Slide1哮喘症状由尚未被控制的气道炎症所致炎症反应的双通道Slide2AdaptedfromNationalInstitutesofHealthGlobalInitiativeforAsthma:GlobalStrategyforAsthmaManagementandPrevention:APocketGuideforPhysiciansandNurses.PublicationNo.95-3659B.Bethesda,MD:NationalInstitutesofHealth,1998;BjermerLRespirMed2001;95:703-719.炎症反应在哮喘中的重要性哮喘本质上是一种炎症反应疾病炎症反应导致气管收缩及气道高反应性,从而产生症状对轻中度哮喘病人应首先进行控制炎症的治疗Slide3•抑制多种炎症介质–细胞因子–粘附分子–可诱导的酶•对炎性反应的多种作用AdaptedfromPeters-GoldenM,SampsonAPJAllergyClinImmunol2003;111(suppl1):S37-S48.炎症反应的双通道皮质激素的作用Slide4尽管使用了吸入激素,气道炎症仍持续存在ICS=inhaledcorticosteroids;OCS±ICS=receivedoralcorticosteroidswithorwithoutICSAdaptedfromLouisRetalAmJRespirCritCareMed2000;161:9-16.20,00010,0001,000100101Eosinophil103/gsputumControlgroup轻到中度哮喘ICSlow-dose(n=10)ICShigh-dose(n=15)OCS(n=10)OCS±ICS(n=7)重度哮喘p<0.01p<0.001p<0.001p<0.01n=74Slide5白三烯其它炎性介质Thisslideisanartisticrendition.AdaptedfromHolgateST,Peters-GoldenMJAllergyClinImmunol2003;111(1suppl):S1-S4;HolgateSTetalJAllergyClinImmunol2003;111(1suppl):S18-S36;HendersonWRJretalAmJRespirCritCareMed2002;165:108-116;Peters-GoldenM,SampsonAPJAllergyClinImmunol2003;111(1suppl):S37-S42;VarnerAE,LemanskeRFJr.InAsthmaandRhinitis.Oxford,UK:BlackwellScience,2000:1172-1185.无炎症反应炎症反应哮喘白三烯:在哮喘早期及疾病全程中的重要性Slide6炎症反应的双通道半胱氨酰白三烯受体的表达NeutrophilMonocyteMacrophageBasophilPluripotenthemopoieticstemcellTCellsEosinophilBLymphocyteCCR3CD4+CD8+CD19M-CSF,GM-CSF,IL-3LTC4,LTD4,LTE4LN5MastCellLTC4LTD4LTE4M-CSFGM-CSFIL-5IL-3GM-CSFLTC4LTD4LTE4CD14IL5RβRepresentstheCysLT1receptorAdaptedfromFigueroaDJetalAmJRespirCritCareMed2001;163:226-233;MelloretalProcNatlAcadSciUSA2001;98:7964-7969CysLT1RCD34+Slide7炎症反应的双通道半胱氨酰白三烯在炎性细胞受体上的作用嗜酸细胞肺巨噬细胞Smooth-musclecellB淋巴细胞CysLT=cysteinylleukotriene;PBMC=peripheralbloodmononucl...