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WAO News & Notes - February 2008
Volume 5, Issue 2

Medical Journal Reviews

Medical Journal Reviews


Reviewed by Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief and Guest Reviewer Gary Hellermann, PhD


1. Mast cell (MC) derived TNF is essential for allergic airway disease.
Mast cell-deficient (MCD) mice were examined to determine their role in producing inflammatory mediators that contribute to airway disease pathology. MCD mice exhibit reduced airway hyperresponsiveness, less goblet cell hyperplasia and lower inflammatory cytokine levels, and this effect is reversed by injecting wild type MCs into the MCD mice. Injection of MCs from mice lacking TNF, however, gives similar results to MCD mice suggesting that TNF is necessary for the inflammation associated with airway disease. Editor's comment: MCs are key players in airway disease and offer potentially effective therapeutic targets. Reuter S et al., Eur Resp J, 19 Dec 07 [Epub ahead of print].

肥大细胞( MC )产生的肿瘤坏死因子是过敏性气道疾病的重要介质
研究肥大细胞缺陷(MCD )小鼠,以明确肥大细胞产生的炎症介质在气道疾病中的病理学作用。肥大细胞缺陷小鼠气道反应性较低,杯状细胞增生和炎性细胞因子的水平降低,且这种作用在给 MCD小鼠注射野生型MCS后被逆转。而[给野生型小鼠]注射肿瘤坏死因子缺乏的小鼠的肥大细胞,可得到与MCD小鼠类似的结果,这提示肿瘤坏死因子对气道疾病的炎症反应是必要的。编者按:肥大细胞在气道疾病中起到关键作用,并提供潜在的有效治疗靶点。 Reuter S et al., Eur Resp J, 19 Dec 07 [Epub ahead of print] Reuter S et al., Eur Resp J, 19 Dec 07 [Epub ahead of print]

2. Antibiotics and topical nasal steroid (NS) for treatment of acute maxillary sinusitis (AMS).
Amoxicillin (A) and budesonide (B), either separate or in combination, were tested in a DBPC randomized trial of 240 adults with acute nonrecurrent sinusitis. Patients with fewer than two Berg-Carenfelt criteria or those with two or more acute attacks of sinusitis in the previous year were excluded. Subjects were randomized to either: A + NS; placebo A + NS; A + placebo NS; or placebo A + placebo NS. They were given A 500 mg three times daily for seven days with or without B 200 µg per nostril once per day for 10 days. Study participants kept a symptom diary, filled out questionnaires and returned the drugs for compliance testing. No improvement in symptom scores was seen with A or B alone or in combination versus placebo. Editor's comment: AMS resolves with or without A or B or their combination. Williamson IG et al., JAMA, 2007; 298:2487-96. [Editorial: Lindback M, pp. 2543-4.]

这个双盲安慰剂对照的随机试验中,240例成人非复发性急性鼻窦炎患者单独或联合应用阿莫西林(A)和布地奈德(B)。符合Berg-Carenfelt标准两项以下者,或过去一年内两次或两次以上的急性发作的鼻窦炎的患者被剔除。研究对象随机分为以下两种治疗措施之一: A +NS;安慰剂 A+ NS; A+安慰剂NS ;或安慰剂A+安慰剂的NS 。疗法为阿莫西林500毫克,每日3次,疗程7天;合用或不合用布地奈德200 μ g/鼻孔/天,疗程10天。受试者每天记录症状日记,填写问卷并返回药物以评价治疗依从性。和安慰剂相比,AB单独或联合应用后,症状评分并没有改善。编者按:急性上颌窦炎的改善与是否使用阿莫西林或布地奈德无关。Williamson IG et al., JAMA, 2007; 298:2487-96. [Editorial: Lindback M, pp. 2543-4.]

3. The prevention of COPD exacerbations by salmeterol/fluticasone propionate (S/FP) or tiotropium bromide (T).
This study is a two year double-blind, double-dummy multicenter comparison of the combination of S 50 µg plus FP 500 µg (SFC) twice a day to T 18 µg once per day in preventing COPD exacerbations in 1323 subjects with severe to very severe COPD (FEV1 < 50% of predicted). Two treatment groups (SFC, n = 658; T, n = 665) were randomized and pre- and post-dose FEV1s obtained. Symptom diaries, medication use (short-acting beta-agonists and oral steroid), healthcare utilization, and filled out respiratory questionnaires were accessed. While there were no significant differences between the two groups in the number of exacerbations, those in the SFC group were less likely to withdraw, had better overall health and lower mortality than those given T. Editor's comment: SFC treatment versus T resulted in fewer deaths and less morbidity, although the primary outcome, COPD exacerbations, was no different.

