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【drug-news】抗真菌药可治疗真菌致敏性哮喘
Rationale: Some patients with severe asthma are immunologically sensitized to one or more fungi, a clinical entity categorized as severe asthma with fungal sensitization (SAFS). It is not known whether SAFS responds to antifungal therapy.
Objectives: To evaluate the response of SAFS to oral itraconazole.
Methods: Patients with severe asthma sensitized to at least one of seven fungi by skin prick or specific IgE testing were recruited. All had total IgE less than 1,000 IU/ml and negative Aspergillus precipitins. They were treated with oral itraconazole (200 mg twice daily) or placebo for 32 weeks, with follow-up for 16 weeks.
Measurements and Main Results: The primary end point was change in the Asthma Quality of Life Questionnaire (AQLQ) score, with rhinitis score, total IgE, and respiratory function as secondary end points. Fifty-eight patients were enrolled, of whom 41% had been hospitalized in the previous year. Baseline mean AQLQ score was 4.13 (range, 1–7). At 32 weeks, the improvement (95% confidence interval) in AQLQ score was +0.85 (0.28, 1.41) in the antifungal group, compared with a –0.01 (–0.43, 0.42) change in the placebo group (P = 0.014). Rhinitis score improved (–0.43) in the antifungal, and deteriorated (+0.17) in the placebo group (P = 0.013). Morning peak flow improved (20.8 L/minute, P = 0.028) in the antifungal group. Total serum IgE decreased in the antifungal group (–51 IU/ml) but increased in placebo group (+30 IU/ml) (P = 0.001). No severe adverse events were observed, but seven patients developed adverse events requiring discontinuation, five in the antifungal group.
Conclusions: SAFS responds to oral antifungal therapy as judged by large improvements in quality of life in about 60% of patients.
英国曼彻斯特大学丹宁(Denning)博士等研究发现，对于真菌致敏性严重哮喘患者，口服抗真菌药物治疗有效。该研究结果发表于《美国呼吸和重症护理医学杂志》（Am J Respir Crit Care Med 2009，179(1):11）。
某些严重哮喘患者对一种或多种真菌有免疫致敏性，临床上称为“真菌致敏性严重哮喘(SAFS)”。为评估抗真菌药能否治疗SAFS，研究纳入58例真菌致敏性严重哮喘患者，将其随机分为两组，口服伊曲康唑200 mg(2次/日)或安慰剂治疗32周，随访16周。所有患者总IgE水平低于1000 IU/ml，曲霉菌沉淀素试验阴性。主要终点指标是哮喘生活质量问卷(AQLQ)评分变化，次级终点指标是鼻炎评分，血浆总IgE水平与肺功能检查等。
结果显示，与基线时相比，伊曲康唑组的AQLQ平均评分增加0.85分，鼻炎评分减少0.43分。上述改善与安慰剂组相比有显著差异(P=0.014和P=0.013)。伊曲康唑组的早晨最大呼气流量改善(P =0.028)，血浆总IgE水平下降(P =0.001)。7例患者因不良反应退出研究(5例为伊曲康唑组患者)，未见严重不良反应。
研究者认为，60%患者生活质量获较大改善，证明抗真菌治疗SAFS有效。该“概念验证”研究揭示，真菌暴露和哮喘之间有着重要联系，但至今对其认识不足。（来源：中国医学论坛报 黄强）
（《美国呼吸和重症护理医学杂志》（Am J Respir Crit Care Med），Vol 179. pp. 11-18，David W. Denning，Robert M. Niven） 感觉有点忽悠，真菌感染致哮喘多半是真菌侵袭气道所致，去除致敏原当然可以治好。 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-20 18:25
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