WEBVTT00:00:01.880 --> 00:00:04.140好今天跟大家分享一个00:00:04.280 --> 00:00:08.340就是内容叫嗜酸粒细胞性支气管炎00:00:10.160 --> 00:00:12.520那么从以下几部分00:00:12.520 --> 00:00:13.560包括定义00:00:13.560 --> 00:00:16.040流行病学以及结论和意义00:00:16.040 --> 00:00:18.700以及它的治疗与管理策略00:00:18.760 --> 00:00:19.440诊断界别00:00:19.440 --> 00:00:21.460诊断等方面来00:00:21.680 --> 00:00:23.300嗯阐述阐述00:00:25.200 --> 00:00:26.400首先我们了解一下00:00:26.400 --> 00:00:27.160他的那个00:00:27.160 --> 00:00:29.620嗜酸性粒细胞炎的起源和现状00:00:29.840 --> 00:00:32.360那么公众对这个EB的了解程度00:00:32.360 --> 00:00:35.020远不如哮喘等其他疾病00:00:35.440 --> 00:00:37.340疾病研究持续深入00:00:37.480 --> 00:00:38.480呃科研界呢00:00:38.480 --> 00:00:41.500不断投入资源研究EB的发展机制00:00:41.640 --> 00:00:42.440治疗手段呢00:00:42.440 --> 00:00:43.740逐渐多样化00:00:43.760 --> 00:00:45.240针对EB的治疗方法呢00:00:45.240 --> 00:00:46.660逐渐也比较丰富00:00:46.760 --> 00:00:48.240个性化治疗方案呢00:00:48.240 --> 00:00:49.200成为可能00:00:49.200 --> 00:00:52.380那么发病率它是逐年上升的00:00:53.240 --> 00:00:55.280随着医学技术的进步00:00:55.280 --> 00:00:57.620EB的诊断率得到了提高00:00:58.240 --> 00:00:59.820那么它的目的00:01:00.480 --> 00:01:03.240就是强调研究这个EB的重要性00:01:03.240 --> 00:01:04.500的目的及意义00:01:05.000 --> 00:01:07.900首先是提高临床的诊治水平00:01:08.120 --> 00:01:09.800通过深入研究EB00:01:09.800 --> 00:01:12.320能够提高诊断和治疗的准确性00:01:12.320 --> 00:01:13.300和有效性00:01:13.320 --> 00:01:15.900能够促进公共卫生的策略00:01:16.360 --> 00:01:18.320制定针对性的公共卫生策略00:01:18.320 --> 00:01:20.420降低EB的发病率和传播00:01:20.800 --> 00:01:22.720改善患者的生活质量00:01:22.720 --> 00:01:24.740提供有效的治疗方案00:01:25.000 --> 00:01:27.640嗯帮助EB患者提高生活质量00:01:27.640 --> 00:01:32.460那么第四个是推动医学科研发展00:01:32.960 --> 00:01:35.380嗯包括加强对EB的研究00:01:35.520 --> 00:01:39.100促进科学医学科研的进步和创新00:01:39.480 --> 00:01:41.300嗯增强国际00:01:42.760 --> 00:01:43.560学术交流00:01:43.560 --> 00:01:45.360通过国际合作研究00:01:45.360 --> 00:01:46.040通过全00:01:46.040 --> 00:01:48.820提高全球对EB的认识和研究水平00:01:49.040 --> 00:01:49.560第五个00:01:49.560 --> 00:01:52.360第六个是支持医疗政策的制定00:01:52.360 --> 00:01:54.080就是为政府和医疗机构00:01:54.080 --> 00:01:55.340提供科学依据00:01:55.440 --> 00:01:57.660优化医疗资源配置00:02:00.040 --> 00:02:02.460那么就是他的00:02:02.880 --> 00:02:06.080从这个临床医生到科研人00:02:06.080 --> 