真菌过敏性哮喘的治疗研究进展

摘要/Abstract

摘要： 真菌过敏性哮喘是由环境中真菌致敏原暴露诱导的一种呼吸道慢性炎症性疾病.真菌过敏哮喘患者肺部炎症细胞、结构细胞及细胞组分间有复杂的相互作用,使得患者气道壁重塑并伴渐进性肺功能障碍,表现为喘息、胸闷、呼吸困难等症状,对患者的工作和生活造成严重影响,而目前糖皮质激素及抗菌药物等传统疗法对其治疗效果欠佳.近年来,很多研究开始致力于对真菌过敏性哮喘新的治疗方法进行积极探索,使得真菌过敏性哮喘的治疗除应用糖皮质激素等传统方法外,在抗真菌感染及其免疫学治疗控制真菌过敏性哮喘方面取得一定新进展.

关键词: 真菌, 过敏性哮喘, 免疫治疗

Abstract: Allergic fungal asthma is a chronic airway inflammatory disease induced by environmental exposure to airborne fungal allergens, which are ubiquitous in many indoor and outdoor environments. As a result of complex interactions among inflammatory cells, structural cells, and the intercellular matrix of the allergic lung, patients with allergic fungal asthma may experience a greater degree of airway wall remodeling and progressive, accumulated pulmonary dysfunction, along with the symptoms of wheeze, chest stufly and dyspnea, and have a serious impact on the job as well as personal life of the patients. However, the current standard asthma treatment options, such as glucocorticoids and antifungal agents, can hardly meet the requirements of this disease. Researches on the mechanism and therapeutics of allergic fungal asthma are gradually increased in the recent decades, and have made some progress, such as immunological therapy. In this review, we analyzed and summarized the Results of these researches.

Key words: fungal, allergic asthma, immunological therapy

中图分类号:

R562.2+5

尹清欣, 史冬梅, 廉翠红, 刘维达. 真菌过敏性哮喘的治疗研究进展[J]. 中国真菌学杂志, 2014, 9(5): 299-302,292.

YIN Qing-xin, SHI Dong-mei, LIAN Cui-hong, LIU Wei-da. The research developments in the therapy of allergic fungal asthma[J]. Chinese Journal of Mycology, 2014, 9(5): 299-302,292.

