気管支喘息に対する複合温泉療法の作用機序 2.内分泌･自律神経系および心因的要素に対する効果

Actions of spa therapy on endocrine-autonomic nerve system and psychological factors were analyzed in patients with bronchial asthma. In endocrine function, serum levels of cortisol and ACTH tended to increase after spa therapy. In autonomic nerve system, decrease in concentrations of serum adrenalin and noradrenalin was observed after spa therapy, and the difference between the initial levels before spa therapy and the levels after the therapy was significant in serum levels of adrenalin. However, serum levels of substance P and Bradykinin were not affected by spa therapy. To evaluate the action of spa therapy on mental condition in patients with asthma, four kinds of psychological tests, CMI, SDS, CAl and SD, were carried out. Improvement of mental disorders in patients with asthma is observed after spa therapy in all psychological tests. These results suggest that spa therapy acts effectively on endocrine-autonomic nerve system and improve psychological conditions.内分泌･自律神経系および心因的要素に対する温泉療法の効果が,気管支喘息を対象に検討された｡内分泌系では,血中コーチゾ-ルおよびACTH値が,温泉療法後に上昇することが示された｡また,自律神経系では,血中アドレナリンおよびノルアドレナリン濃度が温泉療法により減少することが示され,特に,血中アドレナリンは温泉療法前後の濃度に有意の差が見られた｡しかしながら,血中サブスタンスPおよびブラジキニン濃度には,温泉療法による有意の変動は見られなかった｡心因的要素に対する温泉療法の作用を検討するため,CMI,SDS,CAIおよびSDの4種類の心身医学的検査が行われた｡その結果,いずれの心身医学的検査においても,温泉療法により疾患に不利に働く心因的要素が改善する傾向が見られた｡これらの結果より,温泉療法が内分泌･自律神経系に対して有用な作用を有し,また,疾患に不利な心因的要素を改善させる作用を有していることがある程度示唆された

温泉療法による気管支喘息患者の心理的障害の改善

To evaluate improvement of mental disorders by spa therapy for 1-2 months, three kinds of psychological examinations, CMI (Cornel Medical Index), SDS (Selfrating Depression Scale) and CAI (Comprehensive Asthma Inventory) tests, were performed in 37 patients with asthma before and after spa therapy. 1. In CMI test, the scores of physical symptoms, respiratory symptoms, and CIJ symptoms significantly decreased after spa therapy. The score of psychical symptoms tended to decrease after the therapy, however, this was not significant. 2. The mean score of the subjects over 40 points in SDS test significantly decreased from 45.7 points before spa therapy to 37.5 after the therapy. 3. Mental disorders evaluated by various categories in CAI test were significantly improved after spa therapy. The average score in CAI test significantly decreased from 37.1 to 27.8 after the therapy. These results demonstrate that psychological disorders in patients with asthma are improved by spa therapy.気管支喘息に対する温泉療法(1-2ヶ月)による心理的障害の改善を評価するために,3種類の心理学的調査:CMI(Cornel Medical Index),SDS(Selfrationg Depression Scale),CAI(Comprehensive Asthma Inventory)を,気管支喘息患者37例を対象として,入院時と退院時に実施し比較した｡①CMIでは,身体的自覚症,呼吸器系症状およびCIJ症状が,温泉療法後に有意に改善した｡②SDS値が40以上の症例において,温泉療法後,平均値は45.7から37.5へ有意に減少した｡③CAIの種々の心理学的項目により評価した心理的障害は,温泉療法後に有意に改善した｡各心理項目の平均値であるCAIスコアは,治療後,37.1から27.8へ有意に低下した｡これらの結果から,気管支喘息患者に観察される心理的障害は,温泉療法により改善することが示唆された

