( ),,,,
1 1 ( ) 1 ( ) 1 3 5 7 10 2 11 11 11 1 12 3 16 16 17 4 20
2 20 21 5 25 25 38 47 52 6 56 56 59 61 66 7 68 68 71 72 77 79 82 83
86 87 90 8 95 95 99 100 102 9 104 104 105 106 10 109 3 109 113 114 115 11 121 121
4 125 128 130 12 132 132 141 141 142 13 146 146 151 173 176 176 178 180 183
, ( allergy ) 1906 ( Pirguet) A llergic,,, 100 1956,, 49,,,,,,,,,,,,,,,,,,,, 1
2,,,,,,,, ( 7 8 ),! 2005 6 30
( ) 1906, : ; ;,,, 1,, ( ),,
2 ( ),, ( ), I, IgE : ;?, ( ) ; ( ), ( ),,,,,, ( ),,,
( ) : ( ) ; ( ) ; ( ) ; ( ) : ( ) IgE,,, 1., B,, IgE ( E), IgE, Fc 3,,, IgE 2., IgE IgE,,
4,,, ( : ),,,, :,, 1 2 2 8, 24 ( ) ( ) ( ) ( ) ( ),, ; - - K, - ( ),,,,
,, ( ), T T, T, 5,, ( ) 1. T ( T ) B ( B ) N K K
6, 2., 3. IgE ( Fc R ), IgE 4. T, 5.,, ( ),, ; ; T ; ; ;, ( IL ), IL 1 IL 18 ; ( IFN), ( TNF ) ( Ig) :
IgG IgA IgM IgD IgE Fc IgE, 3. 0, 8. 0,, 30 %,, 60%,, T?, T, 7 T H 2, T H 2,,, T H 1 IL-12, T H 1 - ( IF N- ), TH 1, T H 1
8,,,,,,, T H 1 TH 2 TH 2 IgE, T H 1 / TH 2, T,,,,, : : ; : ; : ; : ; ; ; ; ; ; ; ( ) ; ( ) ; :
; ; : ; ; ; ; I 1.,,,,, ;,,,, ;, 2. :,,,, 3., 9 4.,, 5.
10, ( ) 30% 40% 2 3, 1 ( ) ( ) ( ) ( ) ( ) ( ) ( ),,,,,,,
, ( ),,,,, : 11,
12 : ; ; X ; ; ; 1. (1 ) : ( OT ),, 24 48 : E, ; T (2 ) ( IgE IgG ) 2.,,,, (1 ) :, :, 15 20
, IgE,,,,,,,,,,, ; ; ; :,, 15 20, -, : 0. 5 +, 0. 5 1. 0, + + 13, 1. 0 1. 5, 1. 0 + + +, 1. 5, + + + +,,, :,,,, 15,
14 : :, 24 72 ( ), (2 ) :,,,, :, :,, :,, : ( )
,,, 3. IgE (1 ) ( RAST ) : IgE (2 ) ( ELISA ) :, IgE (3 ) IgE : 4. 5. 15
16,,, ( ),, ( ) (1 ) I,, (2 ) (3 ) ( ) ( ),,, T H 2,
( ), IgE,,, 2 5,,,,,,, ( ) I ( ), 17 I ( ) : ( Chlorpheniramine) ; ( Diphenhydramine ) ; ( Ketotifen ) ; (Decloxyzine)
18, : ( Terfenadine) ; ( Astemizole) ; ( Loratadine) ; ( Levocabastine) ;, ( ), ;, : ( Adrenalini Hydrochloridum) ; ( Isuprenaline ) ; ( Albuterpl, Salbutamol, Vent-olin) ; ( Bricanyl) ; ( Ephedrine) ( ) ( Aminophylline) ( ),
, : ( Dexamethasone) ; ( Triameinolone Acetonide) - A ; ; ( ),, : ( Montelukast ) ; ( Zafirlukast ) ( ) ( Cromolyn sodium), 19
20,, : 30 12, 2. 5 IgE,, 2005 7 8, :, :, :
( ), : ( ) ; ( ), :,,, :,,, 21,,,,, : ; ; ;
22 ; ; ; ;, ( ) 1.,,, 22,, 2.,, 98%,,, ( ), 3. ( WA O) ( W H O), : :,, 4 6,,