参考文献

[1] Ghosh S, Hoselton SA, Dorsam GP, et al. Eosinophils in fungus-associated allergic pulmonary disease[J]. Front Pharmacol, 2013 Feb 1,4:8. doi: 10.3389/fphar.2013.00008.
[2] Simon-Nobbe B, Denk U, Pll V, et al. The spectrum of fungal allergy[J]. Int Arch Allergy Immunol, 2008, 145(1): 58-86.
[3] Knutsen AP, Bush RK, Demain JG, et al. Fungi and allergic lower respiratory tract disease[J]. Allergy Clin Immunol, 2012, 129(2): 280-291.
[4] Kurup VP, Shen HD, Banerjee B.Respiratory fungal allergy[J]. Microbes Infect, 2000, 2(9): 1101-1110.
[5] Hedayati MT, Pasquallotto AC, Warn PA, et al. Aspergillus flavus: human pathogen, allergen, and mycotoxln producer[J]. Microbiology, 2007, 153(6):1677-1692.
[6] Pongracic JA, O'Connor GT, Muilenberg ML, et al. Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children[J]. Allergy Clin Immunol, 2010, 125(3): 593-599.
[7] Kauffman HF, Vander HS. Exposure, sensitization, and mechanisms of fungus- induced asthma[J]. Curr Allergy Asthma Rep, 2003, 3(5): 430-437.
[8] Tai HY, Tam MF, Chou H, et al. Pen ch 13 allergen induces secretion of mediators and degradation of occludin protein of human lung epithelial cells[J]. Allergy, 2006, 61(3): 382-388.
[9] Hansel TT, Johnston SL, Openshaw PJ., et al. Microbes and mucosal immune responses in asthma[J]. Lancet, 2013, 381(9869): 861-873.
[10] Gao P, Korley F, Martin J, et al. Determination of unique microbial volatile organic compounds produced by five Aspergillus species commonly found in problem buildings[J]. AIHA J (Fairfax, Va), 2002, 63(2): 135-140.
[11] Corry DB, Kheradmand F. Toward a comprehensive understanding of allergic lung disease[J]. Trans Am Clin Climatol Assoc, 2009, 120: 33-48.
[12] Fukahori S, Matsuse H, Tsuchida T, et al. Aspergillus fumigatus regulates mite allergen-pulsed dendritic cells in the development of asthma[J]. Clin Exp Allergy,2010, 40(10): 1507-1515.
[13] Porter P, Polikepahad S, Qian Y, et al. Respiratory tract allergic disease and atopy: experimental evidence for a fungal infectious etiology[J]. Med Mycol, 2011, 49 (1): 158-163.
[14] Moss RB. Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis[J]. Eur Respir , 2014, 43(5): 1487-1500.
[15] Denning DW, O'Driscoll BR, Powell G, et al. Randomized controlled trial of oral antifungal treatment for severe asthma with fungal sensitization: The Fungal Asthma Sensitization Trial (FAST) study[J]. Am J Respir Crit Care Med,2009,179(1): 11-18.
[16] Pasqualotto AC, Powell G, Niven R, et al. The effects of antifungal therapy on severe asthma with fungal sensitisation and allergic bronchopulmonary aspergillosis[J]. Respirology, 2009, 14(8): 1121-1127.
[17] Wark PA, Hensley MJ, Saltos N, et al. Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: a randomized controlled trial[J].Allergy Clin Immunol, 2003, 111(5): 952-957.
[18] Rjinders BJ, Cornelissen JJ, Slobe L, et al. Aerosolized liposomal amphotericin B for the prevention of invasive pulmonary aspergillosis during prolonged neutropenia: a randomized, placebo-controlled trial[J]. Clin Infect Dis,2008, 46(9): 1401-1408.
[19] Kuiper L, Ruijgrok EJ. A review on the clinical use of inhaled amphotericin B[J].Aerosol Med Pulm Drug Deliv, 2009, 22(3): 213-227.
[20] Ramirez-Velazquez C, Castillo EC, Guido-Bayardo L, et al. IL-17-producing peripheral blood CD177+ neutrophils increase in allergic asthmatic subjects[J].Allergy Asthma Clin Immunol, 2013, 9(1): 23.
[21] Carpenter KJ, Ewing JL, Schuh JM, et al. Therapeutic targeting of CCR1 attenuates established chronic fungal asthma in mice[J]. Br J Pharmacol,2005,145(8): 1160-1172.
[22] Schuh JM, Blease K, Brühl H, et al. Intrapulmonary targeting of RANTES/CCL5-responsive cells prevents chronic fungal asthma[J]. Eur J Immunol, 2003, 33(11): 3080-3090.
[23] Buckland KF, O'connor EC, Coleman EM, et al. Remission of chronic fungal asthma in the absence of CCR8[J]. Allergy Clin Immunol, 2007, 119(4): 997-1004.
[24] Blease K, Jakubzick C, Westwick J, et al. Therapeutic effect of IL-13 immunoneutralization during chronic experimental fungal asthma[J]. Immunol,2001,166(8):5219-5224.
[25] Ramaprakash H, Hogaboam CM. Intranasal CpG therapy attenuated experimental fungal asthma in a TLR9-dependent and -independent manner[J]. Int Arch Allergy Immunol, 2010, 152(2): 98-112.
[26] Ramaprakash H, Shibata T, Duffy KE, et al. Targeting ST2L potentiates CpG-mediated therapeutic effects in a chronic fungal asthma model[J]. Am J Pathol, 2011, 179(1): 104-115.
[27] Moss RB. The use of biological agents for the treatment of fungal asthma and allergic bronchopulmonary aspergillosis[J]. Ann N Y Acad Sci, 2012, 1272: 49-57.
[28] Kreindler JL, Steele C, Nguyen N,et al. Vitamin D3 attenuates Th2 reponses to Aspergillus fumigatus mounted by CD4⁺T cells from cystic fibrosis patients with allergic bronchopulmonary aspergillosis[J]. J Clin Invest, 2010, 120(9): 3242-3254.
[29] Kin NW, Stefanov EK, Dizon BL, et al. Antibodies generated against conserved antigens expressed by bacteria and allergen-bearing fungi suppress airway disease[J]. J Immunol, 2012,189(5): 2246-2256.
[30] 宋素,骆仙芳.支气管哮喘治疗的研究进展[J].浙江中医学院学报, 2002, 26(1):71-74.