浙江中西医结合杂志

童岳阳.成人难治性哮喘临床特征[J].浙江中西医结合杂志,2012,22(9):681-684

成人难治性哮喘临床特征

Clinical Characteristics of Difficult-to-Treat-Asthma in Adults

投稿时间：2012-04-05

DOI：

英文关键词:adults difficult-to-treat-asthma diagnosis therapy

基金项目:

作者	单位
童岳阳	杭州师范大学附属医院呼吸内科杭州 310015

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中文摘要:

目的：探讨成人难治性哮喘（DTA）患者的临床特征。方法：进行哮喘控制水平分级，依照 GINA给予以ICS为主的治疗方案，随访12个月，分析DTA组与哮喘良好控制组两组治疗方案以及 FEV1和ACT评分对治疗的反应。结果： 58例患者全部完成随访。DTA组平均年龄大于哮喘良好控制组，哮喘病程长于后者（P<0.05）； DTA组BMI以及吸烟者比例高于哮喘良好控制组；两组性别、哮喘发病年龄差异无统计学意义（P>0.05）。DTA组与哮喘良好控制组合并过敏性疾病比较差异无统计学意义（P>0.05）。变应原皮肤点刺试验两组总体阳性率差异无统计学意义（P>0.05）。 DTA组接受第4、 5级方案治疗，无成功降级治疗病例，随访12个月哮喘急性发作平均1.33次/人。哮喘良好控制组共14例治疗方案降级，其中3例完全停止药物治疗，随访12个月中3例出现哮喘急性加重。DTA组终点平均ICS日用量与起点相当，并且终点FEV1较起点无明显改善，但终点 ACT评分较起点明显改善（P<0.01），与 FEV1变化不一致。结论： DTA患者平均年龄大，哮喘病程长，体质量指数高，急性发作次数多，平均ICS日用量大；治疗后ACT评分改善程度优于FEV1的改善。

英文摘要:

Objective： To investigate the clinical characteristics of adult difficult-to-treat-asthma. Methods:The clinical data of 58 patients were recorded for classification of the level of asthma control. ICS-based treatment regimens were administered according to the GINA. During a12-month follow up, lung function was evaluated and the level of asthma control was assessed. Differences in clinical data, treatment regimens, and response to treatment (evaluated by FEV1 and ACT scores) between patients with DAT and those with well-controlled asth? ma were analyzed. Results: All of 58 patients completed the study. The DTA group had a longer course of asth? ma(P<0.05), a greater mean age, and a higher BMI and proportion of smokers. No differences in gender and on? set age was noted between the 2 groups(P>0.05). Although the total positive rate of allergen skin prick test was higher in the DTA group than that in the well-controlled asthma group, no significant differences in concurrent allergic disease was seen between the 2 groups(P>0.05). Patients with DTA received treatment regimens for grade IV and V, and all failed to response to degraded treatment regimens. In the DTA group, during the 12-month followup, 14 patients suffered from more than 2 episodes of aggravation of asthma. In the well-con? trolled asthma group, pharmaceutical treatments were completely discontinued in 3 patients out of 14 patients whose treatment regimens were degraded, and during the 12-month follow up， only 3 patients suffered from aggra? vation of asthma. In the DTA group, the mean daily dose of ICS at end point was comparable to that at starting point； no significant improvements in FEV1 were seen; inconsistent with improvements of FEV1 and ACT scores at end point were significantly increased when compared with those at starting point(P<0.01). Conclusion: Pa? tients with DTA had a longer course of asthma, a greater mean age， a higher BMI， more aggravation and higher dose of ICS. In these patients, ACT scores assessed improvement was better than that of FEV1 after appropriate treatment.

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