( 20 010010) 787 1092 1/32 498.50 4 980 2004 9 1 2004 9 1 1 1 000 ISBN 7-204-05940-9/R 019 1880.00 ( 20.00 )
...1...2...5...6...6...8...9...12...14...18...18...19...20...23...28...29...30...32...33 I
...35...35...36...38...40...40...41...55...77...78...82...84...88...89...89...92...92...93... 101... 102... 103... 104 II
... 106... 108...111... 114... 114... 116... 120... 122... 123... 123... 126... 127... 128... 129... 130... 131... 132... 134... 135... 137... 139... 140 III
... 141... 142... 145... 145... 146 ( )... 147 ( )... 147 ( )... 147 ( )... 148 ( )... 148 ( )... 149... 149... 150... 151... 152... 155... 158... 160... 161... 166... 168... 169 IV
... 171... 173... 173... 175... 176... 177... 177... 179... 179... 180... 181... 181... 183... 185... 186... 187... 188... 189... 189... 190... 191... 193 V
... 194... 195... 195... 196... 197... 198... 198... 199 VI
1
(1) 4 2 6 (2) (3) (4) 2
(1) (2) (3) (1) (2) 3
(3) (4) (1) ( ) (2) (3) (4) (5) 4
5
(1) (2) (3) (4) 60% 6
7 12 80%
8 6 8 0.7
90% 1.5 2 9
18 8% 2% 25 30 400 UCB 10 80 60% 5000 300 7% 30% 6 16 1500 2000 ( ) 50% 20% 30% 10
20% 5 11 10 15% (HIV/AIDS) ( ) 60 18 4.6 WHO 11
( ) (1) ( ) (2) 12
IgG 3 6 (3) 20mg 20mg 4 1 2 1 2 1 0.08 0.1mg/kg 2mg 8 (4) 13
14 (1) 15 20g 15g 15g 10g 10g 3 10g( ) 20g 20g 20g 6 10g 10g 10g 6
2 3 2 (2) 0.5g 20 30g 10g 20g 15g 10g 10g 6g 3 6 15g (3) 15
20g 20g 10g 10g 10g 20g 20g 20 30g 6g 10g( ) 3g( ) 15g 10g 15g 20g 10g( ) 15g 10g 10g 15g 15g 20g ) 20g 10g 10g 15g 20g 6g 10g( 5g 15g 24 7 10 1.5cm 3 5 ( 3 5 ) 1 1 3 16
(4) 15g 10g 15g 6 10g 10g 10g 20 30g 3g 10g 10g 17
18 10g 10g 30g 6g 15g 10g 10g 20g 20g 1
DDT 1 2 3 4 19
5 6 7 8 9 10 11 12 MDI 13 ( ) 14 15 16 17 18 19 20 21 22 23 24 (1) 20
(2) (3) (4) ( ) IgG 21
IgG (5) ( ) 2 2 1 2 0.1ml 0.1 0.2ml 1ml 15 20 1 (6) (7) (8) 22
(GER) 50% 60% GER GER GER GER GER GER GER GER GER GER 8% 60% 80% 23
50% 60% 50% 25% 30% GER 30% 75% 10% 20% GER (GERD) GER GER GER 1 ( ) 2 3 GER (LES) Sontag Harper 24
LES LES GER GER GER GER LES GER LES GER GER GER LES LES 25
7 GER GERD IgE GER 1 2 GER 3 4 GER GER 24 ph GER GER ph 26
( ) (lipid ladenalveolarmacrophages) ( ) ( ) GER GER GER H2 (PPI) Field GER 27
3 H 2 PPI 200 44% 24% - IraFinegold ALK-Abello Lars Jacobsen 28
1 700 80% 50% 29
30
(1) (2) ( ) 31
32 ( ) ( ) 3% 5% 100
4 6 2834 4 33
27% 6 4 44% 1 3 3 41% 12 74% 12 Wendy Oddy Oddy 90% 3 3 4 6 Oddy 34
( ) (1) (2) 2 2 2 (3) 1 1 35
1 36
2 37
38
10 2 3 5 7 ( ) 10 2 1 5 10 39
2 2 2 3 2 1 1 2 40
( ) (WHO) WHO (NIH) 17 26 1993 1995 1998 ( GINA) 41
() ( ) ( ) ( Th2 ) ( ) (LAR) (IAR) 42
( ) 1 2 (1) 2 2 ( ) 2 (dang-regulation) (2) ( 2 (3) 2 (4) 43
44 ( ) ( ) A2(TXA2) ( ) (PAF) 1/2 2 (1) ( ) (2)
45 1/2 (3) (4) 2 ( ) () 1
