支气管热成形术对难治性支气管哮喘患者哮喘控制水平及生活质量影响的前瞻性队列研究  

Prospective cohort study of the effects of bronchial thermoplasty on asthma control and quality of life in the patients with refractory asthma

作　　者：郑洋[1] 范芸[1] Zheng Yang;Fan Yun(Department of Respiratory and Critical Care Medicine,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海200025

出　　处：《海军医学杂志》2022年第9期973-977,共5页Journal of Navy Medicine

摘　　要：目的探讨支气管热成形术对难治性支气管哮喘患者的哮喘控制水平及生活质量的影响。方法采用前瞻性队列研究方法,选取2017年5月至2019年10月上海交通大学医学院附属瑞金医院收治的110例难治性支气管哮喘患者为观察对象,根据是否进行支气管热成形术将研究对象分为观察组(n=54)和对照组(n=56)。3个月后,比较2组患者呼吸功能、哮喘控制测试(ACT)评分、哮喘生活质量问卷(AQLQ)评分、哮喘急性发作次数、正常T细胞表达与分泌的趋化因子(RANTES)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)水平,并记录患者术后并发症发生情况。结果治疗3个月后,观察组最大呼气流量变异率(PEFR)显著低于对照组(P<0.05)。观察组对刺激物反应、对病情担忧、心理状况、哮喘症状、活动受限评分以及AQLQ总分均高于对照组(P<0.05)。观察组血清RANTES水平显著低于对照组(P<0.05)。观察组急性发作次数显著低于对照组,ACT评分显著高于对照组(P<0.05)。结论支气管热成形术治疗难治性支气管哮喘近期疗效满意,可提高哮喘控制水平,改善呼吸功能及生活质量,缓解炎症反应,减少急性发作次数,且术后无严重并发症发生,值得临床进一步关注和重视。Objective To explore the effects of bronchial thermoplasty on asthma control and quality of life in the patients with refractory asthma.Methods A prospective cohort study was performed.A total of 110 patients with refractory asthma treated in the hospital from May 2017 to October 2019 were selected as the observational subjects.The study population was divided into the treatment group(n=54)and the control group(n=56),depending on whether bronchial thermoplasty was performed.3 months after treatment,the respiratory function,asthma control test(ACT)scores,quality of life questionnaire(AQLQ)scores,the number of acute attacks,the levels of serum RANTES,IL-17 and the level of tumor necrosis factor-α(TNF-α)were compared between the two groups.Postoperative complications were also recorded in the patients.Results 3 months after treatment,the PEFR in the observation group was significantly lower than that in the control group(P<0.05).The scores of irritant response,anxiety,psychological status,asthma symptoms,activity restriction and total scores of AQLQ in the observation group were all higher than those in the control group(P<0.05).The serum level of RANTES in the observation group was significantly lower than that in the control group(P<0.05).The frequency of acute attacks in the observation group was significantly lower than that in the control group and the ACT scores of the former were significantly higher than those of the latter(P<0.05).Conclusion Bronchial thermoplasty could achieve short term satisfactory therapeutic results in treatment of refractory asthma,enhance control of asthma,improve respiratory function and quality of life,alleviate inflammatory response and reduce the number of acute attacks.No serious complications were seen after surgery.For this reason,it is worth further clinical attention.

关 键 词：难治性支气管哮喘 支气管热成形术 哮喘控制水平 生活质量 安全性 

分 类 号：R562[医药卫生—呼吸系统]