00:02:08.180员以及政策的制定者00:02:08.280 --> 00:02:09.500患者家属00:02:09.800 --> 00:02:10.900嗯00:02:11.480 --> 00:02:15.320学教研教育者以及公共健康倡导者00:02:15.320 --> 00:02:17.140都是需要00:02:18.520 --> 00:02:20.680了解的那么报告的内容呢00:02:20.680 --> 00:02:22.440包括第一00:02:22.440 --> 00:02:25.600它的就是概述的这个内容框架00:02:25.600 --> 00:02:28.500包括内意定义和流行病学00:02:28.800 --> 00:02:30.520它包括包括全面介绍a00:02:30.520 --> 00:02:33.660b的基本定义及流行病学的特征00:02:33.880 --> 00:02:36.180那么第二个是病理生理的机制00:02:36.320 --> 00:02:39.520探讨疫病的发病机制和生理变化00:02:39.520 --> 00:02:43.720第三个就是提供准确的呃诊断标准00:02:43.720 --> 00:02:46.020和其他的疾病的鉴别方法00:02:46.480 --> 00:02:49.440第四个就是概述现有的治疗方法00:02:49.440 --> 00:02:51.140和有效的管理策略00:02:51.280 --> 00:02:51.680第五个00:02:51.680 --> 00:02:55.000就是探讨一笔的未来的研究方向00:02:55.000 --> 00:02:56.380以及发展潜力00:02:56.440 --> 00:02:57.820第六个是结论00:02:58.160 --> 00:02:59.480就是总结报告内容00:02:59.480 --> 00:03:01.860提出实用的建议和展望00:03:02.560 --> 00:03:03.600那么下面我们看一下00:03:03.600 --> 00:03:05.180它的定义和流行病学00:03:05.640 --> 00:03:08.340首先呢就是EB的概念是指什么00:03:09.280 --> 00:03:11.160EB就是嗜酸性00:03:11.160 --> 00:03:13.540粒嗜酸粒细胞性支气管炎00:03:13.680 --> 00:03:14.440它是一种00:03:14.440 --> 00:03:18.560以气道嗜酸粒细胞侵润为特征的00:03:18.560 --> 00:03:20.340非哮喘性支气管炎00:03:20.640 --> 00:03:22.280那么它表现的气道炎症呢00:03:22.280 --> 00:03:24.140就表现为慢性气道炎症00:03:24.280 --> 00:03:26.740通常无明显的喘息症状00:03:26.880 --> 00:03:28.660以咳嗽为主要症状00:03:28.720 --> 00:03:30.980就是以慢性咳嗽为主要表现00:03:31.320 --> 00:03:34.700那么同时区别于其他的00:03:36.320 --> 00:03:37.460呼吸系统疾病00:03:37.720 --> 00:03:40.280那么诊就是第三个呢00:03:40.280 --> 00:03:40.840诊断呢00:03:40.840 --> 00:03:43.320就要需要排除其他类似的这种疾病00:03:43.320 --> 00:03:44.900比如说过敏性鼻炎00:03:45.480 --> 00:03:47.040嗯还有这种非过敏00:03:47.040 --> 00:03:48.040非过敏性炎症00:03:48.040 --> 00:03:48.960虽然与过敏有关00:03:48.960 --> 00:03:51.040但是他与EB的炎症反应00:03:51.040 --> 00:03:52.920并非完全与过敏引起00:03:52.920 --> 00:03:54.780那么他没有7到高反应00:03:54.880 --> 00:03:56.000就是说EB患者00:03:56.000 --> 00:03:58.460是通常不表现出7到高反应的00:03:58.560 --> 00:04:00.240那么病理特征呢00:04:00.240 --> 00:04:01.960就是包括7到b的速算00:04:01.960 --> 00:04:04.900粒细胞增多和粘液分泌增加00:04:07.080 --> 00:04:08.440流行病学特征呢00:04:08.440 --> 