気管支喘息に対する複合温泉療法の作用機序 3.気道炎症反応との関連

The degree and characteristic of airway inflammation were evaluated by the proportions of bronchoalveolar lavage (BAL) cells. Clinical asthma types such as Ia. simple bronchoconstriction, Ib. bronchoconstriction + hypersecretion, and Ⅱ. bronchiolar obstruction correlate with airway inflammation. The increased proportion BAL　neutrophils is characteristic of type Ⅱ asthma, and increase in BAL eosinophil count is often observed in type Ib asthma. Bronchial hyperresponsiveness also correlates with airway inflammation. Action of spa therapy has been speculated to be related to airway inflammation, since the therapy has no action inhibiting IgE-mediated allergic reaction. In fact, spa therapy is more effective in patients with type Ib and type Ⅱ than in those with type Ia showing slight degree of airway inflammation. Bronchial hyperresponsiveness is also improved by spa therapy. From a point of view, the direct action of spa therapy may be to clean airways and improve damaged mucous membrane of the airways, leading to suppression of airway inflammation.気道炎症反応の程度や特徴が,気管支肺胞洗浄液(BAL)中の細胞成分によって評価された｡Ia.単純性気管支攣縮型,Ib.気管支攣縮+過分泌型,Ⅱ.細気管支閉塞型などの各臨床病型は気道炎症反応と関連している｡BAL液中好中球増多は,Ⅱ型喘息の特徴的所見であり,また好酸球増多はIb型喘息でしばしば観察される｡気道過敏性もまた気道炎症反応と関連している｡温泉療法の作用機序としては,温泉療法にIgEにmediateされるアレルギー反応(液性因子相)を抑制する作用がないことから,気道炎症反応(細胞性因子相)の抑制が推測されている｡実際,温泉療法は,気道炎症反応が軽度なIa型喘息に比べ,Ib型やⅡ型などの明らかに気道炎症反応をともなう病型に対してより有効である｡気道過敏性もまた温泉療法により改善される｡これらの 結果から,温泉療法は,気道を清浄化し,気道粘膜を正常化することによって,気道炎症反応を抑制していくものと考えられる

気管支喘息に対する複合温泉療法の作用機序 1.温泉療法の評価方法との関連

Action mechanisms of complex spa therapy (swimming training in a hot spring pool, inhalation with iodine salt solution, and fango therapy) were studied in relation to patient age, clinical asthma type, and airway inflammation. Actions of spa therapy were observed by two clinical effects : direct and indirect effects. Improvement of subjective symptoms, ventilatory function, and bronchial hyperresponsiveness was observed as direct effects of spa therapy, and improvement of suppressed function of adrenocortical glands as indirect effects of the therapy. The clinical effects of spa therapy were higher in patients over the age of 40. Regarding clinical asthma type, the effects were larger in patients with type Ib and type II asthma than in those with type Ia. The efficacy of spa therapy was closely related with airway inflammation in patients with type Ib and type II asthma.複合温泉療法(温泉プール水泳訓練,ヨードゾル吸入,鉱泥湿布療法)の作用機序が,年齢,臨床病型,気道炎症反応との関連のもとに検討された｡温泉療法の作用機序は,2種類の臨床効果,すなわち,直接効果と間接効果により観察された｡自,他覚症状の改善,換気機能の改善,そして,気道過敏性の改善などが,温泉療法の直接効果として,また,副腎皮質機能の改善が間接効果とし て観察された｡温泉療法の臨床効果は,40才以上の症例においてより有効であり,また,臨床病型別では､Ia型に比べ,Ib型およびⅡ型においてより有効であった｡Ib型やⅡ型の気管支喘息では,温泉療法の作用機序と気道炎症反応との間に密接な関連が認められた

