Uvavanyo lweklinikhi lwempembelelo ye-anti-allergic umatrasi igubungela kwizigulana ezinomoya ophakathi ukuya kwi-asthma enzima kunye ne-house mite mite allergy: isifundo esilawulwa ngokungakhethiyo esiphindwe kabini se-placebo.

Imvelaphi: Ukusebenzisa
Umatrasi we-Allergic igquma kwizigulana zombefu kunokukhokelela ekwehleni okubalulekileyo kwinqanaba lezinto ezilwa nothuli lwendlu kwiisampulu zothuli.
Ukongeza kwi-tissue-amine-induced yehla indlela yomoya yokusabela, kukho idatha encinci yokucebisa impembelelo ye-mattress covers ekusebenzeni kwekliniki kunye nomgangatho wobomi kwizigulana ezine-asthma ephakathi ukuya kwi-abst.
Iindlela: Izigulana ezingamashumi amathathu ezine-asthma kunye ne-house mites mites allergies zaphononongwa kuphononongo olungenamkhethe, olungaboniyo kabini, olulawulwa yi-placebo.
Ngaphambi nasemva kokusetyenziswa
Isigqubuthelo sokwaliwa sonyaka om-1 siqokelela uthuli olusuka kumatrasi ukugqiba ukuxinana kwesikhumba kwiNdlu (Der p 1)
I-hyperreactivity yomoya kunye nomgangatho wobomi balinganiswa.
Isigulana sifumene amanqaku eempawu (imiphunga kunye neempumlo)
, Ixabiso lokuhamba kwentsasa nangokuhlwa, ukuhlangula amayeza kwiintsuku ze-14 ngaphambi nangemva kokungenelela.
Iziphumo: xa kuthelekiswa nonyango lwangaphambili, ukuxinwa kweDer p1 eluthulini oluqokelelwe yi-mattress kwiqela lonyango elisebenzayo lehla kakhulu emva kwe-1 unyaka;
Akukho tshintsho lufunyenweyo kwiqela le-placebo.
Kunyango olusebenzayo kunye namaqela e-placebo, akukho phuculo olubonakalayo kwi-PC20 tissue amine.
Umgangatho wobomi kuwo omabini amaqela uye waphucuka ngokufanayo.
Kuwo omabini amaqela, akukho tshintsho lubalulekileyo kumanqaku eempawu zomoya osezantsi.
Xa kuthelekiswa nonyango lwangaphambili, inqaku leempawu zempumlo zeqela lonyango elisebenzayo liye lancipha kakhulu, kodwa kwakungekho mmahluko omkhulu phakathi kwamaqela amabini.
Akukho qela lifumene utshintsho kwincopho yakusasa nangokuhlwa, ukuguquguquka kokuhamba okuphezulu, kunye nokuhlangula ukusetyenziswa kweziyobisi.
Isiphelo: Sebenzisa ukuxhathisa
I-Alergic umatrasi igubungele ikhokelela ekwehleni okubonakalayo kwi-Der p1 yoxinaniso kumagumbi okulala angenakhaphethi.
Nangona kunjalo, kwizigulane ezine-asthma ephakathi ukuya kwi-asthma enzima, le nto yokuphepha i-allergen esebenzayo ayichaphazeli i-airway hyperresponsiveness kunye neeparitha zeklinikhi.
Iindlela ukusuka kuJanuwari 1996 ukuya kuDisemba 1998, izigulane ezingama-38 ezineminyaka eyi-11-44 ezinembali ye-asthma kunye nokwaliwa nothuli lwasendlini ziye zafunwa kwiklinikhi ye-asthma e-hilverum, e-Netherlands.
Imvume enolwazi yafunyanwa kumguli okanye kubazali baso.
Ezi zi gulane zikhethwe ngokusekelwe ekwandeni kokuphendula kwendlela yomoya kwi-inhalation ye-tissue amine (
I-PC20 1 μ g Der p 1/g uthuli).
Ngaphezulu kwe-60% yazo zonke izigulane (ixabiso le-Forecast).
Izigulane zazingenazo iimbali zezifo zokuphefumula kwiiveki ze-6 zokugqibela kwaye azikho ukuhlaselwa kwe-asthma enzima kwiinyanga ze-6 zokugqibela.
Kwiinyanga ezintandathu ezidlulileyo, akukho mntu ufumene i-oral steroids.
Zonke izigulana zazifumene imvume.
Ikomiti yemigaqo yezonyango ye-Asthmacenter heuvel ivume uphononongo.
Uyilo lophononongo olu phononongo lwaluyi-randomized, i-placebo-controlled, i-double-blind, i-parallel-group design ethelekisa imiphumo ye-allergen engangeni yokupakisha kumatrasi, imithwalo, kunye nezigqubuthelo zebhedi phakathi konyaka we-1 kunye nokupakishwa kwe-placebo ehambelanayo.
