.1, Obesity, Asthma Airway Inflammation And Airway Responsiveness, Pediatric Tbm Diagnosis And Treatment

PART1 EFFECTS OF OBESITY ON AIRWAY INFLAMMATION AND AIRWAY REACTIVITY IN MURINE MODEL OF ASTHMAObjective:To establish an obesity animal model to contruct an asthma model,investigate the effects of obesity on airway inflammation and airway reactivity in murine model of asthma,explore the mechanism of relationship between obesity and asthma.Methods:A totle of 40 clean three-week-old weaning female C57 mice,were were randomly and equally divided into 4 groups.Control Group were fed with normal diet food ,sensitised and provocated by NS;asthma group were fed with normal diet food ,sensitised and provocated by OVA;obesity group were fed with high fat diet food ,sensitised and provocated by NS;obese asthma group were fed with high fat diet food ,sensitised and provocated by OVA. Bady weight,the weight of liver,liver weight/bady weight,LEE'S index,airway reactivity,histology of the lung,cell number of bronchoalveolar lavage fluid,concentration of IL-4,INF-γwere compared.Results:1)The bady weight,the weight of liver,liver weight/bady weight,LEE'S index of obesity group and obese asthma group were higher than those of control group and asthma group;2)Obese asthma group displayed high airway reactivity than obesity group and asthma group,obesity group displayed high airway reactivity than control group(P﹤0.05);3)Local inflamation was more significant in obese asthma group than in asthma group;4)Totle cell number and eosinophil of bronchoalveolar lavage fluid in obese asthma group were higher than those in obesity group and asthma group, totle cell number and lymphocyte in obesity were higher than those in control group(P﹤0.05);5)The rate of IL-4/INF-γin obese asthma group was higher than that in asthma group and obesity group,was lower in obesity group than control group(P﹤0.05).Conclusions:1,Fed with self-made high fat food,sensitised and provocated by OVA C57BL mice can established obesity asthma animal model;2,Compared with obesity group and asthma group,obese asthma group display more significant local inflamation and higher airway reactivity;3,As a risk factor of asthma, obesity can aggravate the development of asthma, and association between them is closed. PART2 THE EFFECTS OF OBESITY ON PULMONARY VENTILATION FUNCTION AND AIRWAY REACTIVITY IN ASTHMATIC CHILDRENObjective: To investigate the effects of obesity on pulmonary ventilation functionand airway reactivity in asthmatic children,and to explore the contribution of obesity to the asthma.Methods:Basic pulmonary function and brinchial provocation test were measured in asthmatic children who visited the asthmatic out-patient clinic in Chongqing Children Hosptial from January to December in 2006.Analysed the differences of pulmonary ventilation function and airway reactivity between obese patients,over-weight patients and normal-weight patients.Results:1)2523 cases(1554 boys and 969 girls aged 3 years to 17 years,mean 8.81±4.45 years) were included. 210 cases were obese,515 cases were over-weight;2)Pulmonary ventilation function:Compared with normal-weight patients, FVC,FEV1 were lower in obese patients,older than 9 years over-weight patients;PEF,PEV1/FVC were lower in older than 9 years obese and over-weight patients; PEF75,PEF50,PEF25 were lower in older than 12 years obese and over-weight patients;3 )Airway reactivity:Compared with normal-weight patients , PC₂₀-PEF was lower in obese patients.There were no significant differences in PC₂₀-PEF between normal-weight patients and over-weight patients. Conclusion:1,Rate of obesity is higher in children with asthma;2,Compared with nomal-weight children with asthma,obese children with asthma not only display restricted pulmonary ventilation function,but also display obstructed airflow and impaired small airway;3,Compared with nomal-weight children with asthma,obese children with asthma display higher airway reactivity;4,Obesity increases airway reactivity,restricted pulmonary ventilation function and damaged of small airway. DIAGNOSIS AND TREATMENT OF PEDIATRIC TRACHEOBRONCHOMALACIAObjective:To explore the clinical features of trachcobronchomalacia in children and to investigate the diagnostic and curative value of flexible bronchoscopy for children with tracheobronchomalacia.Method:For diagnosis and treatment, under general anesthesia of propofol,229 children were examined by Olympus BF3c-20 flexible bronchoscopy or by Olympus BF-P20 flexible bronchoscopy in Chongqing Children Hosptial from April,2004 to April,2006.53 cases were confirmed trachcobronchomalacia by bronchoscopy,patients'datea including airway lesion,age,sex,clinical characteristics,final outcomes,aided examinations were collected and alalysed.Results:1) Of 53 children with trachcobronchomalacia, 31 children were not suspected prior to bronchoscopy.,who were misdiagnosed as refractory pneumonia,difficult-to-control asthma and pulmonary atelectasis of unknown origin,bronchiolitis, recurrent respiratory infection. 2)The risk of trachcobronchomalacia varied inversely with the ages,and mailnly boys.3) In 53 children were determined to be as tracheobronchomalacia,28 cases were recurrent or prolonged wheezing,16 chronic cough,5 recurrent respiratory infections,2 atelectasis of unknown origin,2 dyspnea.4) The most cases were mild-moderate malacia, the age of wheezing was younger than that of chronic cough.5)After lavageing and cleaning sputum,all children with tracheobronchomalacia improved when they discharged.Conclusions:1,The infants and toddlers are predisposed more to tracheobronchomalacia.2,Clinical features of children with tracheobronchomalacia are variable and atypical,expiratory stridor and cough are the most commonly reported symptoms.3,Flexible bronchoscopy is a valuable methods to the diagnosis of children with tracheobronchomalacia.4,Lavageing and cleaning sputum using bronchoscopy are helpful to the treatment of tracheobronchomalacia.