局部应用糖皮质激素不同给药方式治疗季节性变应性鼻炎合并哮喘的临床观察  

Treatment of allergic rhinitis with asthma by different ways of inhaling corticosteroids

作　　者：张华[1] 陈璇[2] 王惠妩[1] 向阳冰[1] 

机构地区：[1]新疆医科大学第一附属医院耳鼻咽喉科,乌鲁木齐830054 [2]新疆克拉玛依市中心医院五官科

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第1期16-20,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家“十五”科技攻关项目（2007BA118815）;新疆维吾尔自治区教育厅重大项目（XJEDU2005121） （张华、王惠妩、向阳冰）;（陈璇）

摘　　要：目的观察比较局部应用糖皮质激素不同给药方式治疗季节性变应性鼻炎合并轻一中度哮喘患者的临床疗效。方法分别采用鼻喷、口吸及鼻喷＋口吸联合吸入糖皮质激素（布地奈德）治疗90例季节性变应性鼻炎合并轻-中度哮喘患者12周，观察治疗前后血清总IgE、嗜酸性粒细胞阳离子蛋白（eosinophil cationic protein，ECP）、白细胞介素5（interleukin-5，IL-5）水平、肺功能变化及鼻炎、哮喘记分。结果三组患者治疗后血清总IgE、ECP、IL-5水平和鼻炎、哮喘记分均明显下降，组内治疗前后比较，差异均有统计学意义（P值均〈0．05），组间治疗前后比较差异无统计学意义。鼻喷组治疗后肺功能各指标较治疗前虽有改善，但差异均无统计学意义（P值均〉0．05）。口吸组治疗前后第1秒用力呼气容积（forced expiratory volume in 1 second，FEV1）由（2．04±0．45）L提高到（2．47±0．54）L，FEV1／用力肺活量（forced vital capacity，FVC）比值由（72．73±5．59）％提高到（75．42±5．94）％；FEF25％-75%由1．69±0．52提高到2．06±0．77，差异均有统计学意义（P值均〈0．05）。联合治疗组治疗前后FEV，由（2．32±0．56）L提高到（2．76±0．58）L；FEV1／FVC由（73．80±4．17）％提高到（76．04±4．49）％；FEF25%-75％由2．09±0．45提高到2．34±0．64，差异均有统计学意义（P〈0．05）。治疗后三组间肺功能指标比较，FEV1差异有统计学意义（P=0．041），采用SNK—q法进行两两比较，认为鼻喷＋口吸联合组治疗后FEV1与鼻喷组、口吸组比较差异有统计学意义（P〈0．05）。本组共失访9例。结论局部应用糖皮质激素分别经鼻喷、口吸及鼻喷＋口吸联合三种方法治疗变应性鼻炎合并轻-中度哮喘患者，可以明显缓解鼻炎及哮喘症状，在症状记分和血清学检测方面没有明显差异。Objective To observe the therapeutical effect on allergic rhinitis with asthma by different ways of inhaling corticosteroids. Methods Ninety patients suffering from allergic rhinitis with asthma were classified into three groups in random and treated with budesonide （BUD） by nasal spay, inhaling and nasal spay-inhaling combined administration for 12 weeks, respectively. The concentration of serum total IgE, eosinophil cationic protein（ECP） and IL-5, pulmonary functions were examined before and after treatment. Results The improvement of symptom scores of rhinitis and asthma in three groups were significant （P 〈 0.05 ）. The concentration of serum total IgE, ECP and IL-5 in three groups decreased greatly after treatment （P 〈 0.05 ）. There were significant improvement in FEV1, FEV1/FVC and FEF25%-75% in inhaling group before and after treatment （P 〈 0. 05 ） ： FEV1 from （2. 04 ± 0. 45 ） L to （2.47 ± 0. 54） L, FEV1/FVC from （72. 73 ± 5.59 ） % to （ 75.42 ± 5.94 ） % and FEF：25%- 75% from 1.69 ±0. 52 to 2. 06± 0.77. There was also significant improvement in nasal spay-inhaling combined groups before and after treatment （ P 〈 0. 05 ） ： FEV1 from （2. 32 ± 0. 56 ） L to （ 2. 76 ± 0. 58 ） L, FEV1/FVC from （73.80 ± 4. 17） % to （76. 04 ± 4. 49） % and FEF25%-75% from 2.09 ± 0. 45 to 2. 34 ± 0. 64. The significant difference of FEV1 among the three treatment groups was observed （P = 0. 041 ）. Conclusions The symptoms of rhinitis and asthma in three groups by three ways of inhaling BUD were greatly improved, no significant difference in symptom scores and serum parameters was found.

关 键 词：鼻炎 变应性 季节性 哮喘 糖皮质激素类 投药途径 

分 类 号：R686[医药卫生—骨科学]