Ia型(単純気管支れん縮型)喘息における気道過敏性について…年齢および気管支肺胞洗浄液中の細胞成分との関連について

Bronchial hyperresponsiveness was examined in relation to age, ventilatory function, and the proportion of bronchoalveolar lavage (BAL) cells in 39 patients with type Ia asthma (simple bronchoconstriction) (25 with type Ia-1 and 14 with type Ia-2), classified by clinical symptoms. 1. The proportion of BAL eosinophils was significantly higher in type Ia-2 than that in type Ia-1 asthma patients. 2. Bronchial reactivity to methacholine was not different between type Ia-1 and type Ia-2 asthma patients. 3. Bronchial hyperreactivity tended to decrease as patient age was higher in both types of asthma. Neither ventilatory function (FEV1.0%) nor the proportions of BAL lymphocytes and neutrophils was not correlated with bronchial hyperresponsiveness in both types of asthma. 4. Bronchial reactivity to methacholine more dereased with the increase in the proportion of BAL eosinophils in both type Ia-1 and Ia-2 asthma patients. The results show that bronchial hyperresponsiveness in patients with type Ia asthma is correlated to patients age and the proportion of BAL eosinophils.気管支喘息患者Ia型(単純気管支れん縮型)39人(Ia-1型25人,Ia-2型14人)の気道過敏性を年齢,呼吸機能検査,気管支肺胞洗浄液(BAL)中の細胞成分と関連で検討を行った｡1.BAL液中の好酸球の比率はIa-1型に比べIa-2型で優位に高値であった｡2.メサコリンに対しての過敏性はIa-1型とIa-2型とで差を認めなかった｡3.気道過敏性はどちらの病型においても年齢にともなって減弱する傾向にあったが,一秒率及びBAL液中の好中球,リンパ球の比率とは相関しなかった｡4.メサコリンに対しての気道過敏性はIa-1型,Ia-2型ともにBAL液中の好酸球の比率が増加するにしたがって亢進した｡以上より単純気管支れん縮型(Ia型)の気管支喘息患者の気道過敏性はその年齢,BAL液中の好酸球の比率に相関することが示唆された

Ⅱ型(細気管支閉塞)喘息と閉塞性細気管支炎における細気管支領域の炎症反応の差

Ventilatory function and inflammatory cells in airways were compared between patients with type Ⅱ (bronchiolar obstruction) asthma and those with obstructive bronchiolitis. 1. Age and age at onset were higher in patients with type Ⅱ asthma than in those with obstructive bronchiolitis. IgE-mediated allergic reaction was observed in patients with type Ⅱ asthma, but not in those with obstructive bronchiolitis. 2. In ventilatory function tests, all ventilatory parameters examined were lower in patients with type Ⅱ asthma compared to those with obstructive bronchiolitis, and the differences were significant in FEV1.0% (p<0.001), % MMF (p<0.02), and V50 (p<0.01). 3. The proportion of BAL neutrophils was very high in type Ⅱ asthma (55.7%) and obstructive bronchiolitis (74.4%), however, this was not significant. 4. Absolute numbers/BAL fluid of total cells, BAL macrophages and BAL neutrophils were significantly higher in patients with obstructive bronchiolitis than in those with type Ⅱ asthma. 5. The results on absolute number/mℓ of BAL cells demonstrated that number of BAL neutrophils markedly larger in patients with obstructive bronchiolitis compared to those with type Ⅱ asthma. These results show that high proportion of BAL neutrophils was observed in the two respiratory diseases, however, the degree of inflammation in airways was markedly greater in obstructive bronchiolitis.Ⅱ型喘息と閉塞性細気管支炎の臨床的特徴について,換気機能および気道炎症反応を中心に検討を加えた｡1.年齢,および発症年齢とも閉塞性細気管支炎に比べⅡ型喘息において高い傾向が見られた｡IgE系反応はⅡ型喘息では観察されたが,閉塞性細気管支炎では見られなかった｡2.換気機能では,測定された全ての換気パラメーターにおいて,その値は閉塞性細気管支炎に比べⅡ型喘息でより低い値を示し,FEV1.0%,% MMFおよび% V50では有意の差が見られた｡3.BAL液中好中球頻度は,Ⅱ型喘息(55.7%),閉塞性細気管支炎(74.4%)いずれにおいても高い値を示したが,両者間に有意の差は見られなかった｡4.一方,BAL液中の絶対数では,Ⅱ型喘息に比べ,閉塞性細気管支炎において,総細胞数,マクロファージおよび好中球数が有意の高値を示した｡5.また,lmℓあたりの細胞数の比較でも,閉塞性細気管支炎で好中球数が著明な高値を示した｡これらの結果より,この2疾患では気道内好中球増多は同様に見られるものの,その気道炎症の程度は明らかに閉塞性細気管支炎でより高度であることが示された

