支气管热成形术在难治性哮喘中的治疗价值

发布时间：2018-05-27 13:15

本文选题：难治性哮喘 + 支气管热成形术　；参考：《浙江大学》2017年硕士论文

【摘要】：背景:支气管哮喘(哮喘)是一种常见的气道慢性炎症性疾病,以气道高反应性和可逆性气流受限为特征,晚期可出现气道重塑改变。对于多数的哮喘患者,通过吸入糖皮质激素(ICS)或联合长效β2-受体激动剂(LABA)的规范治疗可以达到良好控制;然而,约有5-10%的患者尽管经过规范的药物治疗,症状仍难以控制,这些患者属于难治性哮喘,其原因常与气道重塑的存在相关。这部分患者疾病恶化风险增高、住院率及病死率增加、严重影响生活质量、增加家庭和社会负担。支气管热成形术(bronchial thermoplasty,BT)是近年来国际上在哮喘非药物治疗方面最重要的突破,其原理是通过支气管镜将射频消融探头置入支气管腔内,将体外射频发生器产生的热能传导至支气管管壁,消融增生的支气管平滑肌细胞,从而达到治疗作用。国际上多项针对BT治疗难治性哮喘的临床研究结果显示,BT可有效改善难治性哮喘患者症状、提高患者生活质量、减少治疗药物使用。2010年4月,美国食品药物监督管理局(FDA)批准了BT可用于治疗18岁以上、应用ICS和LABA控制不佳的重度持续性哮喘患者。2014年欧洲呼吸病学会和美国胸科协会的诊治指南明确指出,BT可以应用于治疗成人的重症哮喘。2014年2月支气管热成形术在我国正式获得批准可用于临床治疗重症哮喘,但关于该技术对我国难治性哮喘患者治疗的有效性和安全性数据尚缺乏,有待进一步积累并明确。目的:分析支气管热成形术治疗难治性哮喘在我国哮喘患者中的安全性及治疗效果。方法:本研究分两部分,第一部分:以2015年3—12月我院收治的6例难治性哮喘患者为研究对象,观察这6例经长期口服或吸入大剂量糖皮质激素和长效β2-受体激动剂规范治疗后仍控制不佳的哮喘患者,经支气管热成形术治疗后的疗效,观察治疗后3周内不良反应发生情况,评估治疗后1年内哮喘症状、哮喘急性发作就诊次数、因哮喘急性发作住院次数、肺通气功能、激素使用剂量和术后1年内的并发症等情况,对比患者BT治疗前1年内哮喘症状、哮喘急性发作就诊次数、因哮喘急性发作住院次数、肺通气功能和激素使用剂量等情况。第二部分:查阅2014年1月-2016年12月在我国杂志上已公开报道的经BT治疗的哮喘患者情况,其中上海市第十人民医院(s)2例,广州医科大学附属第一医院(g)6例,中日友好医院(z)12例;结合我院收治的6例患者的总体治疗前后情况进行综述分析。结果:我院收治的6例患者术前及术后1年内哮喘急性发作患者例数分别为6和5例,哮喘急性发作来院就诊累计次数分别为30次和6次,因哮喘急性发作住院患者分别为5例和0例,累计住院次数分别为12次和0次;术后1年内6例患者总哮喘急性发作就诊次数、总因哮喘急性发作住院次数均较术前1年明显下降;通过比较患者术前和术后1年的哮喘问卷调查发现,患者的主观症状明显改善,经过统计学分析(P0.05)具有统计学意义;通过比较患者术前和术后肺功能指标和激素类药物的使用情况,并经过统计学分析(P0.05),考虑无统计学意义;关于术后并发症情况,6例患者术后3周最常见不良反应为咳嗽、咳痰量增加、喘息,多数在术后1周内缓解,术后3周内无严重不良事件发生,术后1年胸部CT检查未见气道结构性改变,余未见任何与BT治疗相关的不良反应。结合同期其它医院治疗的20例患者进行分析,经我院BT治疗的6例患者,治疗效果与国内其它医院的效果相似。结论:对行支气管热成形治疗的难治性哮喘患者经过1年的随访观察发现,BT治疗可以明显改善患者的主观症状、减少急性发作、改善常规药物对哮喘的控制,但是对患者肺功能指标以及激素类控制药物的用量的影响,表现出个体间的差异;虽然在我院治疗的患者只发生少数轻微的治疗后短期并发症,且控制较好,未出现严重的和长期的治疗后不良反应,但是结合同期其它医院治疗的患者进行分析,BT治疗还是有一定治疗风险的,需注意防范一些严重并发症的发生;通过此项研究发现BT治疗在中国人乃至亚洲人身上也能达到与欧美人相似的疗效。
[Abstract]:Background: bronchial asthma (asthma) is a common chronic airway inflammatory disease characterized by airway hyperresponsiveness and reversible airflow limitation, and airway remodeling changes at the late stage. For most asthmatic patients, standardized treatment by inhaling Glucocorticoid (ICS) or combined with long effect beta 2- receptor agonists (LABA) can be achieved in good terms. Control; however, some patients with 5-10%, despite standardized drug treatment, are still difficult to control, and these are refractory asthma, which are often associated with the existence of airway remodeling. This part of the patients has increased risk of disease deterioration, increased hospitalization and mortality, seriously affected quality of life, and increased family and social burdens. Bronchial thermoplasty (BT) is the most important breakthrough in the international non drug treatment of asthma in recent years. The principle is that the radiofrequency ablation probe is inserted into the tracheal cavity by bronchoscope, and the heat energy produced by the radiofrequency generator in vitro is transmitted to the wall of the bronchial tube and the proliferating bronchial smooth muscle cells are ablated. Therapeutic effects. A number of clinical studies on BT treatment of refractory asthma have shown that BT can effectively improve the symptoms of refractory asthma, improve the quality of life, and reduce the use of drugs in April. The US Food and Drug Administration (FDA) approved BT for treatment over 18 years old and poor control of ICS and LABA. The guidelines for diagnosis and treatment of the.2014 European Respiratory Society and the American Thoracic Association clearly indicate that BT can be used in the treatment of adult severe asthma by February bronchoplasty in China, which is officially approved for clinical treatment of severe asthma in China, but it is related to the treatment of refractory asthma in our country. The data of effectiveness and safety are still scarce and need to be further accumulated and clear. Objective: to analyze the safety and therapeutic effect of bronchial thermo plasty in the treatment of asthma patients in China. Methods: This study is divided into two parts. The first