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Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, and
Guest Reviewer Gary Hellermann, PhD, reviewed premier medical journal articles
for practicing allergists. Richard F. Lockey教授，医学博士，WAO网站主编；Gary
Hellermann, 博士，为从业的变态反应科医生回顾了主要医学期刊的一些重要文章。 1. Risk factors associated with utilization of acute asthma
care. The aim of this study is to identify modifiable risk factors
that predispose asthma patients' use of acute care. Adult asthmatics (n = 554)
were recruited from a large HMO network. At their initial visit, subjects
underwent skin prick allergy testing, spirometry and completed a questionnaire
related to modifiable asthma risk factors. Acute care utilization data was
recorded for the following 30 months. The most significant risk factors for
seeking acute asthma care use were low FEV1 (RR, 4.33), current cigarette smoke
exposure (RR, 1.6), and skin prick reactivity and ownership of a cat or dog
(RR, 1.5). Editor's comment: Decreased FEV1 is a strong predictor of increased
asthma morbidity. Osborne ML et al. Chest 2007; 132:1151-1168. 译文 导致哮喘患者需要急诊处理的危险因素 本研究目的是明确可预测导致哮喘患者需要急诊处理的可控危险因素。从一个大型HMO网络招募成人哮喘患者554例。在其初次随访中，受试者接受过敏原皮肤点刺试验和肺活量测定，并完成一份有关哮喘可控危险因素的问卷。在随后30个月中，随访患者的急性就诊记录。哮喘需急诊处理的最显著的危险因素包括：低FEV1（RR 4.33），当前香烟暴露（RR
1.6），猫/狗过敏原皮肤点刺反应阳性同时家中有这些动物（RR
1.5）。编者按：FEV1的下降是哮喘发作增加强的预测因素。Osborne
ML et al. Chest 2007; 132:1151-1168. 2. Leukotriene modifiers prevent viral URI symptoms in
asthmatics. Viral upper respiratory tract infections (URI) are common
causes of asthma exacerbations. Reports suggest that leukotriene antagonists
(LTRA) may decrease rates of rhinovirus infection through down-regulation of
receptors expressed on nasal epithelial cells. Adult asthmatics (n = 279) who
presented to an emergency department were retrospectively categorized into LTRA
treated and untreated groups. Outcomes examined included frequency of
exacerbations, emergency room visits and hospitalizations over the prior 12
months. In the LTRA treated group, number of infections (p < 0.05),
exacerbations, emergency room visits and hospitalizations (p < 0.01) were
all lower than the untreated group. Editor's comment: Leukotriene receptor
antagonists may provide protection against viral-induced asthma exacerbations.
Horiguchi T et al. Allergol Int 2007; 56:263-267. 译文 白三烯调节剂可预防哮喘患者的上呼吸道病毒感染症状 上呼吸道病毒感染（URL）是导致哮喘加重的常见原因。报告表明，白三烯受体拮抗剂（LTRA）可通过下调鼻上皮细胞的受体表达，降低鼻病毒感染率。急诊科就诊的成人哮喘患者（n=279），回顾性地分为LTRA处理组与对照组，观察内容包括之前12个月中症状加重，急诊就诊及住院的频率。在感染数（P<0.05），症状加重，急诊室就诊和住院几个方面（P<0.01），LTRA治疗组均低于对照组。编者按：白三烯受体拮抗剂可提供防止病毒感染诱发哮喘加重的保护作用。Horiguchi
T et al. Allergol Int 2007; 56: 263-267. 3. The importance of vaccines in disease prevention. Vaccines are among the greatest success stories in U.S. public health over the past century. National recommendations provide guidelines for
use of vaccines to prevent or eliminate 17 vaccine- preventable diseases. This
study compares morbidity and mortality before and after widespread
implementation of national vaccine recommendations in place up to 2005. Primary
outcomes include numbers of cases, hospitalizations and deaths for 13
vaccine-preventable diseases. A 92% decline in cases and 99% decline in deaths
were shown for diphtheria, mumps, pertussis and tetanus, while an overall 80%
or greater reduction in cases and deaths were observed for most other vaccine-preventable
diseases. Editor's comment: Appropriate influenza, pneumonia, and pertussis
vaccinations make sense in all patients with asthma and other chronic
respiratory diseases. Roush SW et al. JAMA 2007; 18: 2155-2163. 译文 疫苗对疾病预防的重要性 过去一个世纪中，疫苗使用是最成功的美国公共卫生措施之一。国家主管部门提供指导疫苗使用的指南，以预防或消除这17种疫苗可预防的疾病。这项研究比较了截止到2005年为止，在广泛推行疫苗之前和之后的感染性疾病的发病率和死亡率。主要结果包括13种疫苗可预防的疾病病例数，住院和死亡人数。白喉，腮腺炎，百日咳，破伤风患者人数在推广疫苗接种后下降了92%，死亡率下降99%；就大多数其他疫苗可预防的疾病而言，发病人数和死亡人数分别下降了80%或80%以上。编者按：适当的流感，肺炎和百日咳疫苗接种可使哮喘和其他慢性呼吸系统疾病患者受益。Roush
