胃食管反流在运动诱发性哮喘中的作用：一项随机对照研究
2009/05/22
背景：运动诱发性哮喘（ETA）是指在运动过程中或运动后诱发引起的哮喘症状。在易发生胃食管反流症状的患者中，运动可能诱发胃食管反流（GER），并导致哮喘症状的发生。
目的：确定ETA患者中伴食管pH异常的流行病学，以及抑酸治疗能否改善ETA患者的症状。
方法：在ETA患者中使用雷贝拉唑和安慰剂治疗的随机、双盲试验。使用脚踏车测试确定患者的最大摄氧量。然后进行30min的脚踏车运动测试，并在患者达到最大摄氧量的60%时开始食管pH测试。患者随机接受雷贝拉唑和安慰剂治疗10周。在10周治疗结束时，重复运动测试。
结果：31例患者完成研究（20例哮喘，11例无哮喘）。30例患者中有22例（72%）食管pH正常。在所有受试者中，雷贝拉唑相比安慰剂能显著改善症状（P = 0.03），在食管pH为阳性的患者中这一关系更显著（P = 0.009）。
结论：ETA患者中反酸很常见。许多伴有与运动相关的呼吸症状的患者被误诊为慢性哮喘，而抑酸剂能改善与运动相关的症状。该研究表明，ETA患者可从抑酸剂中获益。
（林江涛 审校）
Peterson KA, et al. Dig Dis Sci. 2009 Mar;54(3):564-571. Epub 2008 Aug 8
The role of gastroesophageal reflux in exercise-triggered asthma: a randomized controlled trial.
BACKGROUND: Exercise-triggered asthma (ETA) develops when physical activity triggers asthma symptoms during or directly after exercise. In patients prone to symptoms of supra-esophageal reflux, exercise may trigger gastroesophageal reflux (GER), resulting in such symptoms.
AIMS: To determine the prevalence of abnormal pH in patients with ETA and to determine whether acid suppression improves symptoms in ETA patients.
METHODS: We performed a randomized double-blind trial of rabeprazole versus placebo in the treatment of patients with ETA. Patients underwent treadmill protocol to determine their VO(2 max). Next, pH testing was initiated while undergoing a 30-min treadmill program exercising them at 65% of their VO(2 max). They were subsequently randomized to rabeprazole or placebo for 10 weeks. At the end of 10 weeks, exercise testing was repeated.
RESULTS: A total of 31 patients completed the study (20 asthmatics, 11 non-asthmatics). Twenty-two out of 30 (73%) subjects had abnormal pH studies. For all subjects, rabeprazole improved symptoms more than placebo (P = 0.03). The association was stronger in the pH-positive group (P = 0.009).
CONCLUSION: Acid reflux is common in ETA patients. Many patients with exercise-related respiratory symptoms are misdiagnosed as chronic asthmatics. Exercise-related symptoms improve with the use of acid suppression. This study suggests that ETA patients may benefit from acid suppression.
5: Peterson KA, et al. Dig Dis Sci. 2009 Mar;54(3):564-71. Epub 2008 Aug 8
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屋内尘螨过敏原通过Toll样受体4活化气道结构细胞诱导哮喘
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