The Phenotypes and Prognostic Factors In Acute Exacerbations of Asthma

• Main Authors: Kuang-Chau Tsai, 蔡光超
• Other Authors: Pan-Chyr Yang
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/22444412603279204741

碩士 === 國立臺灣大學 === 臨床醫學研究所 === 93 === Asthma is a very common airway inflammatory disease. The unique inflammatory process in asthmatic patients tends to activate Th-2 subtype lymphocytes rather than the usual Th-1. Series of reactions and interactions among cytokines, inflammatory cells and other mediator networks starts right after the activation. This tendency to activate Th-2 cells is believed to being modulated by genetic factors. Many candidate genes have been documented to be strongly related to the developments of asthma, such as genes encoding β2-adrenergic receptor, chemokine CC-16, NOS, TNF-α, IL-4, IL-5, IL-13 etc. Various serum markers have been found and studied for their relationships with asthma. What roles are these markers playing in the acute exacerbations of asthma？Could it be helpful to understand the pathogenesis of acute attack？Is there any different presentations or phenotypes in concerning about acute exacerbations of asthma？And how’s the clinical significance of these differences？It deserves to be answered. The studies were divided into two study periods. The first one was a retrospective descriptive review of all the asthma cases from Jan. to Dec. 2002. All cases are reviewed by chart and clinical data collected to clarify the various clinical presentations of acute exacerbations of asthma. The second period was prospective case control study to compare the serum markers level between asthmatic patients and the controls. In the first part we found that the seasonal changes of acute exacerbations are not as dramatic as people think. The clinical responses to the standard treatments of asthma as guidelines depicted differ significantly, which could not be predicted by the initial severity assessments or peak flow measurements. In the second part we found that TNFa, CD40L and IL-1b serum levels were lower than the controls. However, the levels of sE-selectin and LTB4 were contrarily higher. Besides, if we choose TNFa > 0.22 and Total NO as cut points, it will significantly define two groups of different treatment responses and could be used to predict the prognosis of acute exacerbations of asthma.