00:04:09.480包就是提示00:04:09.480 --> 00:04:11.840揭示了这个EB的流行病学趋势00:04:11.840 --> 00:04:12.440包括第一00:04:12.440 --> 00:04:13.860它的全球发病率00:04:14.040 --> 00:04:15.520在全球范围内00:04:15.520 --> 00:04:17.200EB的发病率逐年上升00:04:17.200 --> 00:04:20.400尤其是在工业化国家更为明显00:04:20.400 --> 00:04:21.320那么它的第二00:04:21.320 --> 00:04:21.960地区差异00:04:21.960 --> 00:04:23.320在不同地区的发展00:04:23.320 --> 00:04:25.880发病率和存在显著差异00:04:25.880 --> 00:04:28.900而且与环境因素和遗传背景有关00:04:29.040 --> 00:04:31.460第三个年龄与性别分布00:04:31.480 --> 00:04:32.440那么研究显示00:04:32.440 --> 00:04:34.120异弊多见于成年人00:04:34.120 --> 00:04:36.460而且女性的发病率高于男性00:04:36.520 --> 00:04:37.980需要进一步的探究00:04:38.080 --> 00:04:39.080季节变化00:04:39.080 --> 00:04:39.840某些地区呢00:04:39.840 --> 00:04:42.880异病的发病率在呃特定季节升高00:04:42.880 --> 00:04:44.660可能与气候变化相关00:04:44.800 --> 00:04:45.920社会经济因素00:04:45.920 --> 00:04:47.840社会经济地位低的患者呢00:04:47.840 --> 00:04:49.160EB的发病率较高00:04:49.160 --> 00:04:50.820可能与居住环境有关00:04:51.080 --> 00:04:52.320嗯环境暴露00:04:52.320 --> 00:04:54.080就是长期暴露于空气污染00:04:54.080 --> 00:04:56.440和烟雾环境中的人群00:04:56.440 --> 00:04:58.100EB风险显著增加00:04:58.560 --> 00:04:59.700嗯职业风险00:04:59.840 --> 00:05:00.840就是某些职业00:05:00.840 --> 00:05:02.620比如说清洁工和矿工00:05:02.680 --> 00:05:05.160因为暴露在这个特定的化学物质中00:05:05.160 --> 00:05:07.300所以异病患病风险是比较高的00:05:09.760 --> 00:05:11.860那下面我们看一下EB的病因00:05:12.000 --> 00:05:13.000它的潜在病因呢00:05:13.000 --> 00:05:16.640包括这个环境因素和过敏源的暴露00:05:16.640 --> 00:05:18.340以及职业暴露和00:05:19.960 --> 00:05:21.020药物因素00:05:21.440 --> 00:05:22.720那么环境因素呢00:05:22.720 --> 00:05:25.140就是说长期暴露于空气污染00:05:25.480 --> 00:05:27.480烟雾等环境污染物00:05:27.480 --> 00:05:29.460增加疫病的发病风险00:05:30.000 --> 00:05:30.800过敏原暴露00:05:30.800 --> 00:05:32.760就是反复接触过敏原00:05:32.760 --> 00:05:33.860比如粉尘00:05:34.160 --> 00:05:34.800花粉00:05:34.800 --> 00:05:38.100然后可以就是诱发这个异鼻的症状00:05:38.360 --> 00:05:39.560那么感染因素呢00:05:39.560 --> 00:05:40.640包括呼吸道感染00:05:40.640 --> 00:05:42.140比如说病毒感染00:05:42.520 --> 00:05:46.660嗯可能触发或者加重加重异鼻的00:05:47.960 --> 00:05:50.680病情那么职业暴露呢00:05:50.680 --> 00:05:52.320就包括某些职业环境中00:05:52.320 --> 00:05:53.120比如长期接00:05:53.120 --> 00:05:53.320触00:05:53.320 --> 