SW et al. JAMA 2007; 18: 2155-2163. 4. Early thimerosal (T) exposure and neuropsychological
outcomes at 7 to 10 years. Mercury exposure of 1047 children (aged 7-10 years) was
determined from medical immunization records and patient interviews to access
neuropsychological performance and exposure to mercury during the prenatal and
neonatal periods (birth to 28 days) and the first 7 months of life. The results
of the analysis do not support a causal association between early exposure to
mercury from T-containing vaccines and immune globulins and deficits in
neuropsychological functioning at age 7 to 10 years. Editor's comment: This
paper confirms many others showing that T does not cause neuropsychological
problems. Thompson W et al. N Engl J Med 2007; 357:1281-1292. 译文 早期硫柳汞（T）暴露对7~10岁儿童的神经心理学影响
1047名儿童（年龄7~10岁），从产前和新生儿期（出生至28天）以及出生后头7个月的医学免疫接种记录获得汞暴露的数据，并通过和患者面谈获得神经心理表现评估。分析的结果不支持在7~10岁儿童从含有柳硫汞的疫苗中早期接触汞与免疫球蛋白以及神经心理功能缺陷之间存在因果关系。编者按：本文证实硫柳汞不会造成神经心理问题。Thompson
W et al. N Engl J Med 2007; 357:1281-1292. 5. IFN-γ production in infancy predicts childhood
wheeze. Blunted IFN-γ responses during infancy are associated
with an increased risk for allergen sensitiza- tion. The aim of this study is
to assess the effect of low peripheral blood cytokine levels in the first year
of life on the development of wheeze in childhood. At age 9 months, peripheral
blood samples of healthy infants were assayed for levels of IFN-γ and IL-2
following mitogen-stimulation of mononuclear cells. Cytokine levels were
correlated with occurrence of wheeze at ages 2, 3, 6, 8, 11 and 13 years. Risk
of wheezing is significantly higher for subjects with low IFN-γ levels at
age 9 months (relative risk, 2.29; 96% CI, 1.35-3.89) compared to high
IFN-γ producers. Editor's comment: This study suggests that immune
susceptibility to asthma is established in the early postnatal period. Stern DA
et al. J Allergy Clin Immunol 2007;120: 835-841. 译文 婴儿期γ-干扰素的产生可预测儿童喘息 婴儿期γ-干扰素反应的减弱可增加过敏原致敏的风险。本研究目的是评估出生后第一年外周血细胞因子水平降低对童年发生喘息的影响。在出生9个月时，检测健康婴儿外周血单个核细胞有丝分裂原刺激后的γ-干扰素和白细胞介素-2水平。细胞因子水平与2、3、6、 8、11和13岁时发生喘鸣的几率呈正相关。和出生9个月时γ-干扰素水平高个体相比，γ-干扰素水平低的个体患哮喘的风险相对较高（相对危险度
2.29；96%CI，1.35-3.89 ）。编者按：本研究显示哮喘的免疫易感性形成于出生后早期。Stern
DA et al. J Allergy Clin Immunol 2007;120: 835-841. 6. A once yearly bisphosphonate reduces clinical fracture
rates. Hip fractures are related to increased morbidity, mortality
and functional decline in older adults. Patients (n = 2127) admitted to the
hospital for surgical repair of a hip fracture were randomized to receive
yearly intravenous zoledronic acid or placebo along with supplemental vitamin D
plus calcium. The primary clinical endpoint was diagnosis of a new clinical
fracture. Rates of new clinical fracture were 8.6% in the zoledronic acid group
vs. 13.9% in the placebo group resulting in a 35% risk reduction (p = 0.001). A
28% reduction in mortality rate from any cause was ob- served in the zoledronic
acid group (p = 0.01). Editor's comment: Osteoporosis occurs in COPD and
steroid dependant asthma. Annual administration of zoledronic acid may reduce
fracture rates and mortality in high-risk individuals. Lyles KW et al. New Engl
J Med 2007; 357: 1799-1809. 译文 每年一次二磷酸盐治疗可降低骨折发生率 老年人髋部骨折与发病率、死亡率增加和功能障碍相关。入院接受髋部骨折手术修复的患者（n
= 2127）随机接受每年一次唑来磷酸静脉注射或安慰剂加维生素D及钙剂治疗。主要临床终点是新发临床骨折的诊断。唑来磷酸组新发临床骨折的几率为8.6%，而在安慰剂组为13.9%，减少骨折风险35%（P = 0.001），唑来磷酸组髋部骨折死亡率降低28%（P = 0.01 ）。编者按：慢性阻塞性肺病及类固醇依赖性哮喘患者可发生骨质疏松,
每年一次应用唑来磷酸可降低高风险个体的骨折发生率和死亡率。Lyles
KW et al. New Engl J Med 2007; 357: 1799-1809. 7. Review of leukotrienes in inflammation. Leukotrienes are important mediators of allergic airway
inflammation. This concise article provides an overview of leukotriene biology.
