切换至 "中华医学电子期刊资源库"

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (01) : 144 -147. doi: 10.3877/cma.j.issn.1674-6902.2024.01.032

综述

难治性哮喘的发病机制及诊治进展
陈华萍1, 陈晓龙1,(), 胡明冬1,()   
  1. 1. 400037 重庆,陆军(第三)军医大学第二附属医院老年医学与特勤医学科
  • 收稿日期:2023-12-17 出版日期:2024-02-25
  • 通信作者: 陈晓龙, 胡明冬
  • 基金资助:
    国家重点研发计划(2020YFC2008900,2020YFC2008903); 陆军军医大学科技创新能力提升专项项目(青年培育项目)(2022XQN33)

Pathogenesis and progress in diagnosis and treatment of refractory asthma

Huaping Chen, Xiaolong Chen(), Mingdong Hu()   

  • Received:2023-12-17 Published:2024-02-25
  • Corresponding author: Xiaolong Chen, Mingdong Hu
引用本文:

陈华萍, 陈晓龙, 胡明冬. 难治性哮喘的发病机制及诊治进展[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 144-147.

Huaping Chen, Xiaolong Chen, Mingdong Hu. Pathogenesis and progress in diagnosis and treatment of refractory asthma[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 144-147.

支气管哮喘(bronchial asthma)是一种由嗜酸细胞、肥大细胞及中性粒细胞等多种细胞组分参与的慢性气道炎症性疾病,以气道高反应性和可逆气流受限为主要临床特征[1,2,3,4]。支气管哮喘大部分经糖皮质激素(inhaled corticosteroid, ICS)联合长效β受体激动剂(long acting beta agonist, LABA)吸入治疗得到有效控制。3%~10%支气管哮喘经中高等剂量ICS与LABA治疗,联用控制性药物规范治疗6个月,症状无法得到很好控制,即为难治性哮喘(refractory asthma, RA)[5]。哮喘流行病学调查报道,我国哮喘人群中14周岁以上难治性哮喘占5.99%,难治性哮喘急诊就诊率和住院率较轻中度哮喘高15~20倍,生活质量严重下降,死亡风险明显增高,家庭医疗花费增加,给家庭及社会造成了巨大负担[6,7]

1
Pihnastyi OM, Kozhyna OS. Use of the complex of models of regression for analysis of the factors that determine the severity of bronchial asthma[J]. Intern Med J, 2020, 2(2): 107-118.
2
Milena D, Tatjana JS, Ivana S, et al. Genetic variants of vitamin D receptor and antioxidant enzyme genes in bronchial asthma:epistatic interactions[J]. Ann Allergy Asthma Immunol, 2020, 125(6): 701-703.
3
Elsaid A, Shoaib RMS, Badr SS, et al. Polymorphisms of interleukin 4 and interleukin 4 receptor genes and bronchial asthma risk among Egyptian children[J]. Clin Biochem, 2021, 93(1): 66-72.
4
Singh S. Bronchial challenge test in patients with a history suggestive of bronchial asthma with normal spirometric studies[J]. Med J Armed Forces India, 2020, 77(1): 82-85.
5
中华医学会呼吸病学分会哮喘学组. 奥马珠单抗治疗过敏性哮喘的中国专家共识(2021版) [J]. 中华结核和呼吸杂志2022, 45(4): 341-354.
6
Zhang Qingling, Fu Xiuhua, Wang Changzheng, et al. Severe eosinophilic asthma in Chinese C-BIOPRED asthma cohort[J]. Clin Transl Med, 2022, 12(2): e710.
7
王文雅. 深入了解中外重度哮喘疾病负担和人群特征[J]. 中华医学杂志2020, 100(14): 1106-1111.
8
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023,