part: 6 cases of refractory asthma treated in our hospital from 3 to December 2015 as the research object, The 6 cases of asthmatic patients with poor control after long term oral or inhaled high dose glucocorticoid and long effect beta 2- receptor agonist were treated with bronchial thermo plasty, and the adverse reactions were observed within 3 weeks after treatment. The symptoms of asthma in 1 years after treatment, the number of acute attacks of asthma, and asthma were evaluated. The number of acute episodes, pulmonary ventilation, hormone dosage and complications after 1 years were compared. The symptoms of asthma, the number of acute attacks of asthma, the number of hospitalization for acute attack of asthma, the ventilation function of the lung and the dosage of hormone were compared in the 1 years before BT treatment. The second part was in December in January 2014, in December. The cases of asthma treated by BT have been reported in China's magazine, including 2 cases of Shanghai Tenth People's Hospital (s), 6 cases of Guangzhou Medical University Affiliated Hospital (g), and 12 cases of Z, and 6 patients treated in our hospital were reviewed and analyzed before and after the total treatment. Results: 6 patients were treated before and after operation in our hospital. The number of patients with acute attack of asthma in the last 1 years were 6 and 5, and the cumulative number of hospitalization for acute attack of asthma was 30 and 6 respectively. The hospitalized patients with acute asthma were 5 and 0, respectively. The cumulative number of hospitalization was 12 and 0, and the number of acute attacks of asthma in 6 patients within 1 years after the operation was always due to acute asthma attack. The number of hospitalized patients was significantly lower than that of 1 years before the operation. By comparing the patients' asthma questionnaire before and after 1 years of operation, the subjective symptoms of the patients were obviously improved, and the statistical analysis (P0.05) was statistically significant. The use of lung function indexes and hormone drugs before and after the operation was compared, and the statistical analysis was made (P0 .05), there was no statistical significance. With regard to postoperative complications, the most common adverse reaction of 6 patients after 3 weeks of operation was cough, the amount of expectoration increased, and the majority of the patients were relieved within 1 weeks after the operation. No serious adverse events occurred within 3 weeks after the operation. No structural changes in the air tract were found in the chest CT examination for 1 years after the operation, and no adverse reaction associated with the treatment of BT was not seen. According to the analysis of 20 patients with other hospital treatment in the same period and 6 patients treated by BT in our hospital, the effect was similar to that of other hospitals in China. Conclusion: after 1 years of follow-up observation on the refractory asthma patients treated with bronchoplasty, the treatment of BT can improve the subjective symptoms of the patients and reduce the acute hair. To improve the control of asthma by conventional drugs, but the effects on the lung function index and the dosage of hormone controlled drugs showed individual differences; although only a few minor postoperative complications occurred in the patients treated in our hospital, and the control was better, there was no serious and long-term adverse reaction after treatment. According to the analysis of patients with other hospital treatment in the same period, BT treatment still has a certain risk of treatment. It is necessary to take precautions against some serious complications. Through this study, it is found that the treatment of BT can also be similar to the European and American people in the Chinese and Asian people.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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