这是一项为期两年的双盲­-双模拟-多中心研究,在1323例严重和非常严重的慢性阻塞性肺疾病患者( FEV1 < 50 %预测值)中,比较吸入沙美特罗50 μ g加丙酸氟替卡松500 μgSFC)每日两次和溴化异丙托品(T 18 μg每日一次对预防慢性阻塞性肺疾病加重的作用 。把患者随机分为两个治疗组(SFC658例;T 665 ),并测定患者治疗前后的FEV1。评价患者的症状日记、药物使用情况(短效β -受体激动剂和口服类固醇) ,医疗保健的使用情况(即急诊/门诊就诊记录),并填写呼吸问卷。两组COPD加重的次数无显著差异,但与T组相比,SFC组退出率较低,整体健康状况较好,死亡率较低。编辑评论:尽管主要研究终点(慢性阻塞性肺病加重)在两组间无差异,但与T相比,SFC治疗可降低哮喘的死亡率。Wedzicha JA et al., Am J Resp Crit Care Med, 2008; 177:19-26.

4. Augmented epithelial endothelin-1 (EDN1) expression in refractory asthma.
Ten healthy controls, ten steroid-naďve patients with mild asthma, and 18 severe asthmatic patients on glucocorticosteroid treatment were recruited for this study. Bronchoscopy specimens were obtained and laser-capture microdissection used to obtain bronchial epithelial cell samples for quantitative real-time PCR analysis of 17 transcripts for a panel of growth factors, cytokines and chemokines. PCR data were verified by immunohistochemistry on bronchial biopsy specimens. The levels of IL-8, CXCL8 and EDN1 were elevated in patients with severe asthma. EDN1 is involved in airway remodeling, and the presence of large numbers of epithelial cells producing EDN1 may account for the increased airway smooth muscle mass and fibrosis seen in these patients. Editor's comment: Therapeutic intervention targeting the endothelin receptor may be effective in treating refractory asthma. Pégorier S et al., J Allergy Clin Immunol, 2007; 120:1301-1307.
难治性哮喘的上皮内皮素-1 EDN1 )表达增加
名健康对照, 10名未使用类固醇的轻度哮喘患者和正在进行糖皮质激素治疗的18个严重哮喘患者入组本研究。用支气管镜检活检取得样本,用激光捕获-显微解剖法得到支气管上皮细胞样本,立刻进行定量PCR,分析17种生长因子,细胞因子和趋化因子。对支气管活检标本进行免疫组化学分析,以验证PCR结果。在重症哮喘患者,白细胞介素-8CXCL -8EDN1水平较高。 EDN1参与气道重塑,这些患者气道中有大量的产生EDN1的上皮细胞,可能是气道平滑肌增生和纤维化的原因。编者按:针对内皮素受体的措施可能治疗难治性哮喘。Pégorier S et al., J Allergy Clin Immunol, 2007; 120:1301-1307.

5. Factors associated with 5-year risk of hip fractures in postmenopausal women.
This report utilized a multiethnic cohort of 93,676 USA postmenopausal women, aged 50-79 years, enrolled in the Women's Health Initiative to examine a number of clinical risk factors and to develop an algorithm for predicting the 5-year likelihood of hip fracture. The model obtained from this observational study was validated by examining data from women in the clinical trial arm and tested in a subset of women from the clinical trial who underwent dual-energy x-ray absorptiometry (DXA) scans. Eleven factors predicted hip fracture within 5-years: age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes. Editor's comment: This large 5-year study should prove helpful in counseling individuals as to their risk of hip fracture. Robbins J et al., JAMA, 2007; 298:2389-98.

本报告是一个队列研究,9367650-79岁的多种族美国绝经后妇女加入妇女健康行动以观察其髋部骨折的临床风险因素,并建立预测5年内髋部骨折发生率的方法。这个观察性研究建立的模型是根据参加临床试验的妇女的观察数据,和参加临床试验的一个亚组中进行双能X线骨密度(DXA )扫描的数据。 十一种因素可预测未来5年髋部骨折:年龄,自我报告的健康状况,体重,身高,种族/族裔,自我报告的体育锻炼,54岁以后的骨折史,父母髋部骨折史,正在吸烟,正在使用糖皮质激素和正在治疗的糖尿病。编者按:这个大型的为期5年的研究应有助于在进行患者髋部骨折风险评估。Robbins J et al., JAMA, 2007; 298:2389-98.