URL    
9
Deckers J, De Bosscher K, Lambrecht BN, et al. Interplay between barrier epithelial cells and dendritic cells in allergic sensitization through the lung and the skin[J]. Immunol Rev, 2017, 278(1): 131-144.
10
Akar-hibril N, sale T, stovic A, et al. Allergic endotypes and phenotypes of asthma[J]. J Allergy Clin Immunol Pract, 2020, 8(2): 429-440.
11
Bacharier LB, Jackson DJ. Biologics in the treatment of asthma innchildren and adolescents[J]. J Allergy Clin Immunol, 2023, 151(3): 581-589.
12
Varricchi G, Poto R, Marone G, et al. IL-3 in the development and function of basophils[J]. Semin Immunol, 2021, 54: 101510.
13
Walsh GM. Recent developments in the use of biologics targeting IL-5, IL-4 or IL-13 in severe refractory asthma[J]. Expert Rev Respir Med, 2018, 12(11): 957-963.
14
Fu Y, Wang J, Zhou B, et al. An IL-9 pulmonary macrophage axis defines the allergic lung inflammatory environment[J]. Sci Immunol, 2022, 7(68): eabi9768.
15
Nabe T. Steroid-resistant asthma and neutrophils[J]. Biol Pharm Bull, 2020, 43(1): 31-35.
16
Kawayama T, Kinoshita T, Matsunaga K, et al. Role of regulatory T cells in airway inflammation in asthma[J]. Kurume Med J, 2018, 64(3): 45-55.
17
Limkar AR, Percopo CM, Redes JL, et al. Persistent airway hyperre-sponsiveness following recovery from infection with pneumonia virus of mice[J]. Viruses, 2021, 13(5): 728.
18
Mavissakalian M, Brady S. The current state of biologic therapies for treatment of refractory asthma[J]. Clin Rev Allergy Immunol, 2020, 59(2): 195-207.
19
Fang L, Sun Q, Roth M. Immunologic and non-immunologic mechanisms leading to airway remodeling in asthma[J]. Int J Mol Sci, 2020, 21(3): 757.
20
Boulet LP. Airway remodeling in asthma:update on mechanisms and therapeutic approaches[J]. Curr Opin Pulm Med, 2018, 24(1): 56-62.
21
Pavón-Romero GF, Serrano-Pérez NH, García-Sánchez L, et al. Neuroimmune pathophysiology in asthma[J]. Front Cell Dev Biol, 2021, 9: 663535.
22
Sui P, Wiesner DL, Xu J, et al. Pulmonary neuroendocrine cells amplify allergic asthma responses[J]. Science, 2018, 360(6393): eaan8546.
23
Niimi A, Fukumitsu K, Takeda N, et al. Interfering with airwaynerves in cough associated with asthma[J]. Pulm Pharmacol Ther, 2019, 59: 101854.
24
赵茜叶,赵德育. 儿童难治性哮喘的识别与处理[J]. 中华实用儿科临床杂志2018, 33(16): 1204-1207.
25
中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版)[J]. 中华结核和呼吸杂志2020, 43(12): 1023-1048.
26
谢文峰,郑东升. 长效β受体激动剂联合吸入性糖皮质激素治疗重症哮喘的临床分析[J]. 中国社区医师2019, 35(21): 57,59.
27
黄凤玲. 个体化健康教育对小儿哮喘治疗依从性及哮喘控制率的影响[J]. 临床合理用药杂志2017, 10(11): 147-148.
28
张 路,陈丽霞. 重症哮喘患者糖皮质激素反应性及其机制的研究进展[J]. 医学综述2017, 23(19): 3801-3805, 3811.
29
崔鑫洋. 茶碱类药物在支气管哮喘治疗中的合理应用[J]. 中国医药指南2021, 19(20): 38-39.
30
莫丽慧,钟丽花. 孟鲁司特联合布地奈德治疗支气管哮喘患儿的临床观察[J]. 中国药房2017, 28(14): 1981-1984.
31
金 明,朱海玲,李任翔,等. 抗白三烯治疗对重症哮喘患者肺功能和炎症细胞因子水平的影响[J/CD]. 中华肺部疾病杂志(电子版), 2018, 11(2): 214-216.
32
Trischler J, Bottoli I, Janocha R, et al. Ligelizumab treatment for severe asthma: learnings from the clinical development programme[J]. Clin Transl Immunology, 2021, 10(3): e1255.