00:05:56.420化学物质可能诱发导致异病的发生00:05:56.520 --> 00:05:58.160那么不同的生活方式呢00:05:58.160 --> 00:06:00.840包括呃比如吸烟啊00:06:00.840 --> 00:06:01.960缺乏运动啊00:06:01.960 --> 00:06:02.480或者是00:06:02.480 --> 00:06:05.100也能增加他的异病的发病风险00:06:05.400 --> 00:06:06.200那么药物因素00:06:06.200 --> 00:06:07.160就是某些药物00:06:07.160 --> 00:06:09.480比如说非载体类的药物00:06:09.480 --> 00:06:12.300可能诱发EB的症状00:06:13.280 --> 00:06:15.520那么发病机制包括以下几个方面00:06:15.520 --> 00:06:17.460第一就是免疫反应异常00:06:17.640 --> 00:06:19.840涉及到THR细胞过度活跃00:06:19.840 --> 00:06:21.620导致嗜酸粒细胞增多00:06:21.840 --> 00:06:23.780那么炎症介质的释放00:06:23.920 --> 00:06:25.240包括多种炎症介质00:06:25.240 --> 00:06:28.580比如说白介素5参与引发气道炎症00:06:28.640 --> 00:06:30.060那么气道重塑00:06:30.160 --> 00:06:31.720包括这种长期炎症00:06:31.720 --> 00:06:34.400可以导致起到结构重塑00:06:34.400 --> 00:06:35.540影响功能00:06:35.720 --> 00:06:38.420那么第四个就是神经调节失衡00:06:38.600 --> 00:06:39.960包括神经态失衡00:06:39.960 --> 00:06:43.860可能可能导致嗯咳嗽敏感性增加00:06:44.480 --> 00:06:45.960嗯第五个是氧化应激00:06:45.960 --> 00:06:46.840氧化应激反应呢00:06:46.840 --> 00:06:49.060可能加剧气道炎症损伤00:06:49.480 --> 00:06:51.440嗯第六个是遗传因素00:06:51.440 --> 00:06:53.000特定的基因变异00:06:53.000 --> 00:06:55.500可能影响EB的易感性00:06:55.840 --> 00:06:57.480那么还有环境交互因素00:06:57.480 --> 00:07:00.360包括环境因素和遗传背景共同作用00:07:00.360 --> 00:07:01.860影响异病的发病00:07:01.920 --> 00:07:03.460那免疫系统失调00:07:03.520 --> 00:07:05.360就是免疫细胞功能紊乱00:07:05.360 --> 00:07:07.020导致异病发生00:07:08.600 --> 00:07:10.580下面我们看一下临床表现00:07:10.800 --> 00:07:12.240嗯临床表现呢00:07:12.240 --> 00:07:14.080它有就是慢性咳嗽00:07:14.080 --> 00:07:16.120患者通常表现为慢性的00:07:16.120 --> 00:07:18.900持续数周或者更长时间的咳嗽00:07:19.040 --> 00:07:20.980这是一批最常见的症状00:07:21.240 --> 00:07:21.720第二个呢00:07:21.720 --> 00:07:23.060是无喘息症状00:07:23.120 --> 00:07:24.200与哮喘不同00:07:24.200 --> 00:07:26.600一批患者通常不表现出明显的喘息00:07:26.600 --> 00:07:27.740或者呼吸困难00:07:28.480 --> 00:07:30.240那么第三个是夜间症状00:07:30.240 --> 00:07:30.960咳嗽加重00:07:30.960 --> 00:07:34.000许多患者是在夜间咳嗽症状加重00:07:34.000 --> 00:07:36.060影响了患者睡眠质量00:07:36.080 --> 00:07:37.560而且他的痰液增多00:07:37.560 --> 00:07:39.160伴有这种痰液分泌增加00:07:39.160 --> 00:07:41.400通常为一种白色的透明00:07:41.400 --> 00:07:42.420的粘液痰00:07:42.560 --> 00:07:44.720那么做咳嗽激发实验00:07:44.720 --> 00:07:46.140可以体现出阳性00:07:46.440 --> 00:07:46.840患者呢00:07:46.840 --> 00:07:50.660EB患者通常出出现是就是咳嗽加剧00:07:50.840 --> 00:07:52.620咳嗽对刺激敏感00:07:56.760 --> 00:07:58.320那么患者对烟雾00:07:58.320 --> 00:08:01.040嗯冷空气等刺激物均为极为敏感00:08:01.040 --> 00:08:02.940一切易引发咳嗽00:08:03.120 --> 00:08:04.880那么第五个就是伴随症状00:08:04.880 --> 00:08:07.280少数患者呢可能伴有轻微的胸闷00:08:07.280 --> 00:08:11.100咳嗽不适等非特异性症状00:08:13.840 --> 00:08:16.040那么就是诊断分析00:08:16.040 --> 00:08:19.240一病中诊断的挑战包括就是说嗯00:08:19.240 --> 00:08:21.160第一他症状缺乏特性00:08:21.160 --> 00:08:24.160EB的症状与其他呼吸系统疾病相似00:08:24.160 --> 00:08:24.640如咳嗽00:08:24.640 --> 00:08:26.940变异性哮喘和慢性阻塞性肺病00:08:27.080 --> 00:08:28.360增加了诊断的难度00:08:28.360 --> 00:08:29.860第二诊断工具有限00:08:29.960 --> 00:08:33.320目前呢缺乏快速简便的诊断工具00:08:33.320 --> 00:08:35.080依赖复杂的肺功能测试00:08:35.080 --> 00:08:36.580和诱导弹分析00:08:36.680 --> 00:08:38.980导致诊断过程呢比较繁琐00:08:39.159 --> 00:08:40.839他的误诊率是比较高的00:08:40.839 --> 00:08:42.199由于症状比较相似00:08:42.199 --> 00:08:45.380所以异病呢通常被误诊为其他疾病00:08:45.400 --> 00:08:47.080延误了患者的治疗时机00:08:47.080 --> 00:08:48.740影响病情管理00:08:48.800 --> 00:08:51.520第四个由于患者的认知不足导致呢00:08:51.520 --> 00:08:53.640他对异病的了解有限00:08:53.640 --> 00:08:56.400可能就是导致患者就医延迟00:08:56.400 --> 00:08:58.620进而影响早期的诊断和干预00:08:59.400 --> 00:09:01.660下面我们看一下它的病理生理机制00:09:04.920 --> 00:09:05.920嗯阐述一下00:09:05.920 --> 00:09:06.560炎症细胞00:09:06.560 --> 00:09:09.620在EB病毒中的AEB中的作用00:09:09.840 --> 00:09:11.720包括第一嗜酸粒细胞00:09:11.720 --> 00:09:14.160嗜酸粒细胞呢是通过释放炎症介质00:09:14.160 --> 00:09:16.780参与起到炎症反应和损伤过程00:09:17.080 --> 00:09:18.420第二个是肥大细胞00:09:18.600 --> 00:09:21.280肥大细胞通过释放阻氨等介质00:09:21.280 --> 00:09:23.260加剧气道的炎症反应00:09:23.560 --> 00:09:24.960第三个是巨噬细胞00:09:24.960 --> 00:09:26.440通过呢巨吞噬作用00:09:26.440 --> 00:09:29.300调节炎症反应和免疫应答00:09:29.400 --> 00:09:31.600第四个是树突状细胞00:09:31.600 --> 00:09:33.960树突状细胞作为这种抗原00:09:33.960 --> 00:09:35.740成成地细胞00:09:35.920 --> 00:09:37.520调节EB的免疫反应00:09:37.520 --> 00:09:39.580那么第第五个是t细胞00:09:41.000 --> 00:09:42.960t细胞主要主导的呢00:09:42.960 --> 00:09:45.360就是免疫反应00:09:45.360 --> 00:09:47.980导致气道炎症和粘液分泌增加00:09:48.320 --> 