15:32:00 CST 2015, time=2015-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21131, encodeId=467c2113102, content=个体化治疗必须来自中医呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=208, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:12:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=21125, encodeId=a64e2112572, content=这样的环境,哮喘是越来越多, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Tue Apr 14 08:09:00 CST 2015, time=2015-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20173, encodeId=3172201e3b3, content=不错的课程, beContent=null, objectType=article, channel=null, level=null, likeNumber=219, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 13:06:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1379741, encodeId=428c13e974171, content=<a href='/topic/show?id=193721289ea' target=_blank style='color:#2F92EE;'>#个体化治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21289, encryptionId=193721289ea, topicName=个体化治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11b4465, createdName=ying_wu, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435301, encodeId=8b9914353018c, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Apr 11 04:22:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20032, encodeId=3be4200324e, content=哮喘的机制不同,确实需要个体化, beContent=null, objectType=article, channel=null, level=null, likeNumber=257, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12781609448, createdName=wu2734033, createdTime=Thu Apr 09 22:02:00 CST 2015, time=2015-04-09, status=1, ipAttribution=)]
    2015-04-14 吴颖

    这样的环境,哮喘是越来越多

    0

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    2015-04-11 x35042875

    不错的课程

    0

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    2015-04-09 wu2734033

    哮喘的机制不同,确实需要个体化

    0

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目的:通过调整混杂因素后,调查胎儿期及幼儿期抗生素暴露因素和小儿哮喘的关系。 实验设计:瑞典全国范围内的婴幼儿的前瞻性研究,包括同胞队列和对照队列,选取了瑞典国内进行健康注册的493785名出生于2006-2010的幼儿进入队列,其中包括180894名同胞幼儿。 分析方法:哮喘患儿均符合标准的哮喘诊断标准,研究者用Cox相对危险回归分析方法调查抗生素暴露和哮喘的关系,对同胞组采用分层相

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当前的哮喘症疗法仅能减缓患者的气喘、咳嗽及其它不适症状;每年有成百上千万美国人遭受着哮喘症带来的身心痛苦,研究者尚不清楚引发哮喘症的原因;如今刊登在国际杂志Journal of Medicinal Chemistry上的一篇研究论文中,来自伦敦大学等处的研究者首次报道了一种新型方法,该方法可以通过靶向作用引发哮喘的变应原来抵御哮喘症的发作。 文章中,研究者Clive Robinson及其同事解释

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严重哮喘急性发作的患者,经常会接受不适当的抗生素治疗。为了明确血清降钙素原(PCT)水平,是否能安全有效地减少此类患者的抗生素暴露,来自我国上海交通大学附属第六人民医院内科和老年医学科的黄高忠医生等,进行了一项研究,提示PCT指导的抗菌治疗可安全减少严重哮喘患者的抗生素暴露。文章发表在近期的Critical Care杂志上。[pdf free] 在这项随机对照试验中,研究者共对216例需

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