Ⅱ型(細気管支閉塞)喘息と閉塞性細気管支炎における細気管支領域の炎症反応の差

Ventilatory function and inflammatory cells in airways were compared between patients with type Ⅱ (bronchiolar obstruction) asthma and those with obstructive bronchiolitis. 1. Age and age at onset were higher in patients with type Ⅱ asthma than in those with obstructive bronchiolitis. IgE-mediated allergic reaction was observed in patients with type Ⅱ asthma, but not in those with obstructive bronchiolitis. 2. In ventilatory function tests, all ventilatory parameters examined were lower in patients with type Ⅱ asthma compared to those with obstructive bronchiolitis, and the differences were significant in FEV1.0% (p<0.001), % MMF (p<0.02), and V50 (p<0.01). 3. The proportion of BAL neutrophils was very high in type Ⅱ asthma (55.7%) and obstructive bronchiolitis (74.4%), however, this was not significant. 4. Absolute numbers/BAL fluid of total cells, BAL macrophages and BAL neutrophils were significantly higher in patients with obstructive bronchiolitis than in those with type Ⅱ asthma. 5. The results on absolute number/mℓ of BAL cells demonstrated that number of BAL neutrophils markedly larger in patients with obstructive bronchiolitis compared to those with type Ⅱ asthma. These results show that high proportion of BAL neutrophils was observed in the two respiratory diseases, however, the degree of inflammation in airways was markedly greater in obstructive bronchiolitis.Ⅱ型喘息と閉塞性細気管支炎の臨床的特徴について,換気機能および気道炎症反応を中心に検討を加えた｡1.年齢,および発症年齢とも閉塞性細気管支炎に比べⅡ型喘息において高い傾向が見られた｡IgE系反応はⅡ型喘息では観察されたが,閉塞性細気管支炎では見られなかった｡2.換気機能では,測定された全ての換気パラメーターにおいて,その値は閉塞性細気管支炎に比べⅡ型喘息でより低い値を示し,FEV1.0%,% MMFおよび% V50では有意の差が見られた｡3.BAL液中好中球頻度は,Ⅱ型喘息(55.7%),閉塞性細気管支炎(74.4%)いずれにおいても高い値を示したが,両者間に有意の差は見られなかった｡4.一方,BAL液中の絶対数では,Ⅱ型喘息に比べ,閉塞性細気管支炎において,総細胞数,マクロファージおよび好中球数が有意の高値を示した｡5.また,lmℓあたりの細胞数の比較でも,閉塞性細気管支炎で好中球数が著明な高値を示した｡これらの結果より,この2疾患では気道内好中球増多は同様に見られるものの,その気道炎症の程度は明らかに閉塞性細気管支炎でより高度であることが示された

肺活量(FVC)低値を示す気管支喘息の臨床的特徴

Clinical features of asthma patients with a low % FVC (<75%) were studied in relation to clinical asthma type and disease severity. 1. The value of % FVC was not related to patient age. 2. A significant association between % FVC value and clinical asthma type was found. The value of % FVC was significantly lower in subjects with type Ⅱ asthma (bronchiolar obstruction) than in those with type Ia-1 and type Ia-2 (simple bronchoconstriction) (p<0.001). 3. % FVC value significantly correlated with disease severity. The value in the subjects tended to decrease as their asthma conditions were more severe. 4. The % FVC value in the subjects was improved after treatment (complex spa therapy). These results demonstrate that a significant correlation is present between low % FVC and disease severity in asthma patients with a low % FVC.% 肺活量が75%以下の低値を示す気管支喘息について,その臨床的特徴を,臨床病型や重症度との関連のもとに検討した｡1.% 肺活量と年齢との間には関連は見られなかった｡2.% 肺活量と臨床病型との問には有意の関連が見られ,Ⅱ型喘息(細気管支閉塞型)における% 肺活量は,Ia-1型やIa-2型などの単純性気管支攣縮型に比べ,有意に低い値を示した｡3.% 肺活量はまた喘息の重症度と有意の関連を示した｡これらの症例では,喘息の重症度が増すにつれて,% 肺活量は減少する傾向が見られた｡4.これら症例の低値を示す% 肺活量は,治療(複合温泉療法)により改善される傾向が見られた｡以上の結果より,これらの症例(% 肺活量が75%以下)では,% 肺活量と喘息の重症度との間にある程度の関連があることが明らかになった

