( 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...1...1 ( )...8...10...12...13...14...15...16...17...17 2500...18...19...19...21...22...26...26 I
...28...29...30...36...37...39...39...41...44...49...51...54...55...55...56...57...57...63...63...64...66...67 II
...69...69...70...71...74...75...78...79...79...80...88...89...90... 121... 122... 123... 125 T... 126... 126... 127... 128 III
... 130... 131... 132... 133... 134... 135... 136... 137... 138... 138... 139... 140... 140... 141... 143... 144... 144... 145... 146... 147... 149... 149 IV
... 150... 151... 152... 153... 154... 155... 156... 158... 159... 159... 161... 166... 168... 170... 170... 171... 172... 175... 175... 177... 177... 178 V
... 180... 181... 184... 185... 187... 188... 189... 190... 191... 192... 193... 194... 195 VI
1 ( ) (asthma) T / 1%
FEV1 FEV1 15% FEV1 PEF 20% IgE Th2 ( ) 2
3 (Clomethasone Dipropionate ) (Budesonide ) 2 ( ) ( ) (Fonoterol) (TAO) (SIT)
1997 1998 WHO SIT a. SIT b. c.sit d. FEV1 70%pre e. f. g. SIT IgE 1 IgE IgE(sIgE) 11q 12q 13q IgE 11 D11S97 DNA 2 4
5 (allergic) 60% 30% (idiopathic) 30% 40 (infants) 10% a. () b. IgE
c. d. ( ) PGE2 (LT) LTC4 D4 E4 2 ( ) T T CD28 B7 IL-1 IL-12 T Th2 Th2 IL-3 IL-4 IL-5 IL-13 TNF- GM- 6
CSF IL-3 IL-5 GM-CSF IL-4 IL-5 IL-13 TNF- VCAM-1 IL-4 IL-13 B IgE B CD40 T CD40 Th1 IL-2 IL-12 IFN- IgE Th1/Th2 IgE IL-8 RANTS 7
8 ( )
9 f 1 2 3
10 4 5 1JL.
11
12 - - - -
13 (ACTH) (bronchialasthma ) (AAI) (BHR) ( )
1 2 3 4 5 6 7 8 9 10 11 12 13 50 B 6 14 15 16 17 14
15 ( ) E E (7 10 )
( ) 86% 200 100 53% 42% 44% 36% 45% 7% 60% 30.5% 800ug 16
T (Cytokines ) T (TH) TH2 I TH1 (1) 17
(2) (3) (25 30 ) 2500 18
0.5% 1% ( ) 19
20 E E (7 10 ) ( )
21 [ ] B IgE (ECF) (IAR) 10 (LAR) (AAI) ( ) ( ) (LTS) (PGS) (TX) (PAF) BHR AAI. (NK) P (SP) --
PAF AAI LAR [ ] T 1 1% 3% 22
23
1 2 3 4 5 FEV1(PEF)<80% 2 FEV1(PEF) >15% PEF 20% 1 2 3 (1) 20mg 3-4 4-6 (2) 2 2 24
25 15-30 (3) (4) (5) 4 5 ( ) 24
26 20 ( ) ( )
27 21 60% 70%
300 77 239 64% 2 28
29 1
30 T 12 [ ]
24 [ ] 1 2 (1) (2) (3)1% O.2% 1 (PEV1) 15% (4) ( ) 3 (1) IgE 31
(2) IgE 4 [ ] 1 (1) 200 1 1-2 30 2 3 (2) ( ) (3) ( ) (4) 10 1 3 30 1 3 300 1 3 a 5 4 1 2 (5) 2000-3000 32
5%NaHCO3 100-300 500 1 1-2 30 3 0.25 5% 0.5 500 0.25-0.5 z 10% 10-20 2 (1). 10 10 3 5 5 10 lo lo 10 10 33
10 10. 10 10 30 ( ) 6 10 10 15 10 10 10 10 (2) 15 30 30 10 10 6 30 15 6 ( ) 34
15 10 1 10 10 6 15 30 5 ( ) 10 6 ( ) 10 15 15 24 15 10 15 10 10 15 10 30 15 (3) 3 1 2 15 30 12 1-1.5 1 3 35
2 3 5 10 1 10 [ ] 1 2 3 4 ( ) 20 60 ( ) 36
1 IgE ( ) B I E I E Fc I E IgE 5- IgE T IgE 37
T 2 (BAL) 3 ( ) - - 38
39 ( ) (Charcort-Leyden ) (Curschmann ) (Laennec )
PaO 2 PaC02 ph CO2 PaC02 X (RAST) IgE IgE 2-6 15% IgE IgA IgM 40
41..... T 1 1% 3%
1 2 3 4 5 FEV1(PEF)<80% 2 42
FEV1(PEF) >15% PEF 20% 1 2 3 (1) 20mg 3-4 4-6 (2) 2 2 15-30 (3) (4) 43
(5) 4 5 ( ) 24 18 10% 5 44
1994 1997 8 1997 ( ) 1999 8 (1) (2) (3) () ( ) (4) (5) 45
46 ( ) ( )
47
48 ( ) ( )
( ) 81.33% 99.33% 1/10 1.5 Manolis Kogevinas 15637 2O-44 12 26 49
2O 30-5O (16 ) 3O 12 Joseph Anto ( ) Anto 12-32 50
51 250 1/20 1/4
52
53
MarySexton 6 103 134 20 54 40 (30)9 (9) 6 5 ( =5.5 95% 2.2 13.7) 6 4 ( 3.9 9.5) 54
Sexton 66% 353 55
56 E [ ] [ ] 25% 78%
57 (bronchialasthma ) (AAI) (BHR) ( ) 30
58 0.5 4 ( ) 15 ( ) ( ) ( ) ( )
59 ( ) ( ) ( ) ( ) 4 6 ( )
60 1996 ph ph
1996 Stephen 77% 55% 24% Richter ph 84% 64% ph Richter 61
62 1996 73%
63
64 2%.