6. Safety and efficacy of bronchial thermoplasty (BT) in symptomatic, severe asthma.
To test the efficacy of BT as a method of reducing airway smooth muscle mass and improving patency by vasorelaxation, a group of patients whose asthma symptoms persisted in spite of treatment with high dose ICS, LABA, and oral glucocorticosteroids (OCS) were randomized into control or BT groups. Thirty-two subjects (15 in BT and 17 in controls) with severe refractory asthma, according to the GINA criteria, were included. About half of each group were taking OCS as well as using ICS-LABA. Outcomes were diary symptoms scores, questionnaires and interviews, and PEF, FEV1 and PC20. BT caused an initial increase in asthma exacerbations followed by statistically significant improvement in airway function, rescue medication use, and symptoms. Editor's comment: Treatments such as BT are welcome additions to the therapeutic arsenal for severe asthma. Pavord ID et al., Am J Resp Crit Care Med, 2007; 176:1185-91.

重度支气管哮喘患者进行气道热成形术( BT)的安全性和疗效 
为评价BT减少气道平滑肌增生和通过血管扩张改善支气管功能的疗效,吸入高剂量皮质激素(ICS-LABA和口服糖皮质激素(OCS)但仍有哮喘症状的患者被随机分为对照或BT组。32例符合GINA标准的重症难治性哮喘患者入组, 其中BT15例,对照组17例。两组中,各有约半数同时使用口服皮质激素和吸入ICS-LABA。研究结果包括日记症状分数,问卷调查和随访,PEF FEV1的和PC20 。在BT组,哮喘加重次数降低,气道功能、抢救药物的使用和症状的改善具有统计学显著性意义。编者按:BT这种疗法是对重度哮喘治疗的有益补充。Pavord ID et al., Am J Resp Crit Care Med, 2007; 176:1185-91.

7. A population-based study of the incidence and complication rates of Herpes zoster (HZ) before zoster vaccine introduction.
This retrospective study involves 1669 adults with confirmed HZ between 1 Jan 1996 and 31 Dec 2001, prior to the use of HZ vaccine. The adjusted incidence of HZ was 3.6 per 1000 person-years, and 68% of cases occurred in persons 50 years of age or older. Most (92%) were immunocompetent and 60% female. The most common complication was post-herpetic neuralgia (18% of the HZ patients) and 25% had at least some HZ-related sequelae. Editor's comment: This is the first large, population-based study to provide baseline data (before Zostavax®, Merck & Co., Inc, New Jersey) on HZ by age, gender and immunocompetence. Yawn BP et al., Mayo Clin Proc, 2007; 82:1341-1349.

本研究回顾性分析了 19961120011231之间的1669例带状疱疹成人患者,当时还没有带状疱疹疫苗可用。校正后的带状疱疹发病率为3.6/ 1000/年,有68 %的病例发生在50岁或50岁以上的患者。大多数( 92 )发生在免疫缺陷患者,60 %患者为女性。最常见的并发症是带状疱疹后神经痛( 见于18 HZ患者),25 %患者至少有一项带状疱疹相关的后遗症。编者按:这是第一个大型人群研究,对带状疱疹按年龄,性别和免疫功能提供了使用HZ疫苗前的基线数据( zostavax ,默克,新泽西州)。Yawn BP et al., Mayo Clin Proc, 2007; 82:1341-1349

8. Virtual Symposium on Airway Smooth Muscle (ASM).
This symposium begins with an introduction emphasizing the role of ASM changes in the pathology of asthma, COPD and cystic fibrosis, and the realization that ASM is an active player in secreting molecules involved in inflammation and airway remodeling. There are 18 articles covering topics ranging from the mechanics of smooth muscle contraction and interactions of smooth muscle cells with their matrix to ASM growth in asthma, genetic differences in ASM function and the ASM cell as an inflammatory cell. Editor's comment: This is essentially a book in journal form-- an up-to-date review of ASM by experts in the field. Panettieri RA, Jr., and Solway J, editors, Proc Am Thoracic Soc, 2008; 5:3-132.

8   气道平滑肌(ASM)研讨会
本次研讨会强调了气道平滑肌的改变对哮喘、慢性阻塞性肺病和囊性纤维化发病的作用,并认识到气道平滑肌分泌的介质在气道炎症及气道重塑中起到重要的作用。本期杂志共有18篇文章,涵盖了如下内容:平滑肌收缩的机制,平滑肌细胞与基质的相互作用,哮喘患者的气道平滑肌增生,气道平滑肌的功能的遗传差异,气道平滑肌细胞的炎性细胞作用。编者按:这是杂志形式的一本书, 由该领域的专家对气道平滑肌进行了全面的最新的综述。Panettieri RA, Jr., and Solway J, editors, Proc Am Thoracic Soc, 2008; 5:3-132.

