• 東南大學(xué)附屬中大醫(yī)院呼吸內(nèi)科(江蘇南京 210008);

支氣管擴(kuò)張癥(簡(jiǎn)稱支擴(kuò))是以進(jìn)行性和不可逆性氣道破壞和擴(kuò)張為特征的慢性氣道炎癥性疾病[1]，大多表現(xiàn)為長(zhǎng)期咳嗽、咳膿性痰，反復(fù)急性發(fā)作，肺功能受損，后者主要表現(xiàn)為阻塞性通氣功能障礙，氣道反應(yīng)性增高，晚期患者常常出現(xiàn)勞力性呼吸困難，嚴(yán)重影響患者生活質(zhì)量[2,3] 。大部分支擴(kuò)患者第1秒用力呼氣容積(FEV )每年下降大約50mL [4] 。在我國(guó)支擴(kuò)的發(fā)病率為0.3‰～0.5‰。2005年美國(guó)成人支擴(kuò)發(fā)病率約為52．3／100 000。發(fā)病率隨年齡而增加，在所有年齡階段女性發(fā)病率均較男性高，預(yù)計(jì)在美國(guó)有18歲以上的支擴(kuò)患者110 000例，每年醫(yī)療費(fèi)用約6．3億美元[5]。

引用本文： 林勇. 吸入激素在支氣管擴(kuò)張癥中的應(yīng)用. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2007, 6(3): 168-170. doi: 復(fù)制

1. Cohen M，Sahn SA. Bronchiectasis in systemic diseases. Chest,1999;116:1063-1074.
2. Wilson CB，Jones PW，O’Leary CJ，et al. Validation of the St. George’s Respiratory Questionnaire in bronchiectasis.Am J Respir Crit Care Med,1997;156:536-41.
3. Martinez-Garcia MA，Perpina-Tordera M, Roman-Sanchez P, et al. Quality-of-life determinants in patients with clinically stable bronchiectasis. Chest,2005,128:739-745.
4. Ellis DA，Thornley PE，Wightman AJ，et al. Present outlook in bronchiectasis: clinical and social study and review of factors influencing prognosis.Thorax. 1981 Sep;36(9):659-64.
5. Trow TK. Clinical year in review II: occupational lung disease, pulmonary vascular disease, bronchiectasis, and chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2006 Sep;3(7):557-60.
6. Tsang KW，Chan K，Ho P，et al.Sputum elastase in steady-state bronchiectasis.Chest 2000；117：420-6.
7. Cole PJ. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J Respir Dis Suppl. 1986；147(Suppl)：6-15.
8. Barker AF.Bronchiectasis.N Engl J Med 2002；346：1383-93.
9. Ho PL，Chan KN，Ip MS，et al. The effect of Pseudomonas aeruginosa infection on clinical parameters in steady-state bronchiectasis..Chest 1998；114：1594-8.
10. Silva L，Jones JAH.，Cole PJ.，et al. The immunological component of the cellular inflammatory infiltrate in bronchiectasis.Thorax 1989.44：668-73.
11. Gaga M，Bentley AM，Humbert M，et al.Increase in CD4+ T lymphocytes，macrophages，neutrophils and interleukin 8 positive cells in the airways of patients with bronchiectasis.Thorax 1998；53：685-91.
12. Watt AP，Brown V，Courtney J，et al.Neutrophil apoptosis，proinflammatory mediators and cell counts in bronchiectasis.Thorax 2004；59：231-6.
13. Richman-Eisenstat JB, Jorens PG, Hebert CA,et al. Interleukin-8: an important chemoattractant in sputum of patients with chronic inflammatory airway diseases.Am J Physiol 1993；264：413-8.
14. Ho JC，Tipoe G，Zheng L，et al. In vitro study of regulation of IL-6 production in bronchiectasis.Respir Med. 2004 Apr;98(4):334-41.
15. Amitani R, Wilson R, Rutman A,.et al. Effects of human neutrophil elastase and Pseudomonas aeruginosa proteinases on human respiratory epithelium.Am J Respir Cell Mol Biol. 1991 Jan;4(1):26-32.