Ekuqaleni kophononongo, umongikazi oqeqeshiweyo wokuphefumla watyelela isigulana, waqokelela iisampulu zothuli kwimatrasi yesigulana kwimilinganiselo yeDer p1, kwaye warekhoda amanyathelo okunqanda i-allergen awayesele ekhona ekhaya.
Zonke izigulana ezibandakanyiweyo kuphononongo zazinemigangatho egudileyo yokulala.
Isigulana siyalelwe ukuba sicoce amaphepha kwi-60 °c ngeveki
Ukongeza kwipakethe ye-mattress, akukho manyathelo athathiweyo ukunqanda izinto ezingalunganga.
Ekupheleni kophononongo, lo umongikazi mnye watyelela izindlu kwakhona ukuze aqokelele uthuli kwiibhedi zebhedi.
Isigulane sasifakwe unyaka wonke;
Ixesha lokubandakanywa liyiminyaka emi-2.
Izigulane ezine-alergy ye-pollen ziye zavavanywa ngaphandle kwexesha le-pollen.
Kutyelelo lokuqala, isigulane savavanywa kliniki.
Umthamo wobomi (VC)
Amaxabiso alinganiswa, iimvavanyo zesikhumba zenziwa, kwaye i-PC20 izicubu ze-Amine zavavanywa.
Yeka ukusebenzisa iziyobisi ngaphambi kwexesha lokufunda: I-steroids e-inhaled kunye ne-acetate ye-sodium kwi-1 iveki ngaphambi kovavanyo lwe-trachea tissue amine stimulation;
Ngaphambi kovavanyo, i-theophylline, iziyobisi zomlomo ze-beta 2 ze-adrenaline, iziyobisi ze-beta ezi-2 ze-adrenaline ezithatha ixesha elide, kunye ne-antihistine zahlala iiyure ezingama-48, kunye nokuphefumla iziyobisi ze-beta ezi-2 ze-adrenaline ezithatha iiyure ezi-6.
Ukuqokelela kunye nokutsalwa kothuli lwendlu ngaphambi, iinyanga ezi-4 kunye ne-8 zongenelelo kwaye ekupheleni kongenelelo luqokelelwa ngumcoci ofanayo (vacuum cleaner).
Philips Vitall 377,1300 Watt, Philips, Eindhoven, Netherlands)
Sebenzisa isixhobo esikhethekileyo sokuhluza kwimatrasi yonke kwimizuzu emi-2 (
ALK e holsham, Denmark).
Ekuqaleni kwesifundo, qokelela uthuli ngokuthe ngqo kwi-mattress;
Ekupheleni kwesifundo, uthuli lwaqokelelwa phezulu kwinkampu.
Isihluzi sigcinwa kwifriji kwi-20 °c de uhlalutyo lwenziwe ekupheleni kophononongo.
Ukuzimisela kwe-Der P1 antigen ngu-elisa (ELISA).
I-antibody ye-Monoclonal ngokuchasene neDer p1 yayizinze kwipleyiti yequla engama-96.
Emva kokufukanyelwa ngencindi yothuli, inyathelo lesibini laqanjwa nge-anti-valent antibody (
Ujongilanga ngaphezulu kwe-enzyme.
Emva kokongeza 1, 2-
Ye-diamine HCl (OPD)
Njenge-substrate, ukufunxa kwi-490 nm kulinganiswa kusetyenziswa umfundi we-ELISA.
Unyibiliko lwe-amine phosphate (
Ukugxininiswa kabini ukusuka ku-0. 25 ukuya 32 mg/ml)
Ilawulwa nge-De Vilbiss 646 nebulizer enesiphumo se-0. 13 mg/ml.
I-nebulizer ifakwe kwibhokisi yevalve ene-aerosol filter.
Ixesha le-atomization laliyimizuzwana ye-30 apho isigulane siyalelwe ukuba siphefumle ngokuzolileyo.
Olu lingelo luqale ngokuphefumla i-phosphate buffer aerosol.
Imilinganiselo emithathu yeVC kunye ne-fev phambi kokuphefumla (
Masterscreen).
I-V1 yalinganiswa emva koxinzelelo ngalunye.
I-PC20 ye-amine ye-tissue ithathwe ngokufakela umgca.
Oomatrasi, imiqamelo kunye neebhedi zeqela longenelelo zisongelwe kwi-LID ebonelelwe nguCarla c\'air (
Ulawulo lwe-Allergy AC btm Velserbroek, Netherlands).
Ikhava ye-placebo ehambelanayo yenziwe yinkampani enye.
Inkampu, ehlelwe ngumongikazi wophando, yahlala kwindawo ye-1 unyaka.