(1) (2) (3) 90m2 m (4) 0.5 1.0 40 m 100 m (5) (firstpasseffect) (1) (2) (3) (MDI) 2 3 (1) 2 (2) (3) MDI 2 46
() 4 1 ( ) 2 4 (1) (2) (3) (4) 2 4 (1) (2) (3) (4) (FEV1 PEF) ph PaO 2 PaCO 2 PaCO 2 PaO 2 ( 47
) () 5 1 2 2 camp (1) 2 (Salmeterol) (Formoterol) 12h (2) (Bambuterol) 10 20mg 1 48
( ) 2 (1) 24h ( ) 12h (2) (5 10mg/L) 3 M1 M3 (1) (COPD) (2) (Combivent) ( ) 49
2 ( ) 4 DNA mrna (lipocorting) (1) ( ) MDI 2 (2) (FluticasonePropioneate) 5 (1) 20mg bid 10mg gd 50
(2) (PAF) (3) A1(TXA1) II (4) () WHO GINA 6 1 2 (PEF FEV1) 51
(FEV1) (PEF) FEV1 PEF (1)PEF (%) >80% 60%-80% <60% (2)PEF PEF (%)=(PEF -PEF ) 1/2(PEF +PEF ) 100% 10% 20% 20% 30% 30% 40% PEF >40% 3 ( ) IgE 52
4 ( ) 2 ( ) 2 4 2 ( ) 3 800 m 1200 m ( )/2 53
3 ( ) 5 6 54
1980 1987 1987 4360 1970 1987 55
15%24% 63 1.8% 80 5.6% 10% 90 77 90 55 36 25 24 23 25 9 1/4 56
(1987 ) 1 2 3 57
1 2 3 4 5 1 () RAST 58
2 3 4 5 (Aspirin) (NSAIDs) ( ) 59
1990 Ketotifen 60
1 (Tyramin) Sodium Metabisulphite Monosodiumglutamateta tartrazine 61
62 2. () ( )
(1) ( 63
(2) ( ) ) 64
65 IgE IgE IgG (3) 3
66
( ) ( ) 67
4 68
69 ( ) 5
Intal( ) 6 70
(Peak Flow Meter) 1 ( ) a. b. c. d. 2 3 71
4 72
1 2 73
3 4 (III ) 74
75 ( Iv) (IV) 80% 20% 80% 50_80% 20_30% (1) 2 (2)
(3) 50% B 50% 9. (n) Lh 76
%=( - / ) 100 20% 300L/min (2) 20% (1) 50% 77
(2) (3) (4) ( ) 78
IgG IgE 2 3 22.5% 1 4 7ml/ 7 10ml 14 15ml 3 3 6 RSV 79
3 20mg 3 4 2 4 4 6 (ketotifen) 0.08 0.12m / g/d 6 12 2 80
81
( ) 1 2 22 26 82
3 4 5 6 7 83
2-3 8 1 9 10 84
1994 17 (GINA ) GINA GINA 1 2 85
3 86
4 87
88 ( ) GINA
l/4 l/3 40% 50 75 260 314 215 1/3 89
(55 ) 90
( ) 2 91
468 8 11 1 75% 20 92
() camp camp IAR. LAR l 2 2 2 2 93
4mg 3 0.1 0.2mg 2 3 2.5mg 2 3 2.5 5.0mg 3 0.1 0.2mg 10 20mg. 3 0.5 1.0mg 3 6h 1 2 2 volmax formaterol broxaterol salmoterol 12h. BHR () ( ) (PDE) camp PDE 94
. IAR LAR 10 20mg/L 25mg/L 0.1g 3 0.25g 10% 20 40mI 1.2 1.5g 12h 12h () 654-2 (iprat-ropiumbromide) cgmp 95
20 40 g 3 4 4 6h () () ( ( LAR) LAR A2 LTS PGS TX PAF PGE 96
100 200mg. 100 200mg 10 20mg 500m1 2 4 30 40mg 5 50 200 g 3 4 () (disodiumcromoglycate) 20mg 3 4 () (ketotifen) 5-HT F F p P LAR IAR 2 2 1 2mg 6 97
() 8 16mg 3 10m1 3 () 4mg 0.1 0.2g 5% () () () 2500 3000m1 () 300 600mg 1000mg 98
40 80mg () 8 12h 0.25g 40m1 15min 1 2h 0.75mg/kg 10 20mg/L 1.5g 6h () 2 Hl ( ) ( ) () () 5% 5% [ BE(mmol/1) BE(mmol/l)] (1kg) Pa02 60mmHg 0.4 BE -3mmol/L () 35mmHg PaO 2 99
6.67kPa(50mmHg) PaO 2 7.98kPa(60mmHg) PaCO 2 () () l 5000 1 1000 1 100 0.05 0.1m1 1 2 0.1ml 0.5m1 15 1 2 () (astemizole) (terfenadine) (tranilast) Hl () 100
101
0.5%-2.0% 5% 1% 10 ( ) 102
103
104
10-1000 5 94% 60 105
1/3 (1) (2) (3) 106
107 C ( ) 1 0.1 1 20
(1) 2 3 108
109 (2) (3)
110 2 (4)
( ) 111
24 ( ) 112
( ) 1 2 3 4 5 10% 6 7 8 113
114
115 5
(1) 15 20g 15g 15g 10g 10g 3 10g( ) 20g 20g 6 10g 10g 20g 10g 6 116