16. King PT，Hutchinson P，Holmes PW，et al. Assessing immune function in adult bronchiectasis. Clin Exp Immunol. 2006 Jun;144(3):440-446.
17. Elborn JS, Johnston B, Allen F，et al. Inhaled steroids in patients with bronchiectasis.Respir Med. 1992 Mar;86(2):121-4.
18. Tsang KW, Ho PL, Lam WK,.et al. Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis.Am J Respir Crit Care Med. 1998 Sep;158(3):723-7.
19. Tsang KW, Tan KC, Ho PL, ，et al：Exhaled nitric oxide in bronchiectasis: the effects of inhaled corticosteroid therapy，Int J Tuberc Lung Dis. 2004 Nov;8(11):1301-7.
20. Tsang KW，Tan KC，Ho PL，et al. Inhaled fluticasone in bronchiectasis: a 12 month study.Thorax. 2005 Mar;60(3):239-43.
21. Chan SL, Chan-Yeung MM, Ooi GC, et al. Validation of the Hong Kong Chinese version of the St. George Respiratory Questionnaire in patients with bronchiectasis.Chest. 2002 Dec;122(6):2030-7.
22. Martinez-Garcia MA, Perpina-Tordera M, Roman-Sanchez P, Soler-Cataluna JJ.，et al.Inhaled steroids improve quality of life in patients with steady-state bronchiectasis.Respir Med. 2006 Sep;100(9):1623-32. Epub 2006 Jan 24.
23. Lundgren JD, Shelhamer JH.. Pathogenesis of airway mucus hypersecretion.J Allergy Clin Immunol. 1990 Feb;85(2):399-417.
24. Kharitonov SA, Wells AU, O’Connor BJ，et al. Elevated levels of exhaled nitric oxide in bronchiectasis. Am J Respir Crit Care Med. 1995 Jun;151(6):1889-93.
25. Byrnes CA, Dinarevic S, Shinebourne EA.，et al. Exhaled nitric oxide measurements in normal and asthmatic children.Pediatr Pulmonol. 1997 Nov;24(5):312-8.
26. Baraldi E, Azzolin NM, Zanconato S, et al. Corticosteroids decrease exhaled nitric oxide in children with acute asthma. J Pediatr. 1997 Sep;131(3):381-5.
27. Kharitonov SA, Yates DH, Barnes PJ. Inhaled glucocorticoids decrease nitric oxide in exhaled air of asthmatic patients. Am J Respir Crit Care Med. 1996 Jan;153(1):454-7..
28. Tsang KW, Lam SK, Lam WK，et al. High seroprevalence of Helicobacter pylori in active bronchiectasis.Am J Respir Crit Care Med. 1998 Oct;158(4):1047-51.
  1. 1. Cohen M，Sahn SA. Bronchiectasis in systemic diseases. Chest,1999;116:1063-1074.
  2. 2. Wilson CB，Jones PW，O’Leary CJ，et al. Validation of the St. George’s Respiratory Questionnaire in bronchiectasis.Am J Respir Crit Care Med,1997;156:536-41.
  3. 3. Martinez-Garcia MA，Perpina-Tordera M, Roman-Sanchez P, et al. Quality-of-life determinants in patients with clinically stable bronchiectasis. Chest,2005,128:739-745.
  4. 4. Ellis DA，Thornley PE，Wightman AJ，et al. Present outlook in bronchiectasis: clinical and social study and review of factors influencing prognosis.Thorax. 1981 Sep;36(9):659-64.
  5. 5. Trow TK. Clinical year in review II: occupational lung disease, pulmonary vascular disease, bronchiectasis, and chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2006 Sep;3(7):557-60.
  6. 6. Tsang KW，Chan K，Ho P，et al.Sputum elastase in steady-state bronchiectasis.Chest 2000；117：420-6.
  7. 7. Cole PJ. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J Respir Dis Suppl. 1986；147(Suppl)：6-15.
  8. 8. Barker AF.Bronchiectasis.N Engl J Med 2002；346：1383-93.
  9. 9. Ho PL，Chan KN，Ip MS，et al. The effect of Pseudomonas aeruginosa infection on clinical parameters in steady-state bronchiectasis..Chest 1998；114：1594-8.