,, :, ( ),,,, : ;,, ( ),,,,, 23 ( ) 1.,,, ; ;,
24 60% 70% 2. ( ) T, T H 1 TH 2 T H 1 ; - ; ; IgE, 3., DNA,,
( ),, T,,,,, 1 %, 3 %, 1500 25 ( ) 1. (1),,, ; (2 ) ;
26 (3 ) ; (4 ) ; (5) ( ), : FEV1 ( P E F ) < 80%, 2 FEV1 ( PE F ) 15 % PE F (, ) 20%, ( ) 2. (1 ) :,,, (2 ) :, 3. (1 ) :, 10, 10 30, 1. 5 3, 15 30 F EV1 15% 20%,
(2 ) :,, 15 30 F EV1, 6 8,,, 3 12,, 4. (1 ) :,, (2 ) :,,, 5. ( ) (1 ) : 1 ( 27 ), 2 ; F EV1 ( PE F ) 80% ; P EF < 20% (2) :, 1 2, 2, F EV1 ( PE F ) 80% ; PE F 20% (3 ) :,
28, 2 FEV1 ( PE F ) 60 % 80 % ; P EF 20% 30% ; FEV1 ( PE F ), (4 ) :,, FEV1 ( PE F ) < 60% ; PE F > 30 % ; FEV1 ( P EF ),, 6. (1 ) : 1,,,,, ; ; (2 ) : ; ; ; (3 ) : 3 ; ; ( )
( ) : 1.,,,,, T, 2. -, : M 1 P, M 2 VIP, 29 3. ( ), IgE, IgE,,,
30 ( ),,,, I ; ;, ;,,,,,,,,,,,,,,,,,, ( ),,
: 1. 2 /3,,, 2. (1 ) :,,,,,,, 46 %, 37%,,,,,, 31,,, (2 ) :,,,
32,,, ; IgE,, I (3) :,,, ( ),,, (4 ) :,,,, ; (5 ) :, 10 15,,,, ;,,,,, (6 ) :,
;,,, I, : ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; (7 ) :,,,,,,,, (8 ) :, 1 /3, 33, 1 /3,, 1 /3,,,, (9 ) :
34 (10) :,, ( ) 1., (1 ) :,, 6%, 30 % (2 ) :,,,, (3 ) X : X, (4 ) :,, ; ; ;, :
: ( FVC), ( FEV1 ), ( FEV1% ) ( FEV 25 75 ) ; : ( PEF ), (CV),, ( F EV1 ), ( PE F ) PE F ( PE F % ) PE F (5 ) :,,, (6 ) :,, P 35 (7 ) :,,, : ( p H), 7. 35 7. 45; ( PCO 2 ), 35 45mm Hg; ( P O 2 ), 80 100 mm Hg; ( H CO - 3 ), 22 26mmoI /L ; ( BE), 0 3mmoI / L
36,, 2.,,, ( ) : (1 ) : : : : ( ) (2 ) :,,, : IgE, IgE, ( ),,
1.,, : 2.,,,,,,,,,,,,,,, 3.,,,,,, 4., 37,,,,,,,,, 5.,
38,, 6.,,, 120 /, ( P EFR ) 50% 7.,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,, ( ) (1 ),,, : : 39 100 / (2 ) : ( ) ; ;, ; ; ; ;
40 (3 ) : : :, :,,, ( ), 1.,, : (1 ), (2 ), (3) : (4 ), (5 ), 2.,,, (1 100,
1. 5 ),, : (1 ),,, (2) (3 ),, (4 ) (5 ) 50%, (6 ) 3.,,,, 41 ( ),, : (1) ( 3 11 ), (2 ), (
42 ), (3 ),, (4 ),, (5 ), 4.,,,, (1 ) (2 ) (3 ) (4 ) 5.,, (1 ),, (2 ),
(3 ), 6., (1 ) (2 ) (3 ) (4 ) 7., : (1 ), (2 ), 43 (3 ),, (4 ) (5 ) ( ), 8.,
44,, (1 ), (2 ) ( ) (3 ) (4 ), 9.,,, : (1), (2 ) : ; (3 ) (4 ) (5 ) 10. : ( ) ; (
) ; ( ) ; ( ) ( ) 1.,, ( ), 2.,,,,,,,,,, 45,,,,,, ( ),, 2
