吸入糖皮质激素预防呼吸道合胞病毒毛细支气管炎后反复喘息的临床观察  

Influence of inhaled glucocorticosteroid on prognosis of infant respiratory syncyeial virus bronchiolitis

作　　者：赵德育[1] 田曼[1] 陈荣华[2] 文惯宇[1] 张兰芳[1] 施圣云[1] 吴美思[1] 

机构地区：[1]南京医科大学附属南京儿童医院,江苏南京210008 [2]南京医科大学儿科研究所江苏南京210029

出　　处：《临床儿科杂志》2008年第1期24-27,共4页Journal of Clinical Pediatrics

基　　金：江苏省南京市医学科技发展项目课题(No.ZKX306)

摘　　要：目的观察吸入糖皮质激素能否预防呼吸道合胞病毒(RSV)毛细支气管炎(简称毛支)后反复喘息的发生。方法选择2003年7月-2004年12月住院的RSV毛支患儿200例,入院后查外周血嗜酸性粒细胞、血清总IgE,血TH1/TH2水平及肺功能。毛支治愈后随机分为治疗组(100例)和对照组(100例),治疗组吸入布地奈德气雾剂3个月,对照组未给予治疗。3个月后随访,复查肺功能。停止治疗后继续观察2年,了解吸入激素3个月对患儿反复喘息发生的影响。结果①毛支治愈后的3个月内,治疗组无症状天数为(78.92±8.03)d,对照组为(74.83±9.54)d,两组比较差异有统计学意义(P<0.01)。②3个月后治疗组肺功能各项指标均比对照组明显好转(P<0.05)。③治疗组按吸入激素疗效分为毛支后喘息组和未再喘息组,这两组患儿入院时外周血嗜酸性粒细胞、血清总IgE、血Th1/Th2差异均有统计学意义(P<0.05),而肺功能差异无统计学意义(P>0.05)。④停止治疗后2年两组患儿喘息再发比例差异无统计学意义(P>0.05)。结论RSV毛支患儿治愈后吸入布地奈德气雾剂3个月,可改善肺功能。外周血嗜酸性粒细胞增多、血清总IgE升高、Th2功能亢进者,治疗期间可以减少毛支后喘息再发。吸入激素3个月不能减少停药后2年内喘息的发生。Objectives To observe the prognosis of respiratory syncyeial virus （RSV） bronchiolitis children by inhaled corticosteroids for three months. Methods Two hundred children recovered from RSV bronchiolitis randomly assigned into two groups. Treatment group inhaled budesonide （200 μg twice daily）, and control group had no treatment. After three months, the effect of treatment and the change of lung function were observed respectively. These RSV bronchiolitis children have been followed another two years without special medication in order to observe the occurrence of wheezing post-bronchiolitis. Results （1） The proportion of symptom-free days was significant higher in the treatment group than that in the control group （P 〈 0.01）. （2） Compared with the control group, the lung function was better （P 〈 0.05） in the treatment group after three months. （3） The patients with eosinophilia, high serum IgE and Th2 levels were more sensitive to inhaled corticosteroids. （4） During the follow up years, no significant difference was found between two groups in the occurrence of wheezing post-bronchiolitis. Conclusions In children recovered from RSV bronchiolitis, three months of inhaled-budesonide can improve the lung function. The patients with eosinophilia, high serum IgE and Th2 levels are more sensitive to inhaled corticosteroids. Three months of inhaledbudesonide can not decrease the risk of wheezing after RSV bronchiolitis.

关 键 词：呼吸道合胞病毒 毛细支气管炎 吸入激素 喘息 

分 类 号：R725.6[医药卫生—儿科]