65 ( )
66 ( ) 5
4 5 9 10 80% 1/3 2/3 301 20 67
68 4 4 1 2 2 3 ( )
Thorax ( ) 100 200 E 30 69
70
71
7% 19% 1% 8 50% 1 3 6 1 72
73 6 1 1
74 2 3
(1) (2) (3) (4) (5) (6) ( ) 4-6 75
76 1 2
77 3 6 8 6 8 4 ( ) ( )
78 3000 10 13 3% 10%
4 1.5 100 200 E 2-3 30 79
6 95% 18% 150 1 7 1982 1992 10 80
( ) ( ) 81
82
83 2 4 ( )
84 ( ) ( )
( ) 85
( ) 86
( 87
100 200 E 88
89 1 500 51% 27% 69% 50% 79% 6%
90 2002 b2
(bronchialasthma) 4 5 1987 1988 3 16-2 16-2 1 12 1 2 91
2 1 1 1 1 1 1 0.01ml/kg( ) 10-15' 4 3 2 6 8 3 3 ( ) 0.5% (FEV1) 15% ( ) 92
93 ( ) (ATP) (camp) camp
5'AMP camp 1 2 2 2 2 (metered doses inhaler MDI ) 4 5 ( ) MDI (nebulizer) 94
( 80% 85%) 4 5mg/kg( ) 5% 10% 30 (6 ) 1 9 0.6.9mg/kg h 10 20 g/ml 4 5mg/kg 6 8 2 3 95
20 80 g 3 6 2 (scopolamine) 0.01 0.02mg/kg (phentolamine) / 96
Brown 1972 (beclomethasone dipropionate aerosol BDA) 1 2 BDA2 4 1 2 ( BDA50 g) 400 g BDA 3 BDA BDA BDA BDA ( ) 97
1972 Wood 0 1 2 PaO 2 (kpa) 9.3 40%O 2 11.3 9.3 9.3 PaCO 2 8.7kPa 7 PaCO 2 6.7 9.3kPa PaCO 2 9.3kPa 1988 40% 4 5ml/PaCO 2 9.3kPa a. 0.5% 1 4 0.25ml 6 98
.5ml 12 1 2 6 b. 4 5mg/kg 20 30 0.6 1mg/kg/h 1 6 4 5mg/kg c. 4 5mg/kg 8 g/ 20 30 4 6 1 2mg/kg 0.25 0.5mg/kg 6 0.1 g/kg min 5 g 10 15 3 4 g/kg min PaO 2 180 200 min 2 24 40% PaCO 2 9.3kPa 99
3 4 (6 8 4 5mg/kg) ( 100mg 200mg 12 ) ( 4mg 12 8mg 12 ) ( ) 100
101 1 95% (RSV) IgE ( ) 4 5
2 ( ) ( ) 3 4 5 6 90% (exercise induced 102
asthma EIA) (5-10 ) 7 camp 1 IgE ( ) B IgE IgE Fc 103
IgE IgE 5- IgE T IgE T 2 (BAL) 3 ( ) 104
105 - - 1 1988 1991 20 100
0.9% 1.1% 1978 14 1.9% 1.3% 1984 25 1.3% 2.7 1.3% 5.2% 45 0.9% 40 0.9% 14.4 1.6% 1979 1988 10 12 4.8% 0.03% 2 5 70 80% 4 75% 3 50% 3 10 1984 1 6 106
107 / IgE 2 RSV RSVIgE 3 1 2
108 ( )
109 (Chancot-Lyden) 0
110 1 300 106L(300/mm 3 )
2 3 X X 4 20 111
0.01 0.02ml 1 100(W/V) 1 1000 1 10000 24 48 5 - (TLC) (FRC) (RV) (VC) (FVC) (FEF25-75%) (PF) (PEFR) 3 4 112
2 15% 6 ph PaO 2 PaCO 2 ph PaO 2 PaCO 2 ph PaO 2 PaCO 2 113
7 (methacholine) 1 1 3 IgE 70 2 1 4 3 114
X 4 X CT 5 X 6 115
116 10% X 7 ( )
IgG IgE 2 3 22.5% 1 4 7ml/ 7 117
10ml 14 15ml 3 3 6 RSV 2 3 20mg 3 4 2 4 4 6 (ketotifen) 0.08 0.12mg/kg/d 6 12 118
119
120 ( ) 2 4/10 80% 70%10
121 IgE
122 ( )
123 IgG () (1) 30%
(2) 10% 30% 124
125 80% 70% 10 (1) (2) (3) (4)
T T (1) (T4 ) 30% 40% (2) (T8 ) IgE T8 IgE ( ) T T4 T8 T T4 T8 T8 IgE 126
(1) (2) - (3) (4) 127
128 ( ) 1 2
129 I 1 2 16 18 2 55% 15 30%
