职业性哮喘患者脱离致喘因子暴露后的转归情况分析：系统分析
2007/04/13
在工业化国家中，职业性哮喘是最多见的职业性肺病之一，但目前我们对该病的预后及转归情况知之甚少。George Rachiotis等人回顾分析了1977～2004年间发表的39篇文献，对职业性哮喘患者避免接触致喘因子后症状及肺功能的转归情况进行综合评价。他们分析了文献中报道的39,1681个完全恢复的和28,695个非特异性气道高反应性有改善的职业性哮喘患者的资料。结果发现：
（1）各文献中报道的停止致喘因子暴露后哮喘患者的症状好转率不一（0%～100%）。患者年龄越大，症状越不易好转；致喘因子暴露的持续时间越短，症状好转率越高。
（2）综合评估非特异性气道高反应性发生率发现，大分子量致喘因子诱发的职业性哮喘患者中非特异性气道高反应性发生率更高，但是，尚不清楚来自专科门诊的职业性哮喘患者是否也符合这种情况。
他们认为，从文献中可以得到的肯定结论是，有相当比例的职业性哮喘患者，即使脱离了致敏工作环境，哮喘症状仍无缓解。但由于各文献结果差异太大，对职业性哮喘患者避免接触致喘因子后的预后及转归尚无定论。因此，有必要进一步探讨避免致喘因子暴露后职业性哮喘患者预后的决定因素。
（毛辉 四川大学华西医院呼吸科 610041 摘译）
（Thorax 2007; 62: 147-152）
Outcome of occupational asthma after cessation of exposure: a systematic review. George Rachiotis, Rashna Savani, Andrew Brant, Stephanie J MacNeill, Anthony Newman Taylor, and Paul Cullinan.Thorax 2007; 62: 147-152.
Background: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease.
Methods: A systematic review of the published literature on the symptomatic and functional outcomes of occupational asthma was carried out after avoidance of exposure to the causative agent. Through a full search of electronic and bibliographic sources, original studies documenting complete recovery from asthma (n = 39,1681 patients) or improvement in non-specific bronchial hyper-responsiveness (NSBHR; n = 28,695 patients) were identified. The median duration of follow-up was 31 (range 6–240) months for studies of symptomatic recovery and 37 (6–240) months for studies of NSBHR. Most studies were of patients recruited from special clinics.
Results: Reported rates of symptomatic recovery varied from 0% to 100%, with a pooled estimate of 32% (95% CI 26% to 38%). These rates were lower with increasing age (p = 0.019) and among clinic based populations (p = 0.053). Patients with the shortest durations of exposure ( 76 months) had the highest rate of recovery (36%; 95% CI 25% to 50%), but the effect was not linear. The pooled prevalence of persistent NSBHR at follow-up was 73% (95% CI 66% to 79%). This figure was higher among patients whose disease was due to high-molecular-weight agents (p = 0.006) and, less clearly, those from clinic-based populations (p = 0.561). In between-study comparisons, no clear patterns of improvement relating to total duration of exposure or follow-up were found. From within-study comparisons there was some evidence that a shorter duration of symptoms was associated with a higher rate of symptomatic recovery.
Conclusion: The available data on the prognosis of occupational asthma are insufficiently consistent to allow confident advice to be given to patients with the disease. Clinicians and epidemiologists with an interest in this disease should consider a collaborative and carefully standardised study of the prognosis of occupational asthma.
上一篇：
湿度异常对于儿童哮喘的影响：基于人群发病率的病例对照研究
下一篇：
美国印地安成人哮喘