Umgangatho wobomi ngomgangatho wemibuzo yobomi kwizifo zokuphefumula (QoL-RIQ). 17 IQoL-
I-RIQ yi-questionnaire yobomi obuchanekileyo besifo kwizigulane ezine-asthma kunye ne-asthma engapheliyo, equkethe izinto ze-55, ezahlulwe kwiindawo ezisixhenxe: iingxaki zokuphefumula (izinto ezi-9)
Iingxaki zomzimba (9 izinto), iimvakalelo (9 izinto)
, Qalisa / uphucule imeko yeengxaki zokuphefumla (izinto ezi-7)
Imisebenzi ngokubanzi (izinto ezi-4)
Imisebenzi yemihla ngemihla neyasekhaya (izinto ezili-10)
Imisebenzi yentlalo, ubudlelwane phakathi kwabantu kunye nokwabelana ngesondo (izinto ezi-7).
Ukuze kugxilwe kwingxaki kumava esigulana, iprojekthi isekelwe "kwingxaki engakanani" abayifumanayo kwezi mpawu okanye iimvakalelo zingasentla.
Ngokumalunga neeprojekthi ezinxulumene nemisebenzi, umbuzo uthi \"bathinteleke kangakanani ekwenzeni lo msebenzi uthile \".
Izigulane zacelwa ukuba zinike iimpendulo zazo kwisikali se-Likert samanqaku angama-70, ukusuka \"akukho kwaphela\" ukuya \"kuxinzelelo olugqithisileyo" okanye umqobo. Ukuthembeka (uvavanyo-
Ukuphononongwa kwakhona, ukuhambelana kwangaphakathi)
Kwaye yangqina ukusebenza kwayo.
Iiparamitha zeklinikhi ze-17 ngexesha leentsuku ze-14 ngaphambi kokungenelela kwaye ekupheleni kweenyanga ezili-12 zokulindela okomileyo zifuna ukuba izigulane zibhale amakhadi edayari ye-asthma kunye neempawu zempumlo, ixabiso le-peak flow values, kunye nokurekhoda amayeza kabini ngosuku.
Iimpawu ze-asthma ziquka ubunzima bokuphefumla, ukukhohlela, ukukhohlela kunye nokuphefumla.
Iimpawu zeempumlo ziquka ukuxinana kweempumlo, ukuthimla kunye nokurhawuzelelwa.
Into nganye ihlulwe kumanqaku e-0 (akukho zimpawu) ukuya kwi-4 (Iimpawu ezinzima).
Izigulana zaqeqeshelwa ukwenza i-peak flow drills kusetyenziswa isixhobo esincinci se-micro-equipmentWright meter.
Bayalelwe ukuba benze izifundo ezintathu kwaye babhale amaxabiso aphezulu xa bevuka ekuseni nangaphambi kokulala ebusuku.
Izigulane zacelwa ukuba ziqhubele phambili ngamayeza aqhelekileyo okuphefumla kwaye zibhale amayeza awongezelelweyo okusindisa xa bewafuna.
Uhlalutyo lwedatha kunye nohlalutyo lwamanani lwenziwa nge-SPSS.
Uthelekiso lweqela (
Ngaphambi nasemva kongenelelo)
Yenziwe ngovavanyo lwesiginitsha yeWilcoxon.
Hlalutya idatha yelog usebenzisa iimvavanyo zesimboli. IMann-
Uvavanyo lukaWhitney U lwasetyenziselwa ukuthelekisa phakathi kwamaqela. amaxabiso e-p ka-0. 5)
Kwiqela lonyango kunye neqela le-placebo, kwakukho amanqaku e-18 kwiingxaki zokuphefumula, iingxaki zomzimba ezinxulumene neengxaki zesifuba, i-trigger / ukuphuculwa, kunye namanqaku apheleleyo.
Nangona kwakungekho mmahluko obalulekileyo kumda wokuphucula phakathi kwamaqela amabini, ukuphuculwa kweqela lonyango kwakubalulekile.
Kwakungekho mmahluko obalulekileyo kwimilinganiselo yesiseko seeparamitha zeklinikhi kumanqaku eempawu ze-asthma phakathi kwamaqela (itheyibhile 2).
Amanqaku aphakathi kweempawu zemiphunga yamaqela amabini awazange atshintshe kakhulu kwi-1 unyaka.
Inqaku leempawu zempumlo zeqela lonyango lehle kakhulu (p=0. 04)
Kodwa hayi kwiqela le-placebo.
Umahluko phakathi kwala maqela mabini wawungabalulekanga.
Isiseko sexabiso ef (
Ekuseni nangokuhlwa)
Amaqela amabini ayathelekiseka (itheyibhile 3).