Concepts discussed include leukotriene synthesis and effects of receptor
activation and blockade. The correlation of leukotriene-associated inflammation
in various diseases is discussed. Editor's comment: The leukotriene pathway is
an important target in allergic inflammation. Peters-Golden M et al. N Engl J
Med 2007;357: 1841-1854. 译文 白三烯在炎症中的作用 白三烯是过敏性气道炎症的重要介质。本文是关于白三烯的简明生物学概述。本文讨论的问题包括白三烯的合成和白三烯受体活化和拮抗的效应，以及与白三烯相关炎症的各种疾病的关系。编者按：白三烯通路是过敏性炎症一个重要的治疗靶。Peters-Golden
M et al. N Engl J Med 2007;357: 1841-1854. 8. Invasive methcillin-resistant staphylococcus aureus
(MRSA) infections. This report describes the incidence and distribution of
invasive MRSA disease in 9 US communities to estimate the burden of invasive
MRSA infections in the United States in 2005. Main outcome measures include
incidence rates, estimated number of invasive MRSA infections and related
in-hospital deaths. In 2005 the standard incidence rate of invasive MRSA was
31.8 per 100,000. Highest incidence rates were seen among individuals > 65
years (127.7 per 100,000), blacks (66.5 per 100,000) and males (37.5 per 100,000).
With 1589 in-hospital deaths among patients with MRSA, the standardized mortality rate was 6.3 per 100,000. Of the 8987 reported cases of invasive
MRSA infections in 2005, 58.4% were community-onset infections, 26.6% were
hospital- onset and 13.7% were community-associated. Editor's comment: Invasive
MRSA infection is a major public health problem no longer confined to the
hospital environment. Klevens RM et al. JAMA 2007; 298:1763-1771. 译文 侵袭性耐甲氧西林金黄色葡萄球菌（MRSA）感染 本报告描述了2005年美国9个社区发生侵袭性MRSA感染性疾病的发病率及分布，对侵袭性MRSA感染造成的负担进行估算。主要观察指标包括侵袭性MRSA感染发病率，估计患者人数和相关院内死亡人数。在2005年侵袭性MRSA感染的标准化发生率是31.8万/10万，65岁以上人群标准化发病率最高（
127.7 /10万 ），黑人标准化发病率
66.5 /10万，男性标准化发病率
37.5 /10万。2005年中，MRSA感染患者有1598例在院内死亡，标准化死亡率是6.3
/10万，对8987例报告侵袭性MRSA感染的病例中，58.4
％在社区感染发病，
26.6 ％在医院发作，13.7
％为社区相关型发病。编者按：侵袭性MRSA感染是一个重大的公共健康问题，已不再局限于医院环境。Klevens
RM et al. JAMA 2007; 298:1763-1771. 9. Hepatitis a postexposure prophylaxis:
vaccine vs immune globulin. Following hepatitis A exposure, immune globulin is known to
provide effective protection from fulminant infection. This study compares the
protective benefit of hepatitis A vaccine vs. immune globulin following
exposure to an infected individual. Contacts (n = 1090) of hepatitis A-infected
individuals were randomized to receive a single dose of hepatitis A vaccine or
immune globulin within 14 days following exposure. Evidence of symptomatic
hepatitis A infection was monitored from 15 to 56 days following exposure. Of
the 568 subjects who received the vaccine, infection was confirmed in 25 (4.4%)
vs. 17 (3.3%) who received immune globulin. Editor's comment: Hepatitis A
vaccine provides comparable postexposure protection to immune globulin and
confers the benefit of long-lasting protection. Victor JC et al. N Engl J Med
2007; 357:1685-1694. 译文 甲型肝炎暴露后预防性治疗：疫苗与免疫球蛋白比较 甲型肝炎病毒暴露后，已知免疫球蛋白能为预防急性感染提供有效保护。这项研究比较了甲型肝炎灭活疫苗与免疫球蛋白为病毒暴露后个体提供防护的效果。与甲型肝炎感染者有接触史个体（1090例）于暴露后14天内随机分组，一组予以单剂量甲型肝炎疫苗，一组予以免疫球蛋白。病毒暴露后15至56天监测研究对象是否出现甲型肝炎感染症状。568名接受疫苗治疗的个体中
25名（4.4 %）被感染，而免疫球蛋白组17名被感染（3.3%）。编者按：甲型肝炎疫苗可提供与免疫球蛋白相当的暴露后保护作用，并可获得持久的保护作用。Victor
JC et al. N Engl J Med 2007; 357:1685-1694. 10. Review of dendritic cells in allergy. This review is one of several in this issue devoted to
dendritic cell biology. In particular, this article outlines the importance of
dendritic cells in the pathogenesis of atopic diseases including contact
dermatitis, asthma and atopic dermatitis. Particular attention is focused on
the role of haptens as maturation factors for dendrtic cells in the skin.