33
李春晓,张 敏,熊庄莉,等. 瑞利珠单抗治疗严重哮喘的研究现状[J]. 中国临床药理学杂志2018, 34(8): 996-999.
34
Del GS, Eiwegger T, Firinu D, et al. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI guidelines-recommendations on the use of biologicals in severe asthma[J]. Allergy, 2020, 75(5): 1023-1042.
35
孙 莹,蔡莉莉,李 璇,等. 贝那利珠单抗治疗重度嗜酸粒细胞性哮喘的临床研究进展[J]. 实用药物与临床2023, 26(5): 461-466.
36
Castro M, Corren J, Pavord ID, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma[J]. New England Journal of Medicine, 2018, 378(26): 2486-2496.
37
Liu Y, Zhang S, Chen R, et al. Meta-analysis of randomized controlled trials for the efficacy and safety of antiinter leukin-13 therapy with lebrikizumab in patients with uncontrolled asthma[J]. Allergy AsthmaProc, 2018, 39(5): 332-337.
38
Corren J, Karpefors M, Hellqvist S, et al.Tezepelumab reduces exacerbations across all seasons in patients with severe, uncontrolled asthma: A post hoc analysis of the PATHWAY phase 2b study[J]. J Asthma Allergy, 2021, 14(11): 1-11.
39
Epstein TEG, Calabria CW. Is immunotherapy safe for treatment of severe asthma[J]. Curr Opin Allergy Clin Immunol, 2022, 22(6): 396-401.
40
Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study[J]. Lancet, 2019, 394(10196): 407-418.
41
王东辉,张 方. 重症支气管哮喘的诊治进展[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(5): 638-641.
42
Chaudhuri R, Rubin A, Sumino K, et al. Safety and effectiveness of bronchial thermoplasty after 10 years in patients with persistent asthma (BT10+): a follow-up of three randomised controlled trials[J]. Lancet Respir Med, 2021, 9(5): 457-466.
[1] 林凌, 李佩, 赵玮. 牛牙样牙发病机制的研究进展[J]. 中华口腔医学研究杂志(电子版), 2023, 17(02): 75-80.
[2] 暴静, 吴霞, 田雅萍, 尹钢. 维生素D3联合孟鲁司特钠治疗支气管哮喘对血清VEGF、TGF-β1及肺功能的影响[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 63-67.
[3] 谭玲芳, 周克兵. 基于生物信息学整合鉴定与支气管哮喘相关的潜在诊断生物标志物[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 329-334.
[4] 路东明, 陈建华, 艾月琴. 布地格福吸入气雾剂治疗支气管哮喘的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 361-363.
[5] 刘汶睿, 高丽娜, 于书娴, 周建刚. 支气管哮喘患者血清IL-27与IFN-γ及肺功能相关性分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 224-226.
[6] 刘娜, 赵然然. 支气管哮喘微量元素水平与免疫功能的相关性分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 74-76.
[7] 李德莲, 杨鹏, 王琳. FeNO联合总IgE、CXCL13检测对儿童支气管炎继发哮喘的意义[J]. 中华肺部疾病杂志(电子版), 2022, 15(06): 838-840.
[8] 许厅, 熊智倩, 刘俪婷, 姜燕, 苏朝江, 刘宗旸. 维持性血液透析患者皮肤瘙痒症的发病机制及治疗研究进展[J]. 中华肾病研究电子杂志, 2023, 12(06): 334-338.
[9] 胡欣欣, 孟晓凡, 郭兆安. 高血压肾病的发病机制研究进展[J]. 中华肾病研究电子杂志, 2023, 12(06): 339-343.
[10] 唐凯, 刘正峰, 宋佳蔚, 卢秀珍. 角膜巩膜干凹斑的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(04): 231-235.
[11] 李文捷, 卢弘. 幼年特发性关节炎相关葡萄膜炎的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(01): 40-44.
[12] 张坤淇, 张睿, 徐佳, 康庆林. 漂浮膝损伤的诊治进展[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 252-256.
[13] 金刚, 李英真, 施维, 李博. 帕金森病在病理生理学中的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 315-319.
[14] 王敏, 张妍, 王盈熹, 赵龙, 夏书月. 外泌体在慢性阻塞性肺疾病中的作用[J]. 中华临床实验室管理电子杂志, 2023, 11(01): 45-51.
[15] 刘康蔚, 姚健凤. 老年慢性便秘患者的肠道菌群研究进展[J]. 中华老年病研究电子杂志, 2023, 10(04): 40-46.
阅读次数
全文


摘要