9. Randomized trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnea (OSA).
This study tests the efficacy of surgical treatment (septoplasty) in 49 OSA patients to improve nasal as opposed to oral breathing. Subjects were randomized into surgery (27) or sham surgery (22) groups. Baseline measurements were similar in the two groups. The average apnea / hypopnea index (AHI) was similar in the two groups, but the surgery group included four treatment successes (significant increases in nasal breathing epochs and decrease in AHI) while there were none in the sham group. Editor's comment: Only four patients improved with nasal surgery, 23 did not. Treatments other than nasal surgery are needed for OSA. Koutsourelakis I et al., Eur Resp J, 2008; 31:110-117.

鼻部手术治疗阻塞性睡眠呼吸暂停患者( OSA )的固定性鼻塞的一项随机临床试验 
本研究观察了49 OSA患者鼻中隔成形术对改善鼻腔呼吸的作用,这些患者因固定性鼻塞而张口呼吸。研究对象随机分为手术( 27 )或假手术( 22 )。两组间基线指标类似。术后两组平均呼吸暂停/低通气指数( AHI )相似,但手术组有4例治疗成功(鼻呼吸时程显著增加,AHI降低) ,而假手术组没有一例成功。编者按:只有4例患者在鼻腔手术后得到改善,而 23例没有。OSA患者需要鼻部手术以外的其他治疗。Koutsourelakis I et al., Eur Resp J, 2008; 31:110-117.

10. Flu myths: dispelling the myths associated with live attenuated influenza vaccine (LAIV).
This timely review compares LAIV to conventional trivalent inactivated influenza vaccine and dispels the misperceptions associated with the former. Live virus shedding is one fear, but data demonstrate that viral titers from LAIV are well below the dose needed to cause infection. Also, there is no evidence that the attenuated virus can revert to the wild type and cause disease. Side effects from LAIV can include rhinorrhea and low-grade fever; serious adverse reactions have not been reported. Although LAIV is not recommended for asthmatics, one trial of children with moderate to severe asthma showed that LAIV was well-tolerated and effective. Editor's comment: Increase use of LAIV could reduce the worldwide incidence of this disease. Tosh PK et al., Mayo Clin Proc, 2008; 83:77-84.
禽流感:解读减毒活流感疫苗( LAIV   
这一及时的综述对LAIV和传统的三价灭活流感疫苗进行了比较,并消除了对前者的误解。人们担心减毒活疫苗会导致活病毒脱落,但数据表明LAIV的病毒滴度远低于需要引起感染的剂量。此外,也没有证据表明减毒病毒可以还原到野生型并导致疾病。副作用LAIV可以包括流涕和低烧;严重不良反应尚未见报道。虽然LAIV不推荐用于哮喘患者,但一个中度至重度哮喘儿童的临床研究表明,LAIV有良好的耐受性和有效性。编者按:增加使用LAIV可减少世界范围内禽流感的发病率。Tosh PK et al., Mayo Clin Proc, 2008; 83:77-84.

11. Global strategy for asthma management and prevention: GINA executive summary.
GINA, the Global Initiative for Asthma, is dedicated to providing accurate and useful information on asthma management. The current emphasis is on optimizing "asthma control"; the GINA recommendations are adapted for regional differences in treatment availability, resources and services. Editor's comment: This is a comprehensive document about asthma management and prevention with 409 references. Bateman ED et al., Eur Resp J, 2008; 31:143-78.
11  哮喘管理和预防的全球战略:GINA内容提要
,全球哮喘动议,致力于提供哮喘管理的准确有用的资料。当前的重点是优化“哮喘控制”;GINA的建议根据可用的治疗方法、卫生资源和医疗服务的地域差异进行了调整。编者按:这是有关哮喘管理和预防的一份全面的文件,有409篇参考文献。 Bateman ED et al., Eur Resp J, 2008; 31:143-78.