130 (1) (2) (3) (4)
131 (5) E(IgE) IgE ( ) 6
132
133 5 9 12 2
G(IgG) 6 IgA 6 3 6 9 134
135 56% 76% 75% 50% 80%
136 10% 24 (1) (2) (3) (4) (5)
(6) (1) (2) (3) 6 (4) (5) (6) (7) 137
(5 10 ) 138
( ) 139
140 (1) (2)
141 (3) (25 30 )
142 8kPa 5.33 667kPa 2.67kPa
143
144 (1) (2) ( ) (3) (4) (5)
145 (1)
146 (2)
147 (1)
148 (2) (3) ( ) ( ) (4) (5) 5 10 (6)
149 3 IgA IgG IgA E(IgE)
150
4 5 7729 64% 74% 45% 65% 82% 151
20 1951 Ratner 60% 80% 6 92 94 2 38 2 152
153 A SIgA ( ) 90% 99% 100 1000
- - (1) (IAR) 10 15 30 1.5 3 15 30 FEV1 15% 20% I (2) (LAR) 15 30 FEV1 154
6 8 3 12 50% 73% 86% IgE I (1) 24 C 3 155
(2) (3) (4) FEV 1 130 / X PO 2 60mmHg PCO 2 40mmHg 3 4 156
25mg 3 10 20mg 3 4 F 157
10% 158
159
160 (1) DDV (2)
161 143 3 61.5% ( ) ( ) (1)
a b c d e 162
I 1924 Van Leeuwen I 163
164 (2) (3) 35% 50%
165 (4) (5) Agarwal 15% 50% 2% 5% Peter () () (6)
166
167
168 0.5% 2.0%
1.5% 5.1% 5.4% 7.4% 0.5% 2.0% 30% 10 1199 4 46.6% 5 9 21.0% 10 67.7% 5 80% 1.5 1 3.0 1 1964 12 3.2 1 1979 1.75 1 1983 1.63 1 1983 169
0.2% 7.4% 1.1% 9.9% 0.5% 2.0% 5.29% 40 0.5% 30 7 4% 1958 0.46% 1979 0.69% 1959 4.5% 1980 5.29% 170
(1) (2) 171
172 (3) (PEFR)
(1) (2) (3) (1) PEFR PEFR PEFR (2) 1.1 2 4 173
0.7 (3)24 (4) (5) (6) PEFR (7) (8) 174
1220 589 () 48.2% 145 3992 56% 76% Schwartz TurnerWarwick 1984 200 I 672 139 (20.7%) I 200 I 757 39 5.2% 175
50% 2 176
30 40 ()60 15 2O 2 177
( ) ( ) Graham Roberts 50 200 Roberts ( ) 4% 8% 178
179 (ICU) 19 2 52.6% ( ) 10.5% 1 9.85 5.89
Mount Sinai Hugh ASampson Sampson Sampson 180
79 30 24 36 ( ) 30 15 20 15 15 40 25 20 5 10 20 15 20 181
20 20 15 5 3 5 7 24 182
183
184 20 80 90
3 4 2 Beth Israel Dr.Mary Lee-Wang 185
40 18 55 8 (flunisolide 250 ) 2 8 1 7 (PEFR)190L/min 379L/min 207L/min 347L/min (P=0.95) FEV1 1.6L 2.3L 1.4L 2.1L(P=0.33) 0.7 0.9(P=0.39) (prednisone) 186
1000 500 10 50 50 50 250 250 500 187
(COPD) WanC.Tan COPD Tan 17 29 14 COPD 52% DNA 7% DNA (47%) 188
24%) COPD (36%) Stanford 20 (2003 5 ) 24 2436 12 189
12 4.06 2.35 1.83 2.27 73% 122% 79% 4.06 4.51 Stanford FDA 190
FDA 1 FDA 60 000 13 174 13 13 179 4 8 1 FDA 191
1997 1999 1293 5 60 Cox 45% DavidS.Pearlma. 432 192
100mcg 50mcg ( ) 10mg( ) 12 Pearlman ( ) Babu Salvi 193
6% 20% E2 Babu Babu 1 G.Di Cristina 194
1992 1262 ( 651 9.57 ) 1998 1210 ( 639 9.02 ) 11.9% ( [OR] 1.90) (OR 3.15) (OR 2.52) 10.2% 20.1% 31.6% McMaster 195
196 EllenMcDonald 10 10 (HEFA) 216
197