支气管扩张合并支气管哮喘患者表面激素吸入的安全性及疗效观察  

Efficacy and safety of inhaled glucocorticosteroids in the treatment of bronchiectasis complicated with asthma

作　　者：翁俊良[1] 郑义珊 马琼凤[1] 

机构地区：[1]汕头大学医学院第一附属医院,广东汕头515041 [2]汕头市龙湖人民医院

出　　处：《中国呼吸与危重监护杂志》2005年第6期459-462,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：广东省科委科研基金资助(2003C33714)

摘　　要：目的探讨支气管扩张合并支气管哮喘应用表面激素吸入的疗效及安全性.方法选择支气管扩张合并支气管哮喘(简称支扩合并哮喘)患者48例,随机分为吸入激素组和常规治疗组,每组24例.吸入激素组在常规治疗基础上,加用二丙酸倍氯米松(必可酮)气雾剂治疗,每天1 000 μg,连续治疗3个月;常规治疗组仅使用常规对症治疗.观察治疗前及治疗3个月后临床症状、每月发作频率、痰液涂片白细胞分类计数、影像学改变、肺功能(FEV1)、气道阻力(Raw)、气道传导率(Gaw)、气道高反应性(BHR)的变化.结果吸入激素组临床症状好转,发作频率下降,肺部感染控制良好,明显优于常规治疗组.治疗前和治疗3个月后比较,吸入激素组症状评分由12.75分下降为3.58分,常规治疗组由13.03分下降为12.61分(P＜0.001).吸入激素组发作频率由每月9例次降低为1例次,常规治疗组由每月8例次降低为7例次(P＜0.001).吸入激素组嗜酸粒细胞由治疗前(8.72±1.25)%降至治疗后(3.45±2.25)%(P＜0.001),常规治疗组嗜酸粒细胞由(7.18±1.67)%降至(7.02±0.85)%(P＞0.05).吸入激素组治疗后胸部X线检查未见新渗出病灶,常规治疗组有10例出现新的小片状阴影.吸入激素组治疗前24例BHR均为3～5级,治疗后12例转为1～2级;常规治疗组治疗前、后24例均为3～5级(P＜0.001).吸入激素组治疗前、后Raw分别为(523±95)%和(176±25)%,常规治疗组分别为(534±90)%和(516±81)%(P＜0.001).吸入激素组治疗前、后Gaw分别为(22.5±4.5)%和(89.0±14.5)%,常规治疗组分别为(24.7±4.8)%和(31.0±6.2)%(P＜0.001).吸入激素组治疗前、后FEV1分别为(2.12±0.39)%和(2.86±0.32)%(P＜0.001),常规治疗组分别为(2.25±0.36)%和(2.31±0.38)%(P＞0.05).结论支扩合并哮喘患者在常规对症和抗感染治疗的基础上,应用表面激素吸入能有效改善患者的临床症状和肺功能,降低气道高反应性,减少感染的频率.Objective To explore the efficacy and safety of inhaled glucoeortieosteroids in treatment of bronchiectasis complicated with asthma. Methods 48 eases of patients with bronchiectasis and asthma were ineluded and divided into two groups randomly. Group A （24 eases）inhaled glueoeorticostemids （Beeotide 1000μg·d^-1 for three months）on the base of routine therapy. Group B（24 eases）were treated routinely only. The clinical symptoms, attaek frequency,leucocyte differential counts in sputum, X-ray chest film, lung function （ FEV1, Raw, Gaw） and bronchial response（BHR） were observed be.fore and after the treatment. Results Clinical symptoms, frequency of asthma attack anti lung infection were improved more significantly in group A than in group B .The symptoms score were decreased frorn 12.75 to 3.58 in group A and from 13.03 to 12.61 in group B respectively （P 〈 0.001 ）. Asthma attaek frequency decreased from 9 times to 1 time per month in group A and from 8 times to 7 times in group B（ P 〈 0.01 ）. Eosinophil percents in sputum were （8.72±1.25） % and （ 3.45 ±2.25 ） % before and after treatment in group A and （7.18 ±1.67 ） % and （7.02 ±0.85） % in group B （ P 〉 0.05 ）. No newly cxudative focus on chest film was found in group A, otherwise, patchy infiltrating shadows were shown in 10 cases in group B. ~verity of BHR descended from degree 3 - 5 to degreel ~ 2 but no signifi- cant change was observed in group B. Raw was （523 ±95） % and （ 176 ±25） % before and after treatment in group A and （534±90） % and （516 ± ） % before and after treatment in group B（ P 〈 0. 001 ）. Gaw was （22.5±4.5）% and （89.0±14.5）% before and after treatment in group A,（24.7±4.8）% and （31.0±6.2）% before and after treatment in group B（P 〈 0.001）. FEVt was respectively （2. 12± 0.39）% and （2.86±0.32） % before and after treatment in group A and （ 2.25± 0.36） % and （2.31±0.38 ） % before and after treatment in group B （ P 〉 0

关 键 词：支气管扩张 支气管哮喘 吸入性表面激素 临床疗效 

分 类 号：R562.2[医药卫生—呼吸系统]