月经期前后支气管反应性增加：以人群为基础的SAPALDIA 2队列研究
2010/07/05
背景：目前针对月经期前后哮喘的研究结果尚不一致，不同的研究方法也限制了不同研究之间的比较。
目的：本试验是一项以人群为基础的队列研究，在绝经前妇女中探讨支气管对乙酰甲胆碱高反应性（BHR）的周期性变化，并评价口服避孕药（OC）对上述变化的影响。
方法：基于瑞士的一项队列研究[空气污染和成人肺疾病(SAPALDIA)队列研究2001/2002]，对571名未使用激素治疗的、年龄为28～58岁的未绝经女性进行乙酰甲胆碱激发试验，同时记录月经周期。危险窗为月经第一天的前后3天。采用Logistic回归和线性回顾分析，对BHR的主要预测因子校正并对哮喘状态分层。在该样本中的130名服用OC的女性中进行有关OC的影响研究。
结果：BHR发生率为13％（至最大累积剂量2 mg，FEV1下降超过20%），6％的人患有哮喘。共计有143人在危险窗进行乙酰甲胆碱激发试验。结果显示，BHR在危险窗内显著增加（OR：2.3; 95% CI, 1.27-4.29）。采用三角函数确定周期相关形式。此外，口服避孕药对哮喘状态具有调节作用，在无哮喘患者中具有较低OR值，服用OC女性OR<1。
结论：上述结果显示，月经周期存在BHR的周期性变化，这也证实了激素对哮喘的影响。口服避孕药具有一定保护作用。对于今后女性哮喘患者的药物治疗和呼吸功能检测时，BHR的周期性变化具有重要的临床价值。
Dratva J, et al. J Allergy Clin Immunol. 2010 Mar 12. [Epub ahead of print]
Perimenstrual increase in bronchial hyperreactivity in premenopausal women: Results from the population-based SAPALDIA 2 cohort.
Dratva J, Schindler C, Curjuric I, Stolz D, Macsali F, Gomez FR, Zemp E; on the behalf of the SAPALDIA Team.
BACKGROUND: Studies on perimenstrual asthma are inconsistent, and different methodologies limit comparisons.
OBJECTIVE: To investigate cyclic variations in bronchial hyperreactivity (BHR) to methacholine in premenopausal women in a population-based cohort and assess effect modification by oral contraceptives (OCs).
METHODS: Day of menstruation cycle at the time of methacholine challenge was calculated in 571 menstruating women without hormonal treatment, age 28 to 58 years, on the basis of questionnaire data from the Swiss cohort study on Air Pollution And Lung Disease In Adults (SAPALDIA) cohort 2001/2002. A window of risk was defined 3 days before and after the first day of menstruation. Logistic and linear regression analyses were performed adjusting for main predictors of BHR and stratifying for asthma status. The impact of OCs was studied in the same sample enlarged by 130 women taking OCs.
RESULTS: The prevalence of BHR was 13% (fall of >/=20% in FEV(1) up to a maximal cumulative dose of 2 mg), and 6% had asthma. A total of 143 women had undergone methacholine challenge within the risk window. We observed a significant increase in BHR within the window of risk (odds ratio [OR], 2.3; 95% CI, 1.27-4.29). A cyclic association pattern was confirmed by trigonometric functions. Effect modification by asthma status and oral contraceptive use was found, with lower OR in subjects without asthma and OR <
CONCLUSION: The data provide evidence of a systematic variation in BHR during the menstruation cycle, supporting the hypothesis of a hormonal influence. OCs appear to have a protective effect. Cyclicity of BHR could be of clinical importance in view of future medication recommendations and timing of respiratory function tests in women.
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哮喘或慢性阻塞性肺疾病导致固定性气流阻塞：5年的随访研究
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哮喘患儿血浆反应性氧化物水平增加及其与血细胞、总IgE、过敏原特异性IgE水平的关系