46, ( ) (1 ),,,,, (2 ),,, (3 ),, (4 ),,, (5 ), (6 ) 1,, (7 ),,,
,,,,,,,,,,,,,,, ( ) (1 ),,,, 47 (2 ),, (3),,, (4 ), ;,, ;
48 (5 ),,,, ( ) 1., (1),,,, 100 /, PEF 70%, PaO 2, PaCO 2 < 40mmHg, SaO 2 > 95% (2),,,,,,,
100 120 /,, PEF 50% 70%, PaO 2 60 80mmHg, PaCO 2 45mmHg, 2. (1 ) :, 2 :,,,, 1 4 ( 100 400 g), 5 10, 4 6 2 4, 20 30,, 2,, :, 49, 2 :,,, (2 ) :,
50,,,, 3., : (1 ) :, P EF 80% 2 (2 ) :, PE F 80% 3 4 2, 24, (3 ) :,, 4, PE F 50% 80% 2,
(4 ) :,, PE F 50%, 4. (1 ),,,,, (2 ), : 2 ( ),, 51 : ; ; ;, ; ; 1.,
52 ( ),, 2. : ; ;, 2 3.,,,, 4.,,, T, 5., 1.?,, 1 5 : 18,
: ; ; 2.?,, ;,,, ;,, 3.? (1 ) : 1 1, :, ; ; ; ; 53 (2 ) :,,, ;, ; 4.?,,,
54,, 5.?,,,,,,,,,, 1 2, 5 10,, 6.?,, ( ),,, 7.?,,,,,,
8.?,,,,,, ( ),,,,, 9.?,,,,,, 10.? 55
56 ( ),,,,,,, 10% 20%,,,,, ( ) ( ), ( ), : (1 ) : ;
(2 ) :, ; (3 ) :, ; (4 ) :,,,,,,,,,,,,,,, 57,,,,,,, 40%, 4 ;
58,, 80%,,,,,,, IgE 1.,,, 10, 20,,,,,,, 2. IgE ( 2 ),
,,,, ;,,,,,,,,,, (1 ),,,, 59 (2 ),,, 1 2,,
60,,,, (3 ),, (4 ),,,, (5 ),,,,,,,, 3 4,,,,,
,,,,,,,,,,,, : 1.,,,,, 61,,,,,,,
62,,,,, ;,,,,,,,,, A,,,,,,,,,,,,,,
2.,,, 3, 2,, 3.,,,, ( ), 20, 1, 90%, 60%,,,, :, 63,,,,,, ;,, ;,,,,,,,,
64,,,,,,,,,,,,,,,,,,,, ;,,,,,,, 90%,,,
,,,,, 10 1,, 1, 2,,, 4.,,,,,,,,,, 65,,,,
66 1.?,,, 50% ;, 70% 2.?,,,, 80%, 90% 3.?,, 4.?,,,, 1 3,,,
,, 5.? 3 5, 2 6.?,,,, 7.,?,,,, 8.? 67,,,, ;,,,,
68,, ( ) 1., ( ) 80 % 95 %,, 26. 5% 2., (1 ) : (2 ) :
(3 ) :, 10% 20 % ; ; ; 3., (1 ) :,, (2 ) :,,,, T, T T T, 69 ( ), 4, ( ), 24 48 4.,,,
70, 1 2 5. (1 ) ; (2 ), ; (3 ), ; (4 ), 48 4 7,, ( ) (1 ) (2 ), (3 ), (4 ),,
( ) (1) : 3% (2 ) : 10 % 10% ( ),,,, : (1 ) ; (2 ), 71 ; (3 ),,,, ( ) (1 ),,,,,
72 (2 ),,, 3%, ( ) 1. : ( ) ; ; IgE ; 30,, 12 12% 26%, 65% 6, 80% 1 2., 70%,
, T, T H 2 T H 1 TH 2 4 ( IL - 4 ) IL - 5, TH 1 IL - 2 - T H 1 / T H 2,, camp, T H 1 / TH 2,, T, T, ( ) 3. 73 (1 ) : 60% 6,, : ; ; ( ) ; ( ) ; ;
74 2 (2 ) : 4,,,, (3 ) : 12,,, 60% 70% 4. H anifin Rajka : (1 ) ; (2),, ; (3 ) ; (4 ) ( ) (1 ) ; (2 ) / / ;
(3 ) ; (4 ) IgE ; (5 ) ; (6 ) ( ) / ; (7 ) ; (8 ) ; (9 ) ; (10) ; (11) Dennie ; (12) ; (13) (14) ; (15) / ; (16) ; 75 (17) ; (18) ; (19) ; (20) ; (21) ; (22) ;
76 (23) / 4, 23 3 3 3 3, ( ) (1 ) (2 ), (3 ) (4), (5 ),, (6 ) 3, 55 (7 ), (8 ) ( ) (1 )