  10. 10. Silva L，Jones JAH.，Cole PJ.，et al. The immunological component of the cellular inflammatory infiltrate in bronchiectasis.Thorax 1989.44：668-73.
  11. 11. Gaga M，Bentley AM，Humbert M，et al.Increase in CD4+ T lymphocytes，macrophages，neutrophils and interleukin 8 positive cells in the airways of patients with bronchiectasis.Thorax 1998；53：685-91.
  12. 12. Watt AP，Brown V，Courtney J，et al.Neutrophil apoptosis，proinflammatory mediators and cell counts in bronchiectasis.Thorax 2004；59：231-6.
  13. 13. Richman-Eisenstat JB, Jorens PG, Hebert CA,et al. Interleukin-8: an important chemoattractant in sputum of patients with chronic inflammatory airway diseases.Am J Physiol 1993；264：413-8.
  14. 14. Ho JC，Tipoe G，Zheng L，et al. In vitro study of regulation of IL-6 production in bronchiectasis.Respir Med. 2004 Apr;98(4):334-41.
  15. 15. Amitani R, Wilson R, Rutman A,.et al. Effects of human neutrophil elastase and Pseudomonas aeruginosa proteinases on human respiratory epithelium.Am J Respir Cell Mol Biol. 1991 Jan;4(1):26-32.
  16. 16. King PT，Hutchinson P，Holmes PW，et al. Assessing immune function in adult bronchiectasis. Clin Exp Immunol. 2006 Jun;144(3):440-446.
  17. 17. Elborn JS, Johnston B, Allen F，et al. Inhaled steroids in patients with bronchiectasis.Respir Med. 1992 Mar;86(2):121-4.
  18. 18. Tsang KW, Ho PL, Lam WK,.et al. Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis.Am J Respir Crit Care Med. 1998 Sep;158(3):723-7.
  19. 19. Tsang KW, Tan KC, Ho PL, ，et al：Exhaled nitric oxide in bronchiectasis: the effects of inhaled corticosteroid therapy，Int J Tuberc Lung Dis. 2004 Nov;8(11):1301-7.
  20. 20. Tsang KW，Tan KC，Ho PL，et al. Inhaled fluticasone in bronchiectasis: a 12 month study.Thorax. 2005 Mar;60(3):239-43.
  21. 21. Chan SL, Chan-Yeung MM, Ooi GC, et al. Validation of the Hong Kong Chinese version of the St. George Respiratory Questionnaire in patients with bronchiectasis.Chest. 2002 Dec;122(6):2030-7.
  22. 22. Martinez-Garcia MA, Perpina-Tordera M, Roman-Sanchez P, Soler-Cataluna JJ.，et al.Inhaled steroids improve quality of life in patients with steady-state bronchiectasis.Respir Med. 2006 Sep;100(9):1623-32. Epub 2006 Jan 24.
  23. 23. Lundgren JD, Shelhamer JH.. Pathogenesis of airway mucus hypersecretion.J Allergy Clin Immunol. 1990 Feb;85(2):399-417.
  24. 24. Kharitonov SA, Wells AU, O’Connor BJ，et al. Elevated levels of exhaled nitric oxide in bronchiectasis. Am J Respir Crit Care Med. 1995 Jun;151(6):1889-93.
  25. 25. Byrnes CA, Dinarevic S, Shinebourne EA.，et al. Exhaled nitric oxide measurements in normal and asthmatic children.Pediatr Pulmonol. 1997 Nov;24(5):312-8.
  26. 26. Baraldi E, Azzolin NM, Zanconato S, et al. Corticosteroids decrease exhaled nitric oxide in children with acute asthma. J Pediatr. 1997 Sep;131(3):381-5.
  27. 27. Kharitonov SA, Yates DH, Barnes PJ. Inhaled glucocorticoids decrease nitric oxide in exhaled air of asthmatic patients. Am J Respir Crit Care Med. 1996 Jan;153(1):454-7..
  28. 28. Tsang KW, Lam SK, Lam WK，et al. High seroprevalence of Helicobacter pylori in active bronchiectasis.Am J Respir Crit Care Med. 1998 Oct;158(4):1047-51.