2 3 2 (2) 05g 20 30g 10g 20g 15g 10g 10g 6g 3 6 15g (3) 117
20 30g 20g 20g 10g 10g 10g 20g 20g 6g 10g( ) 3g( ) 15g 10g 15g 20g 10g( ) 15g 10g 10g 15g 15g 20g ) 20g 10g 10g 15g 20g 6g 10g( 5g 15g 24 7 10 15cm 3 5 ( 3 5 ) 1 1 3 118
119 (4)
15g 10g 15g 6 10g 10g 10g 20 30g 3g 10g 10g 10g 15g 10g 20g 10g 10g 30g 6g 20g 1 2 3 120
121 4 5 A B C D E F G 6
1 5 5 122
2 (1) (2) (3) (4) (5) 123
124
125
126
4 60 1 3 127
1 50% 3 60 70% 0.5% 2% 128
129 5 3 50% ( ) ( )
130
131 5 5 10 70%
132
1 2 3 15 2 ( ) 133
2 2 ( ) 134
26 29 40%60% 5 8 135
10 ( ) ( ) 15 10 15 4 5 20 30 60%85%( 220 ) 136
137 10 15 70%3 50% ( )
138
2 3 6-12 26 29 40%60% 139
5 8 1 1 2 7 7 1 3 3 1 ( ) 1-2 4 ( ) 1 5 1 140
6 3 2 1 10 2 7 30-40 ( ) 1 1000 3 2 8 ( )50 500 50 5 9 2 8 10 1 150 3 141
1988 1995 111702 923 12 1 142
2 3 ( ) 4 ( ) 5 ( ) 6 ( ) 7 8 2 143
144-9 10 11
145 12 1 2 3 1
2 3 1 ( ) 2 ( ) 146
( ) ( ) ( ) ( ) ( ) 250 150 1.5 500 3 1 147
(60 )30 ( ) 4.5 2 15 15 0-15% 10-20 3 10-20 ( ) 4 30 1 3 148
( ) ( )2 1 7 10 2 149
( ) 5 10 (1) 3 1 2 11 13 (2) 3 2 1 6 3 (3) 150
(4) (5) (6) 170 70% 85% 90% 151
10 30 20 60 30 45 15 2 (1) 6g (2) (3) 1 90g 7 ( ) (4) 1 1 2 152
(5) (6) (7) 1 75g (8) 250g 75g 75g (9) 1 1 3 10g (10) 50g ()25g 5 (11) 1 1 1 (12) 1 1 ( ) 2 ( 1 1 ) 153
(13) ( ) 100 3 1 (14) 2 15g 2 500mL (15) 12 35 15 30 50mL 1 2 2 2 3 (16) ( ) 1 (81 ) 1 (17) (18) 1 1 75g 10 3 2 10 3 154
155 (19) 300g 250g 2 14 (20) 250g 120g 120g 120g 1 1 (21) 180mL 0.6g (1)
2 3 (2) (3) 156
2 (4) 157
158
159
1 2 3 4 [ 1 2 3 1 2 3 160
1 2 3 4 5 6 7 27 1 1.1 161
1993 27 14 13 8 2.8(3-15 ) 2 62.9% -14 5.6 3.4 24 3 44.4% ( ) 63.2%(12/17) 94.1% 4 1 ( ) 1.2 8 3 / 2500 2 10 1.3 1.3.1 (1) (2) (3) 162
1 3.2 10 14 3 37.03% 51.85% 11.11% 2 2.1 4 1 ( ) 2.2 163
2.2.1 2.2.2 2.3 ( ) 2.4 164
VCD 2.5 SIL-2R 6 2500 3-12 SIL-2R 3 165
166 1 2 ( ) 3
4 5 167
168 6 7 (
169 ) 24 4 5
170 (1) 2 1 3 1 16 (2) (3) (4) (5) (6)
171 (7) (8) 10 20 30 1 2
3 172
1 2 3 4 5 6 20 90 173
174
() 175
1 2 2 3 4 176
100 1 2 3 4 177
(1) 6 20 7 10 (2) 15 15 20 10 (3) 15 1 5 10 (4) 15 5 6 1 (5) 250 10 2 (6) 30 5 25 2 500 178
( ) ( ) ( ) ( ) 36 42 22% 20 179
213 25% 12% A C E 180
( 5 6 / ) 181
182
) 183
184
13222 2.7% 5.74% 185
1998 (Massachusetts General Hospital) (Carlos A.Camargo) 186
18-54 572 / (PEF) / 9000 187
FDA Jewish MonicaKraft 188
6500 25% Strachan 6.5 1.59 Strachan 189
6 15% 8 190
191 10 300 3 6 100%
3 6 192
460 20 ADAM33 2 ADAM33 ADAM33 193
2 3 45 3 194
Mie Yakemura 1673 22109 1 2 1 2 30 9 8 713 58% 195
78% 51% 5 000 196
Melbourne's Monash Michael 10 197
Th2 T 40 30% 70 20 80% 198
15000 4 11 17% Chang Yeung 3 23% 2000 ( 2001 34 11) (SO 2 ) 10 g/m 2 1.017 (NO)1.026 (O 3 )1.031 (SPM)1.015 SO2 10 g/m 2 3.3% NO 5.5% SPM 3.0% O 3 5.9% 199
WHO 200