(2 ) (3 ) (4 ) : A (5 ) : ( ) 1., : ;, ; ;, 2.,, :,, ; : ; : ; 77 : : ;, ;, ; 3. (1 ) :,,,,
78,,, 2 3, 3 6, (2 ) :,, (3 ) :,,,,,, ( ) (1 ) (2 ), (3 ) (4 ), (5 ), ( ) (1 ) C,,
(2 ) (3 ),, (4 ) : 3 %,, ( ) 1.,, 20% 2., : 79 (1 ) : (2 ) : (3 ) : (4 ) : (5 ) :
80 (6 ) : (7 ) : 3., IgE ;, IgG IgM,, C3a C5a, ; C3a C5a,, ; ;,, 4. (1 ) :,,,,,, (2 ) :,,,, : (3 ) :,
(4 ) :,,, (5) : (6 ) :,, (7 ) : 4 6, ( ) (1 ) (2 ), 81 (3 ), (4 ), (5 ),, ( ) (1 ) :, C,
82,, (2 ) :, 2 3 ; ; (3 ) ; ; ; ( ) 1.,,,,, 2.,, 3. (1), (2),,,,
(3 ),, (4),, 1 2 (5 ), (6 ),, ( ) (1 ), ; (2), : 0. 1% 0. 3 0. 5 ; ; ;,, 83 (3 ) ( ) 1.
84,, 2. :, ; ;, ; ; 3. (1 ) : : ;, ;, 7 8, 24 ; ; ; (2 ) :,, 4. (1 ) (2 ), 4 20,, 24, 20
(3), (4 ), (5),, (6 ), (7 ),, ;, ; ; ( ), (1 ) 85, (2 ), (3 ) (4 ),
86 (5 ), (6 ), ( ) 1. C 2.,, 3. (1 ) (2 ) (3 ),, (4 ), (5 ), ; ; 4% ( ) 1.
2. (1 ) ( ) (2 ) :, 1 5,, 1 2,,,,,,,,,,,, ( ) (1) :,, 87 (2 ) :, C,, (3 ) : ( ) 1.
88 IgA,, 2. (1 ) :, 1 /3 (2 ) :, (3 ) : (4 ) :,, 3. (1 ), (2) (3 ),,
,, (4),, (5 ),,, (6),,, (7 ), (8 ) :, ;, ; IgA ; O (9 ), 89 ( ), (1 ) : (2 ) :,
90 (3 ) :,, (4) :,, (5),, 3, 3, (6 ) (7 ),, C K ( ) (1 ) (2 ) C (3 ) (4 ) (5 ) (6 ) 1.? :
: : :, :,, 2.?,,,,,, 91 3.,,?,,,,,,,,
92,,, 4.?,,,,,, 5.?,,,,,, 6.,?,,,,,
,, 7.,?,,, -,,,,,, 8.?,,,,,,,,,,,,, 93,,,,,, 9.?,, 7 10,
94 24,,,,,,,,, 10.?,,,,,,,,,
,, ( ) 1.,,, 95, 50 % 18 35,, IgE IgE, 4,,
96 10 : (1 ) : (2 ) : ( ) (3 ) : IgE I,,,, 2. : (1 ) :, (2 ) :,,,,,,
(3 ) :,,, (4 ) : ; IgE ;,,,,,,, ( ) 97 1.,,,, 60% 11 20, 2 10,,, ( 3 % )
98 I, IV, I : IgE,,, ( ),, : 2 6,, ( PG ) ( TS ) ( TAX) ( P AF ) ( ),,, 2. : (1 ) :,,,,,,, (2 ) :,,,,
(3 ) : :,,,,,,, 50% : :, :,,,,,,,,,,, 99,,,,,,,
100,, 1.,,,,, 2. : (1 ) : 1,,, : ; ; : 0. 05%, 1, 65 ; 0. 05 %,, (2 ) : : 2% 4%
; 0. 1%, 250 0. 05%, ; 2 4 (3) :, 1% 0. 1 % 1 % rimexolone ( ),, ;,,, 3 :,,, 101,,,,,, (4) :,,,,
102 ; ; ; ; ( ) :, ; (5) : T A (2 %, 1%, 0. 5%, 0. 1% ) ; FK506 ( 0. 1 %, 0. 05%, 0. 02 % ) F TY720 ( ), ; ;, (6 ) :, ( ) 1.?,,,
,, 2.?,,,,, 3.?,,,, 4.?,,, 3 103, 5.?,,,,
104,, 1.,,, 20% 90%,,,, 2. (1 ) (2 )
(3 ), (4 ) (5 ) B 3. (1 ) (2 ) (3 ) (4 ), 1.,,,, 105,,,, 2.