12. Sinusitis in children.
Sinusitis in children may manifest with cough, nasal congestion and other symptoms of an URI. Recurrent sinusitis can be associated with GERD, anatomic defects or immunodeficiency. This comprehensive review explains the clinical symptoms of sinusitis in children and the current best methods to diagnose, prevent, and treat this disease. Editor's comment: This review is excellent reading for all physicians who care for children. Virant FS, Ped Asthma Allergy & Immunol, 2007; 20:157-67.
12  儿童鼻窦炎  
鼻窦炎在儿童可能表现为咳嗽,鼻塞或其他上呼吸道感染症状。复发性鼻窦炎可以与GERD,解剖缺陷或免疫机能丧失相关。本综述全面描述了儿童鼻窦炎的临床症状,目前诊断、预防和治疗这种疾病的最佳方法。编者按:这是供儿科医生阅读的很好的综述。Virant FS, Ped Asthma Allergy & Immunol, 2007; 20:157-67.
13. Morbidity and mortality for vaccine-preventable diseases in the U.S.
This review compared morbidity and mortality before and after wide spread implementation of national vaccine recommendation for 13 vaccine-preventable diseases for which recommendations were in place prior to 2005. A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Epidemic transmission of polio virus, measles, and rubella viruses was eliminated. Smallpox was eradicated worldwide. Declines were 80% or greater for cases and deaths of vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, HiB, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively. Editor's comment: Vaccines work! Every physician should make sure their patients are up-to-date on all vaccinations. Roush, SW et al., JAMA, 2007;298:2155-63.
13   美国疫苗可预防疾病的发病率和死亡率
这项综述比较了2005年广泛实施国家疫苗计划之前和之后的13种疫苗可预防的疾病的发病率和死亡率。1980年以前,疫苗注射使得发病率下降92 %以上,死亡率下降99 %以上的疾病包括白喉,腮腺炎,百日咳和破伤风。脊髓灰质炎病毒,麻疹,风疹病毒的广泛流行被消灭。天花在全世界范围内被根除。自1980年以来,疫苗可预防的疾病发病率和死亡率下降80 %或以上的疾病包括A型肝炎,急性乙型肝炎,乙型流感嗜血杆菌,水痘。侵入性肺炎发病例数和死亡率下降率分别为34 %和25 %。编者按:疫苗确实有效!每一个医师应确保他们的患者接种所有疫苗。Roush, SW et al., JAMA, 2007;298:2155-63.


WAO Web Site Editors:
Editor-in-Chief: Richard F. Lockey, USA
Regional Assistant Editors: Juan Carlos Ivancevich, Argentina; Nikolaos G. Papadopoulos, Greece; Hirohisa Saito, Japan; Cassim Motala, South Africa; Emil J. Bardana, Jr., USA
Editors at Large: Connie H. Katelaris, Australia; Bob Q. Lanier, USA; Cassim Motala, South Africa; Ruby Pawankar, Japan
Translators: Juan Carlos Ivancevich (Spanish), Dirceu Sole, Carlos Nunes (Portuguese), Yehia El Gamal (Arabic), Hirohisa Saito (Japanese), Yin Jia, Gu Jian Qing, Wen Li Ping, Guan Kai (Chinese), Krysztof Kowal (Polish), Georgy Gudima (Russian)

WAO Web Site Mission Statement
The World Allergy Organization (WAO) Web Site supports the WAO mission. WAO is a global resource and advocate in the field of allergy, asthma and clinical immunology, advancing excellence in clinical care, education, research and training through a world-wide alliance of allergy and clinical immunology societies. 

The WAO website is an up-to-date compendium of information about allergy, asthma and immunology for all physicians, including specialists, other health care professionals and patients.  It also provides a network for global contacts in the field. 

The following information is found on the WAO website:

1.       A monthly WAO News and Notes E-Letter, translated into seven languages, providing up-to-date reviews of the scientific literature in the specialty from approximately 15 major journals, as well as meeting announcements, postings of educational resources, and reviews of new books.

2.       Up-to-date reviews of allergy, asthma and immunologic diseases, slide presentations for lectures on these subjects, interactive case studies, an “Ask the Expert” column for physicians who have a clinical question, Conversation interviews with world experts, and web-based seminars in basic immunology and allergic diseases.

3.       Links to major web-based allergy, asthma, and immunology resources.

4.       Information about WAO, WAO Member Societies, and the biennial WAO World Allergy Congresses.


世界过敏组织(WAO)网站支持WAO使命。 WAO是全球性资源中心,过敏、哮喘和临床免疫学领域的提倡者,通过全世界过敏和临床免疫学会联盟推进过敏性疾病的最佳临床治疗、教育、研究和培训。





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Email: info@worldallergy.org

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世界变态反应组织的使命是建立一个全球性的变态反应学会联盟,不断推动临床、科研、教学与培训工作的进步。欢迎您浏览我们的网站: http://www.worldallergy.org/

World Allergy Organization (WAO)
555 E. Wells Street, Suite 1100
Milwaukee, WI 53202-3823
Email: info@worldallergy.org


Made possible through an unrestricted educational grant from Novartis.

Translator: Liping Wen MD Peking Medical College Hospital   译者:北京协和医院变态反应科 文利平