肝素雾化吸入治疗喘息样支气管炎反复发作的免疫学机制  

Immunological mechanism of heparin aerosol inhalation for recurrent asthmatic bronchitis

作　　者：邢燕[1] 刘爽[1] 张豫华[1] 高丽[1] 

机构地区：[1]郑州大学人民医院河南省人民医院儿科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2016年第9期925-927,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省卫生厅科技攻关项目(201203103)

摘　　要：目的探讨在常规治疗基础上给予肝素雾化吸入治疗小儿喘息样支气管炎反复发作的疗效及免疫学机制。方法喘息性支气管炎患儿50例,随机分为观察组30例和对照组20例,对照组给予吸氧、抗感染等常规治疗,观察组在对照组基础上给予肝素100u/kg+生理盐水5mL雾化吸入,2次/d,共14d。记录2组喘息时间和肺部啰音时间;分别于治疗前及治疗14d后检测2组血清白细胞介素(interleukin,IL)-4、IL-8、正常T细胞表达分泌的活性调节蛋白(regulated upon activation normal T cell expressed and secreted,RANTES)、干扰素-γ(interferon-gamma,INF-γ)水平及CD4^+CD25^+CD127^-Treg细胞比率,并与18例体检健康者(阴性对照组)进行比较。结果观察组喘息时间[(4.5±1.1)d]及肺部啰音时间[(6.9±0.8)d]较对照组[(6.6±1.4)、(8.1±0.9)d]短(P<0.01);治疗前,观察组和对照组血清IL-4[(2.45±0.22)、(2.38±0.18)ng/L]、IL-8[(33.90±2.20)、(32.10±2.00)ng/L]、RANTES[(48.8±8.7)、(41.9±9.5)μg/L]水平均明显高于阴性对照组[IL-4(1.41±0.17)ng/L、IL-8(15.60±2.20)ng/L、RANTES(13.3±4.8)μg/L](P<0.01),INF-γ[(0.37±0.14)、(0.38±0.09)ng/L]及CD4^+CD25^+CD127^-Treg细胞比率[(6.4±0.9)%、(5.5±0.8)%]均低于阴性对照组[(1.44±0.20)ng/L、(7.9±1.2)%](P<0.01);观察组治疗后血清IL-4[(1.52±0.13)ng/L]、IL-8[(18.60±2.10)ng/L]及RANTES[(23.1±4.5)μg/L]水平均较对照组治疗后[(1.78±0.16)ng/L)、(22.90±1.20)ng/L、(28.0±6.1)μg/L]降低(P<0.05),观察组治疗后血清INF-γ[(1.46±0.16)ng/L)]及CD4^+CD25^+CD127^-Treg细胞比率[(7.2±0.9)%]均较对照组治疗后[(0.83±0.09)ng/L、(6.4±1.0)%]增高(P<0.05)。结论喘息样支气管炎反复发作患儿在常规治疗基础上给予肝素雾化吸入治疗,可下调血清IL-4、IL-8、RANTES水平,上调INF-γ和CD4^+CD25^+CD127^-Treg细胞比率,缩短喘息时间及肺部啰音时间。Objective To explore the therapeutic effect and immunological mechanism of heparin aerosol inhalation in addition to the routine treatment for recurrent asthmatic bronchitis in children. Methods Fifty patients with asthmatic bronchitis were randomly divided into observation group （n= 30） and control group （n=20）. Control group was given routine treatment including oxygen inhalation, anti-infection and fluid infusion. Observation group was given aerosol inhalation with heparin 100 u/kg ＋ 5 mL normal saline twice a day totally for 14 days, besides the routime treatment in control group. The wheezing remission time and the pulmonary rale extinction time were recorded. The interleukin （IL）-4, IL-8, regulated upon activation normal T cell expressed and secreted （RANTES）, interferon-gamma （INF-y） and CD4＋CD25＋CD127- Treg ratio were detected before and after 14-day treatment in two groups, and were compared with those in 18 healthy volunteers （normal control group）. Results The wheezing remission time and the pulmonary rale extinction time were signigicantly shorter in observation group （（4.5± 1.1）, （6.9±0.8） d） than those in control group （（6.6±1.4）, （8.1±0.9） d） （P〈0.01）. The levels of IL-4 （（2.45±0. 22）, （2. 38±0. 18） ng/L）, IL-8 （（33.90±2.20）, （32.10±2.00） ng/L） and RANTES （（48.8±8.7）, （41.9±9.5） μg/L） in observation group and control group were significantly higher than those in normal control group （（1.41±0. 17）ng/L, （15. 60± 2. 20） ng/L, （13. 3 ± 4.8） μg/L）before treatment （P〈0.01）, and the levels of INF-γ （（0. 37± 0. 14）, （0. 38 ± 0. 09） ng/L） and CD4＋CD25＋CD127- Treg ratio （（6. 4 ± 0. 9）%, （5. 5 ±0. 8）%） in observation group and control group were significantly lower than those in normal control group （（1.44±0.20） ng/L, （7.9 ± 1.2）%） （P〈0.01）. The levels ofIL-4 （（1.52±0.13） ng/L）, IL-8 （（18.60±2.10） ng/L） and R

关 键 词：喘息样支气管炎 肝素 雾化吸入 白细胞介素-4 白细胞介素-8 正常T细胞表达分泌的活性调节蛋白 干扰素-γ CD4+CD25+CD127- Treg细胞比率 

分 类 号：R725.6[医药卫生—儿科]