106 (1) :, 10, 24 (2 ) :, (3 ) :, (4 ) (5 ) 3. (1 ),, (2 ) (3 ),, C (4 ) : C B 6 (5 ) : 50%, (6 ),,, : 1.?
:, 20% 90% : 31, 7 ; 57, 13 ; 88, 22. 7% 2.?,,,,,, 3.?,,,,, 107,,, 4.?,,,,
108,,,,,, 80%,,,,.,,.,,
20% 50 %, 0. 3% 3. 7 % 65% 69%, 5%,, ; 109,, ( ) (1 ) : ;
110 (2 ) : ; (3 ) : ; (4 ) : ; (5 ) : ; (6 ) : ; (7 ) : ; (8 ) : ( ), (1) ( ) : IgE,, (2) ( ) : IgG IgM,, (3 ) ( ) : IgG
IgA IgM,, 8 12, (4) ( ) : 24 72 ( ) 1.,, 30% (1 ) : :, 24, 111 (2 ) : ( ) (3 ) :
112,, (4 ) : 2. 50%,, 3. 20%, :, ;,, ;,,, ( )
,,, : (1 ) :,,, (2 ) :,,, (3 ) :,, 113 (1 ) 3 (2 ) (3),,
114 (4 ) 1. (1 ) :, (2 ) :,,,,, (3 ) :,, (4 ) :, 1,,,,, 3 5,
,, 3 5, (5 ) :,, 1 000 10 000,,,,,,, (6 ) :,,, 2. (1 ) : (2 ) : (3 ) : (4 ) : 115 (5 ) : 1.?,,,
116,,, 24,,, 1 2,, 24, 2.? : (1 ) : ; (2 ) : ; (3 ) : ; (4 ) : ; (5 ) :, ; (6) :
; (7 ) : ; (8 ) : ; (9 ) : ; (10) : 3.?,,,,,,, 4.?, 117,,,, 3,,, 24 48,
118, 4 1 5.? (1 ) :,,,,,, (2 ) :,,, 2 3,, 6.? :,,,
7.?,,,,,,,, 30 50,,,, 8.??,, 3 4, 3 4, 119,,, 9.? :, 1 3,
120,,,,,, 10.? :,,,,
1.,,,,,,,,,, 121,,,, 50, 7 1, 70 5 1, 90 3 1,
122,,,,,,, 2.,,,,,,,,,,,,, 3.,,?,
,,,,,,,,,,,,,,,, ( ) 123,, (1 ) :,,,, ( ),
124, ( ),,, (2 ) :,,,, (3 ) :,, 20,, 20, (4 ) :,,
, (5 ) :,,, (6 ) :,,,,,,, 125 (1 ) :,,,, (2 ) :,,
126,, (3 ) :,,,,, (4 ) :,,,,,,, (5 ) :,, ;, (6 ) :,,,
,,,,,,,,,, (7 ) :,,,,, (8 ) :,, 127,, (9 ) : 15,, 15,,
128 (10 ) :, 0. 7 % 10%,, 0. 004% 0. 015 %,,, ( ), : 72,,,, ( ), ( ),,, V,,,,,? : (1 ),,
(2),,,, (3 ),, 10% C, 1 % (4),,,,, 10, 10,, 1 1000 0. 5 1, 129 (5), :, 1 1000 0. 5 1, 20 30 0. 5 ( 10 ), 5 10 25
130,,,,,, 1.,?,,,, ( ),,, ( ),,, 2.?,
,,, 3.?,, 20,, 20, 4.?,,, 131, 5.?,,,
132,,, 1. (1 ) ; (2 ) ; ; (3 ) ; (4 ),,,,
2. (1) :,,, (2 ) :,,, (3 ) :, (4 ) : 133,, ( ),
134, 1. (1 ), (2 ) (3 ), (4) 3 5 1, (5 ),, 2. (1 ), (2 ) (3 ), (4 ) ( ),,,, 90%
1. (1),, (2 ) (3 ),, 2. (1 ), (2 ), (3),, ;,, 5% 3 % 135 (4),, ( ),,, 0. 6 0. 8,,
136,, 3, 2,,,, ( p H 1 2 ), 1. (1 ) (2 ) (3),, (4 ), 2. (1 ),, (2 ),, (3 ), ( ),
