布地奈德吸入治疗对儿童咳嗽变异性哮喘的肺功能和炎性递质的影响  

The effect of budesonide on lung function and inflammatory mediators in children with cough variant asthma

作　　者：李建伟[1] 刘长山[2] 

机构地区：[1]济宁医学院附属医院儿科 [2]天津医科大学第二医院儿科,300211

出　　处：《中国综合临床》2014年第10期1104-1107,共4页Clinical Medicine of China

摘　　要：目的 探讨吸入性糖皮质激素（ICS）治疗对咳嗽变异性哮喘（GVA）患者的肺功能和血清炎性递质的影响.方法 将50例确诊的CVA患儿随机分为A组30例,B组20例.另设健康对照组（健康体检儿童）为C组20名.所有研究对象治疗前均进行基础肺功能、支气管舒张试验（BDT）和血清白细胞介素（IL）5、IL-8、IL-10的检测.入组后A组患儿接受ICS长期干预治疗,治疗方案为吸入布地奈德气雾剂200 μg,每日1次,随访观察6个月;B组为对照组,未接受ICS长期干预及全身性糖皮质激素治疗,对症治疗及必要时加用沙丁胺醇气雾剂.评估治疗前各组及治疗前,治疗后3、6个月A、B两组肺功能[包括用力肺活量（FVC）、1 s用力呼气容积（FEV1）、呼气峰流速（PEF）及最大呼气中段流速（MMEF）]、BDT和血清IL-5、IL-10、IL-8水平及改变情况.结果 （1）肺功能：治疗前3组FVC、FEV1及PEF差异均无统计学意义（P均＞0.05）,而A、B两组的MMEF显著低于C组（F=58.40,P＜0.05）.A组经ICS治疗后3、6个月与治疗前比较,MMEF均有明显改善（P ＜0.05,P＜0.01）.B组治疗后3、6个月与治疗前比较,MMEF改善均无统计学意义（P＞0.05）.治疗前C组BDT阳性者明显低于A、B两组;A组治疗后3、6个月与治疗前比较,BDT阳性率均有所下降,且随疗程延长,呈下降趋势;而B组治疗后3、6个月与治疗前比较,BDT阳性率下降无统计学意义（P＞0.05）.（2）血清IL-5、IL-10、IL-8水平：治疗前C组血清IL-5、IL-8水平低于A、B两组,IL-10水平高于A、B两组（P＜0.05）;治疗3、6个月后,A组血清IL-5、IL-8水平明显低于治疗前,IL-10水平高于治疗前,且随疗程延长,变化更趋明显.B组治疗前与治疗后3、6个月比较则变化无统计学意义.A、B两组治疗后3、6个月比较有统计学意义（P＜0.05）.结论 ICS是治疗CVA有效抗炎药物,而且ICS的疗程需要坚持长期的原则.Objective To investigate the effect of inhaled corticosteroid （ICS） on lung function and inflammatory mediators in cough variant asthma （CAV）.Methods Fifty patients with CVA were randomly divided into group A （n =30） and group B （n =20）,and 20 normal cases were recruited as healthy group （group C） in this study.All the cases were given a lung function test,bronchial dilation test（BDT） and serum levels of inflammatory mediators（interleukin（IL）-5,IL-8 and IL-10） assessment.The cases in group A were given longterm ICS intervention therapy of inhaled budesonide aerosol at dose of 200 μg/day with 6 months＇ follow-up period.The cases in group B and C were given salbutamol and symptomatic treatment if necessary.Assessment about lung function （forced vital capacity （FVC）,1 s forced expiratory volume （FEV1）,peak expiratory rate （PER） and maximum mid-expiratory flow rate（MMEF））,BDT,and inflammatory mediators in all groups were performed before and after treatment.Results （1） Lung function：before treatment,the level of FVC,FEV1 and PEF in three groups were not significantly different （P 〉 0.05）.MMEF in group A and B is significantly lower than that in group C （F =58.40,P 〈 0.05）.In group A,MMEF was significantly improved （P 〈 0.05,P 〈 0.01） after 3 and 6 months ICS treatment.In group B,MMEF was not statistical improvement compared with before treatment（P 〉0.05）.The BDT positive rate in group C was significantly lower than that in group A and B.The BDT positive rate in group A decreased after ICS treatment for 3 and 6 months.Meanwhile,the BDT level decreased as the longer treatment.In group B,there was no statistical decrease in terms of BDT positive rate（P 〉0.05）.（2）Inflammatory mediators：in group C,the serum levels of IL-5 and IL-8 were lower than those in group A and B,but the level of I L-10 was higher than it in the other two groups（P 〈0.05）.After 3 and 6 months ICS treatment,the serum levels of IL-5 and IL-8 were si

关 键 词：咳嗽变异性哮喘 支气管舒张试验 吸入性糖皮质激素 白细胞介素 

分 类 号：R725.6[医药卫生—儿科]