00:09:49.300呃00:09:49.920 --> 00:09:51.960中性粒细胞在EB的某些阶段00:09:51.960 --> 00:09:53.680参与炎症的过程00:09:53.680 --> 00:09:55.180导致组织损伤00:09:55.200 --> 00:09:56.880那b细胞产生的抗体00:09:56.880 --> 00:09:59.200参与的EB的免疫应答00:09:59.200 --> 00:10:00.540影响炎症过程00:10:00.600 --> 00:10:04.160那视碱粒细胞通过炎症释放00:10:04.160 --> 00:10:06.020增加EB的炎症应答00:10:08.880 --> 00:10:12.880那么炎症介质通常包括白介素500:10:12.880 --> 00:10:14.220白介素1300:10:14.280 --> 00:10:16.360肿瘤坏死因子干扰素00:10:16.360 --> 00:10:19.860白三烯阻氨和前列环前列腺素00:10:20.360 --> 00:10:22.740那么下面我们看一下气道重塑00:10:22.840 --> 00:10:25.040就是气道重塑对EB的影响00:10:25.040 --> 00:10:27.220气道重塑呢包括以下几方面00:10:27.240 --> 00:10:28.440就是长期炎症反应00:10:28.440 --> 00:10:29.720导致气道壁的增厚00:10:29.720 --> 00:10:31.020影响气流通过00:10:31.040 --> 00:10:32.480那么上皮细胞炎症呢00:10:32.480 --> 00:10:34.620导致上皮细胞损损伤00:10:34.720 --> 00:10:36.900影响气流的屏障功能00:10:37.080 --> 00:10:38.540影响气道屏障功能00:10:38.920 --> 00:10:39.280呃00:10:39.280 --> 00:10:41.680此外就是细胞外基质的过度沉积00:10:41.680 --> 00:10:43.940导致气道气道的结构改变00:10:44.000 --> 00:10:45.440那么神经纤维重塑00:10:45.440 --> 00:10:47.740也可能增加气道的咳嗽敏感性00:10:47.880 --> 00:10:51.000粘液分泌增加可以导致气道阻塞00:10:51.000 --> 00:10:52.100加重症状00:10:52.160 --> 00:10:53.200平滑肌的增生00:10:53.200 --> 00:10:55.860导致气道狭窄和收缩功能异常00:10:56.080 --> 00:10:58.600微血微血管的改变影响气道炎症00:10:58.600 --> 00:11:00.660反供应和炎症反应00:11:00.760 --> 00:11:03.640重塑过程中免疫功能失调00:11:03.640 --> 00:11:05.660可能导致慢性炎症00:11:14.240 --> 00:11:15.840那么下面看一下00:11:15.840 --> 00:11:18.940就是神经机机制在一笔中的作用00:11:19.640 --> 00:11:21.480包括呢咳嗽敏感性增加00:11:21.480 --> 00:11:22.940神经元性增加00:11:23.080 --> 00:11:25.080自主神经系统失调00:11:25.080 --> 00:11:26.500咳嗽中枢重塑00:11:26.520 --> 00:11:28.400神经态异常表达00:11:28.400 --> 00:11:31.020以及神经免疫相互作用几方面00:11:31.200 --> 00:11:32.520那么免疫反应中呢00:11:32.520 --> 00:11:35.840包括TR T H二细胞的主导调节性00:11:35.840 --> 00:11:36.920t细胞功能输出00:11:36.920 --> 00:11:37.880状细胞功能00:11:37.880 --> 00:11:39.600b细胞活化以及自然杀伤00:11:39.600 --> 00:11:42.260细胞活性以及细胞因子网络00:11:43.000 --> 00:11:44.960下面我们看一下遗传和环境因素00:11:44.960 --> 00:11:45.900包括呢00:11:46.640 --> 00:11:47.600基因多态性00:11:47.600 --> 00:11:52.720环境因素暴露遗传和环境交互作用00:11:52.720 --> 