1., 6 10, 200 300,,,,,,, (1 ) (2 ),,,,, (3 ), (4 ),,,, 137 (5 ), ; (1 ),,
138 (2 ),,, (3 ), :, 2., 5 11 (1 ) (2 ) 1 2 10,,,, 3 7, 1 (3 ) (4 ), (1 ),, (2 )
(3 ) (4 ) 3.,,, (1 ) (2 ) (3 ),, ; (4 ) (1 ) (2 ) (3 ) 139 ( ),,,,
140,,, 1. (1 ),,,, (2 ) (3 ), (4 ), 2. (1 ),,,,,, (2 ) 10% (3 ), (4 )
(1),, (2 ) ;,,,, B 1,, (3 ),, 141,,,,, (1 ),, ;,
142 (2),, (3), 0. 01% 5 10 (4 ) 0. 1% 0. 3 0. 5, 15 20, (5 ), (6 ), (7 ) 1. B 1? B 1 B 1,,,, 2.?,,, 90%,,,,,
, 3.?,, :,, ;,, 10 20, ; 0. 1% 0. 3 0. 5, 15 20 ; ;, ; ; ; ; 4.?,,, 143,, 40 5.?,,, 3
144,,, 6.?, 10, : 7.? :, ; ;,, ; ;,, 8.? : ; ; ; ; ; IgE IgE
9.?,,,, 10.?,,, 7 8, ; 5 8, ; 4 5 ;, 145
146,,,, ( ), T B T, B, ( ),,,
B,,,, IgM IgA IgG IgE IgD, 10 15, T ; 6 13 30 ;, 20 20 ; 10 T, 3 4, IgG, IgG, IgG,, IgG, 147 IgG IgG, 3, IgG, 3 6,, 3 75%, 5 6 IgM, 3 6
148 40% 50%, 1,, IgM, ABO IgA, 1, IgE, 2 3 ( ) 1., 50% 75%,, 70% 50% 30% ( ),, 2. ( 1 ),
, ( 28 ),,,,, IgA,, 2 3,,,,,,,, 149 3.,,,,,
150 4.,,,? (1 ) :,, 3 5, 10 14,,,, (2 ) :,, ;,,,,,,,,,,,,,,
,,, (3 ) :,,,,,,, (4 ) :,,,,,,,, 151, ( ) 21, ( ),, 30% 1, 80% 90%
152 4 5, 50% 10 20,, 95%, 1.,, ( 3 ), I,,,,,, 80, ( ), ( IgE ) 2.,,, ( ) (
, ),,, ; ;,, ( ), ( ),,,,, 10 3., (1 ) : 153, (2 ) :,,,
154 (3 ) :,, (4 ) :,, CD8 + T,,, ;, (5 ) :, (6) :, 6 10 1 10,, (7 ) :
(8 ) : 4.,, (1 ) :,,,,,,,,,,,, 155 (2 ) :,,,,,
156,,,,,, :,,,, ; ; ; ; (3) :, :, 1 2,,, 1 3,,,, (4 )
, :? ;? ;,?,,,,,,,,,,,, 2 ; 2 5.,,,,,, 157 (1 ) :, 2 -,, Pedr sen 10,,
158 (2 ) : 2 :,, :, (3 ) : :, :,, (4 ) :,,,, ( ) 12, ( ) 2 5 (5 ) :,,,,, T, 1 3,
( ) 1. ( ), I,, 1,,,,, 75%,, 159 2. ; ;,, ;,
160, 3. (1 ) :,, (2 ) :,,, (3) :, 80% 85%, (4 ) :,, ( ), ( ) 1.,,, 45% 56%,
,, :, 3,,, (1 ) : 1 3,,,,,, (2 ) :,,,,,,, (3) :, 161,,,,, :, : ( ) ( ), 1,
162, 2.,,,,,,,,,,, ;, ; ; ;, ;,,, ;,,,,
,, 3.,,,, ( ), ( ),,,,,,,,,,, ; 163 4., ( ),,,,, 4 20,
164,, 4 5 24,?,, : (1 ) :,,,,, (2 ) :,, (3 ) :,, (4 ) :,,,,, 1 3
(5 ) :,, 5., 1 60,,,,,,,,,,,,, C 165,,, ( )