Editor's comment: Dendritic cells play a critical role in the pathogenesis of
allergic disease. Aiba S. Allergol Int 2007; 56:201-208. 译文 过敏反应中的树突状细胞 这篇综述是专门讨论树突状细胞生物学的几篇文献中的一篇。本文重点描述了树突状细胞在特应性疾病，包括接触性皮炎，哮喘和特应性皮炎发病中的重要作用。特别值得注意的是，本文侧重于半抗原促进皮肤树突状细胞成熟的作用。编者按：树突状细胞在过敏性疾病发病中发挥关键作用。Aiba
S. Allergol Int 2007;56:201-208. 11. Early treatment with prednisolone (P) or acyclovir (A)
in Bell's palsy. This is a DBPC, randomized, factorial trial of patients with
Bell's palsy recruited within 72 hours following the onset of symptoms.
Patients were assigned to receive 10 days of treatment with P, A, both agents,
or placebo. The primary outcome was facial function. Secondary outcomes
included QOL, appearance, and pain. 496 of 551 patients underwent randomization
and at three months, the proportions of patients who had recovered facial
function were 83.0% in the P group as compared to 63.6% who did not receive P
(P<0.001) and 71.2% in the A group as compared to 75.7% of those who did not
receive A (adjusted P=0.50). After nine months, the proportions were 94.4% of P
versus 81.6% for no P (P<0.001) and 85.4% for A and 90.8% for no A (adjusted
P=0.10). In patients treated with both drugs the proportions were 79.7% at
three months (P<0.001) and 92.7% at nine months (P<0.001). There were no
differences in secondary outcomes or serious adverse events. P improves the
chance for complete recovery at three to nine months whereas A does not add any
benefit for Bell's palsy. Editor's comment: P given as early as possible is the
treatment of choice for Bell's palsy. Sullivan F et al. N Engl J Med 2007;
357:1598-1607. 译文 早期应用泼尼松龙（P）或阿昔洛韦（A）治疗面神经麻痹 这是一个双盲-安慰剂对照-随机-阶乘的临床试验，面神经麻痹患者出现症状72小时内入组。患者被随机分组后接受10天的治疗，一组接受阿昔洛韦，一组接受泼尼松龙，一组同时接受两种药物治疗，另一组接受安慰剂。主要观察指标是面部功能。次要观察指标包括生活质量、外观和疼痛。551例中，496例随机分组。3个月后，P组患者中83.0%面部功能康复，而未接受P治疗的患者中为63.6%（P<0.001）面部功能康复，接受A治疗组患者中面部功能康复者占71.2%，未接受A治疗的患者中75.7%面部功能康复（调整后的P值为0.50）。9个月后，泼尼松龙治疗组和未接受泼尼松龙组的这个比例分别为94.4%和81.6%（P<0.001），阿昔洛韦组和非阿昔洛韦组分别为85.4%和90.8%（调整后的P值为0.10）。同时接受两种药物治疗的患者中，该比例分别为79.7%（ 3个月时
[ P < 0.001 ]）和92.7%（9个月时
[P<0.001]）。在次要观察指标和严重不良反应事件方面各组间无显著性差异。泼尼松龙治疗可增加患者3个月和9个月时完全康复的几率，而阿昔洛韦对面神经麻痹治疗并不增加任何益处。编者按：面神经麻痹治疗应首选尽早给予泼尼松龙治疗。Sullivan
F et al. N Engl J Med 2007; 357:1598-1607. |
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The World Allergy Organization's
mission is to build a global alliance of allergy societies to advance
excellence in clinical care, research, education and training. Visit us on
the Web at www.worldallergy.org 您因如下原因收到此次通讯：您是世界变态反应协会会员，或者您曾向世界变态反应协会订阅过电子月刊，或者您以前曾与世界变态反应协会进行过有关联系。如果您不希望继续收到来自世界变态反应协会的信息，请以“删除”为主题回复此邮件。 Made
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Translator: Liping Wen MD Peking Medical College Hospital 译者：北京协和医院变态反应科 文利平 |
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