00:11:55.180家族式以及生活方式和地域差异00:11:55.800 --> 00:11:56.400嗯00:11:56.400 --> 00:11:58.640后面我们下看一下他的病理生理00:11:58.640 --> 00:12:00.080总结就是也就看一下00:12:00.080 --> 00:12:02.180也就是看一下他的病理生理特征00:12:02.320 --> 00:12:04.320包括复杂的多因素疾病00:12:04.320 --> 00:12:05.860包括EB射击00:12:06.400 --> 00:12:08.820遗传环境和免疫等多因素00:12:09.000 --> 00:12:11.140其病理生理期比较复杂00:12:11.160 --> 00:12:12.420诊断呢是缺乏00:12:12.480 --> 00:12:15.760就是退役性症症状和诊断诊断工具00:12:15.760 --> 00:12:21.180那诊断和治疗是需面临就是挑战的00:12:21.240 --> 00:12:23.240那么他正出现的症状呢00:12:23.240 --> 00:12:25.660是持续性的炎症及咳嗽00:12:26.360 --> 00:12:27.920影响患者的生活质量00:12:27.920 --> 00:12:29.600那么第四个就是研究潜力00:12:29.600 --> 00:12:31.560深入他的这个病理生理机制00:12:31.560 --> 00:12:33.640有助于开发新的诊断工具00:12:33.640 --> 00:12:34.780和治疗方法00:12:35.080 --> 00:12:37.380那么下面我们看一下诊断标准00:12:37.640 --> 00:12:39.820诊断标准呢就包括慢性咳嗽00:12:40.280 --> 00:12:43.180需要排除其他原因以及肺功能正常00:12:43.320 --> 00:12:44.360影像学正常00:12:44.360 --> 00:12:46.020痰酸粒细胞增多00:12:46.160 --> 00:12:48.100对糖皮质激素敏感00:12:48.160 --> 00:12:49.600咳嗽激发试验阴性00:12:49.600 --> 00:12:50.940无喘息症状00:12:51.200 --> 00:12:51.840辅助检查呢00:12:51.840 --> 00:12:53.540包括肺功能过敏源00:12:53.640 --> 00:12:55.180以及咳嗽激发实验00:12:55.320 --> 00:12:56.720诱导痰影像学00:12:56.720 --> 00:12:58.660血液检查及病例镜检查00:12:58.680 --> 00:12:59.920那么它的鉴别诊断呢00:12:59.920 --> 00:13:02.180包括就是哮喘00:13:02.640 --> 00:13:04.220COPD过敏性鼻炎00:13:04.600 --> 00:13:07.580胃食管反流以及慢性咽炎00:13:07.720 --> 00:13:08.720物质的分析00:13:08.720 --> 00:13:10.680包括常见病因有症状相似00:13:10.680 --> 00:13:11.900医生认知不足00:13:12.200 --> 00:13:13.520诊断供给不足00:13:13.520 --> 00:13:15.060患者就医延迟00:13:15.400 --> 00:13:16.360那么病例分析呢00:13:16.360 --> 00:13:19.420我们就是看以下几例病例分析00:13:19.520 --> 00:13:21.200病例一我们看到一个患者00:13:21.200 --> 00:13:24.40030岁是因慢慢性咳嗽误诊为哮喘00:13:24.400 --> 00:13:25.860那么经过诱导分析00:13:26.360 --> 00:13:28.880明确诊断为嗯EB00:13:28.880 --> 00:13:30.240那么患者二病例00:13:30.240 --> 00:13:31.720二是长期吸烟的患者00:13:31.720 --> 00:13:33.060被诊断为COPD00:13:33.320 --> 00:13:36.220进一步检查考虑是EB00:13:36.360 --> 00:13:37.340那么治疗00:13:37.480 --> 00:13:38.740治疗和管理策略00:13:38.880 --> 00:13:40.720治疗首先我们要缓解就是00:13:40.720 --> 00:13:42.860它的主要目标是缓解症状00:13:44.400 --> 00:13:45.380预防复发00:13:45.440 --> 00:13:46.360改善生活质量00:13:46.360 --> 00:13:47.160减少并发症00:13:47.160 --> 00:13:48.620提高患者的依从性00:13:48.720 --> 00:13:50.120促进心理健康00:13:50.120 --> 00:13:51.280优化医疗资源00:13:51.280 --> 00:13:52.760那么常用的药物包括00:13:52.760 --> 00:13:54.260吸入性糖皮质激素00:13:54.360 --> 00:13:55.760白三烯受体拮抗剂00:13:55.760 --> 00:13:56.820抗阻胺药00:13:57.160 --> 00:13:58.560嗯支气管扩张剂00:13:58.560 --> 00:13:59.860抗生素口皮糖00:13:59.880 --> 00:14:01.120口服糖皮质激素00:14:01.120 --> 00:14:02.780以及粘液素溶解剂00:14:03.360 --> 00:14:04.480那么非药物治疗呢00:14:04.480 --> 00:14:06.120包括就是环境因素啊00:14:06.120 --> 00:14:07.200生活方式调整00:14:07.200 --> 00:14:08.540包括心理支持啊00:14:08.640 --> 00:14:09.280呼吸训练00:14:09.280 --> 00:14:10.600以及物理治疗等00:14:10.600 --> 00:14:11.400管理策略呢00:14:11.400 --> 00:14:12.760就包括患者的需要00:14:12.760 --> 00:14:13.600定期随访00:14:13.600 --> 00:14:14.580患者教育00:14:14.880 --> 00:14:15.640个体化治疗00:14:15.640 --> 00:14:17.640多科学多学科的合作00:14:17.640 --> 00:14:20.700以及远程的监测及科学社会支持00:14:20.760 --> 00:14:23.040那么未来的展望包括这个00:14:23.040 --> 00:14:24.300新型药物研发00:14:25.320 --> 00:14:27.980呃个体化的治疗策略以及00:14:29.560 --> 00:14:31.220综合治疗措施00:14:31.480 --> 00:14:32.120人工智能00:14:32.120 --> 00:14:32.960辅助检查00:14:32.960 --> 00:14:34.700辅助诊辅助诊疗00:14:34.880 --> 00:14:36.520呃生物标志性研究00:14:36.520 --> 00:14:39.260以及远程监测技术00:14:39.600 --> 00:14:41.080呃基因治疗00:14:41.080 --> 00:14:43.100以及患者自我管理工具00:14:43.760 --> 00:14:45.200那么最后结论就是说00:14:45.200 --> 00:14:46.900EB是一个复杂的00:14:47.360 --> 00:14:48.560切被误诊的疾病00:14:48.560 --> 00:14:50.560那诊断和治疗呢00:14:50.560 --> 00:14:51.620需要个体化00:14:51.800 --> 00:14:53.460加强公众的教育00:14:53.760 --> 00:14:56.200第四个就是科研投入需要增加00:14:56.200 --> 00:14:58.560第五个就是国际合作的重要性00:14:58.560 --> 00:14:59.920那么提出的建议就是00:14:59.920 --> 00:15:02.520需要加强医务人员的培训00:15:02.520 --> 00:15:05.860第二呢开发简便简便的诊断工具00:15:05.920 --> 00:15:07.980第三个推动公众健康00:15:08.320 --> 00:15:11.840嗯第四个就是促进国际合作研究00:15:11.840 --> 00:15:13.260第五个支持患者00:15:15.000 --> 00:15:15.400组织00:15:15.400 --> 00:15:18.520提为患者提供信息和心理支持00:15:18.520 --> 00:15:19.700提高生活质量00:15:20.320 --> 00:15:22.880哦今天的分享就到此结束00:15:22.880 --> 00:15:23.740谢谢大家