166,,,,, 1. :,,,,,, IgE,,,,, ( ) 2., 80% 15,,, 20
,,,,,,,,,,,,, ( ), 3.,, 167, 4.,,
168,,, A,,, ( ),,,, 460,, 1.,,,,,,
, 10 1, 8 10,,,,,, 2.,,,,, 3. 169,,,,,,,,
170 :,, ( ) 1.,,,, (1) :, ( ),,,,, (2 ) :, 30,
,,,,,, (3 ) :,,,,, (4 ), 2 3,,,,,,,,,, 6 12 171,, 2.,,,
172 ( ),,, (1 ) :,,,,,,,, /,,, (2 ) :,,,,,,,, (3 ) :,, 30,
,,,,,, (4 ) :,,,, 173,,,,, 1.?, :
174, ( ) ; ( ) ; ( ) ;, ; ( ) 2.?,,, ;,,,,, 3.,? 4.?,,,,,,,, 2 %,, 5.? (1 )
(2 ),, (3 ), (4 ),, (5 ), ;, (6 ), 6.?,,,,,, 175,,
176 : :, : :, : IgE :, E,,, I :, :,,
( Ig) :, :,, :, :,,, :,, 177 : : ( 1 ) :, ; ( 2 ) :, ; ( 3 )
178 :, ; ( 4 ) ; ( 5 ) ; ( 6 ) : :,,, ;, ;, 1. ( H 1 ) Chlorpheniramine 4mg 3 / Diphen hydramine 25mg 3 / 20mg / Terfenadine 10mg 3 / Cetirizine 10mg 1 /
Loratadine 10mg 2 / Levocabastine 2 / 10mg 1 / 2. Ketotifen 1mg 2 / 3. Epinephrine 0. 1 0. 5mg Medihaler - Epi Isuprenaline ( 8 ) ( 8 ) Albuterpl Bricanyl 2. 5mg 3 / Ephedrine 25mg 3 / 4. 179 Aminophylline : / 0. 1g 3 5. Beclom et hasonedipropionate Dexamethasone 100 200 g / 0. 75mg /
180 19mg / Triameinolone Acetonide 40mg / A 6. Zafirlukast 20mg 2 / Montelukast 10mg 1 / (, ) 1. (4 10 ) 10 9 /L 50% 70% ( ) 35% 60% ( ) 25% 33% ( ) 35% 53% ( ) 2. (0. 005 0. 05 ) 10 9 / L 3. IgA 0. 69 3. 82g /L IgG 7. 23 16. 85g /L IgM 0. 63 2. 77g /L IgD 1 4mg /L IgE 0 0. 36mg / L 4. T
CD 3 + CD 4 + CD 8 + 60% 80% 35% 55% 20% 30% CD 4 + /CD 8 + 1. 5% 2. 0% 5. 0. 5 0. 7 6. 1q 157 237mg /L 3 0. 85 1. 93g /L 4 0. 12 0. 36g /L 7. < 15mm / H ( ) < 20mm / H ( ) 8. O < 1 400 9. p H 7. 36 7. 44 12. 798 13. 332kPa ( ) 4. 66 5. 99kPa ( ) 1. 5mmol /L ( ) 21 26mmol /L ( ) 21 27mmol /L ( ) 181 95% 98% ( ) 10. 3. 66 0. 74L( ) 2. 51 0. 46L( )
182 / 5. 4 0. 97L( ) 3. 85 0. 54 ( ) 2. 95 0. 72 ( ) 2. 12 0. 37 ( ) 1. 72 0. 57L( ) 1. 28 0. 35L( ) 31. 8 7. 9L( ) 33. 4 7. 7L( ) 0. 59 0. 18L( ) 0. 44 0. 14L( ) 3. 17 0. 82L( ) 2. 29 0. 6L( ) / 84. 0 8. 9% ( ) 87. 2 8. 2% ( ) 11. ( OT), 24 48
( ),,, : ; ;,,,,,,, 183, 2005 5