Emva konyaka we-1 wokungenelela, akukho tshintsho oluphawulekayo kwi-efs yasekuseni nangokuhlwa, ukuhluka kwe-peak flow variable okanye ukusetyenziswa kweziyobisi zokuhlangula kumaqela omabini ezigulane.
Jonga le theyibhile: Jonga i-inline Jonga i-pop-up table 2 uphawu lwamanqaku phambi nasemva kongenelelo (
Ukubhaliswa okuphakathi kwiintsuku ezili-14)
Jonga le theyibhile: Jonga i-inline View pop-up table 3 incopho yexabiso letrafikhi phambi nasemva kongenelelo (
Ukubhaliswa okuphakathi kwiintsuku ezili-14)
Injongo yesi sifundo kukufunda
Kwipakethe ye-aleji ye-mattress kwigumbi lokulala elingenakhaphethi, evezwe kwi-Der p1 ebhedini, i-aleji kwiintwala zothuli lwendlu kwizigulana ezine-asthma ephakathi ukuya kobukhali.
Sifumene ukwehla okukhulu kwingxininiso yeDer p1 eluthulini oluqokelelwe ngumatrasi kwiqela elisebenzayo lonyango xa kuthelekiswa neqela le-placebo.
Izicubu ze-PC20 i-Amine ayizange iphucule ngexesha lokungenelela kwe-1 ngonyaka.
Nangona ukuphuculwa okuphawulekayo kwiimpawu zempumlo kunye nomgangatho wobomi kubonwa kuphela kwiqela lonyango elisebenzayo, asifumananga mmahluko omkhulu phakathi kweqela le-placebo kunye neqela elisebenzayo lonyango ekutshintsheni iimpawu zemiphunga kunye neempumlo, umgangatho wobomi, amaxabiso aphezulu, kunye nokusetyenziswa kweziyobisi zokuhlangula.
Izifundo zakwangoko zisebenzisa iindidi ezahlukeneyo zokupakishwa koomatrasi nazo zabonisa ukuncipha kokuvezwa kweDer p1 ngaphezulu komatrasi (itafile yesi-4).
Nangona kunjalo, ezinye izifundo azizange zibonise ukuhla koxinzelelo lweDer p1, kwaye kwezi zifundo ikhaphethi kwigumbi lokulala ayizange isuswe.
21,22 asibandakanyi umba wongcoliseko lweDer p1 kumgangatho we-13 ngokubandakanya kuphela izigulane ezingenakhaphethi kwigumbi lokulala.
Oku kunokukhokelela ekubeni, nangona isiseko sethu sokugxininiswa kweDer p1 siphezulu kunezinye izifundo, sinokunciphisa kakhulu kwiqela eliphathwayo ngokusebenzayo.
I-22, i-23 iyancipha kwi-concentration ye-allergen ifikelele emva kweenyanga ze-4 kwaye yahlala ingatshintshi kulo lonke ixesha lokufunda.
Jonga le theyibhile: Jonga i-inline Jonga i-pop-up table 4 Isishwankathelo seziphumo kunye noseto lwe-mattress elawulwayo yokugubungela isifundo nangona ukuxinwa kwe-Der p1 kwiqela lonyango elisebenzayo lancitshiswa kakhulu xa kuthelekiswa neqela le-placebo, asizange sifumane ukuhla okukhulu kwi-airway hyperresponsiveness.
Olunye uphononongo luye lwasilela ukubonisa ukuphucuka kwindlela yomoya.
Izifundo ezimbini ze-22, i-23, i-10, i-11, i-22 ayizange ifumane ukuncipha okukhulu kwi-allergen concentration eluthulini, eyachaza ukungabikho kokuphucula kwi-airway hyperreactivity.
UFrederick et al wathi zonke izigulane zilawulwa ngokufanelekileyo kunyango lokuthintela rhoqo, ngoko ke akukho tshintsho oluncinci okanye akukho lutshintsho kwiiparitha zeklinikhi.
Nangona uCloosterman kunye noogxa bakhe, abantu be-11 abazama ukuphepha le mpembelelo yonyango ngokubandakanya kuphela izigulane ezingazange zisebenzise i-steroids e-inhaled okanye ezikwazi ukuziyeka, azizange zifumane uphuculo olubonakalayo kwi-hyperresponsiveness ye-airway, akukho phuculo olubonakalayo kuyo nayiphi na imilinganiselo yeklinikhi esetyenzisiweyo, njengamanqaku eempawu, ukuhlukahluka kwe-ef, kunye nokuguqulwa kwe-F1.
Singazilungelelanisa njani ezi zimvo?
Ngaphandle kwedosi ephezulu ye-cortisol ephefumlelweyo, izigulana ezibandakanyekayo kuphononongo lwethu zine-hyperreactivity enzima (> 800 μg)
Ngokwahlukileyo, iPC20