気管支喘息症例に対する鼻腔内ステロイド療法

Bronchial asthma is often accompanied with allergic rhinitis or chronic sinusitis. Mucosal abnormalities of sinonasal cavity may influence lower respiratory responses in patients with asthma. We experienced a case of 72-year-old woman with asthma, who had dyspnea on exertion and a large volume of expectoration of more than 100mℓ a day. Furthermore she had nasal symptoms (nasal obstruction and rhinorrea) with prominent post-nasal discharge. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa. Although her asthma symptoms such as wheezing and dyspnea improved by administration of bronchodialators, antiallergic agent, and beclomethason di isocyanate (BDI) accompanied with spa therapy after admission, the volume of expectoration revealed no decrease and her peak expiratory flow (PEF) didn't increase. The volume of expectoration and the PEF showed marked improvement after starting of intranasal glucocorticoid therapy. It is suggested from her clinical course that treatment with intranasal glucocorticoids is very important in asthmatic patients with mucosal abnormalities of sinonasal cavity.気管支喘息症例には,アレルギー性鼻炎や慢性副鼻腔炎の合併が認められる｡鼻腔内への吸入ステロイド投与が喘息症状を改善したという報告も存在し,鼻腔病変が下気道の反応に何らかの影響を及ぼしている可能性が考えられる｡今回,気管支喘息にて入院した72才の女性の症例を呈示する｡労作性呼吸困難と多量の喀痰排出が認められ,入院後の投薬や温泉療法にて呼吸困難は改善したが,喀痰排出は減少せず,ピークフロー値も上昇が認められなかった｡明らかな後鼻漏が認められ,CTにて両側鼻腔粘膜の著明な肥厚の所見が見られたため,鼻腔内吸入ステロイド投与を開始した｡開始後,喀痰排出量,ピークフロー値は著明な改善を示した｡この症例のように,鼻腔あるいは副 鼻腔に対する治療が喘息症状を改善する症例が存在する可能性が考えられた

サーモグラフィーによる体表面温度の測定

Body Surface Temperature was observed by thermography. The surface temperature of a healthy person's lower limbs, after being cooled in a water bath, increased in parallel with time. Patients with Diabetes Mellitus had different patterns in the rate of increase of the surface temperature. After cold loading, one patient had a 99% recovery ratio of surface temperature, the same level as healthy volunteers (83%, and 88%), as calculated by a picture processing program with the computerized thermotracer. However, the recovery ratio of other patients was poorer, ranging from 56% to under 6% recovery. This measurement of elevation of body temperature is useful for the estimation of peripheral blood flow in patients with lower limbcirculation failure.健常人並びに糖尿病患者を対象にして下肢の体表面温度を測定した｡測定にはサーモグラフィーを用い,得られた画像の数値化にはコンピュータを用いた画像処理システムを利用した｡健常人を用いた実験では,20℃の水を用いた冷水負荷を5分間行うことにより,冷水負荷後,下肢の体表面温度は時間とともに上昇して30分後に良好な回復を得ることができた｡画像処理により28℃以上の体表面温度を呈した下肢の面積を負荷前と比較したところ,回復率は,2名の健常人についてみるとそれぞれ83%,88%であった｡27℃で画像処理を行った場合には回復率は93%となり過大評価される可能性があった｡また,29℃で画像処理を行ったところに,逆に,64%となり過少評価される可能性があり,28℃が最も良い条件であった｡この様な条件下で,糖尿病患者7名について同様に測定を行ったところ,1名は健常人と同じく99%の良好な回復率を呈した｡しかし,他の1名は56%であり,残りの,5名は6%以下であった｡この様に,糖尿病患者では,下肢の体表面温度の冷水負荷後の回復率に顕著な差を認めた｡この差は,糖尿病患者における,末梢循環障害の程度を反映しているものと考えられた｡この様にコンピュータを用いた画像処理システムの応用によりサーモグラフィーの画像は数値化することが出来,測定結果はより客観的に据えることが可能となった｡画像処理されたサーモグラフィーは下肢の循環障害を持つ患者の末梢血流量の評価に有用な測定方法であると考えられた