规律使用吸入性糖皮质激素联合长效β受体激动剂的成人支气管哮喘控制现状及影响因素分析  

Control Status of Bronchial Asthma in Adults Regularly Treated with Inhaled Corticosteroids and Long-ActingβAgonist and Its Influencing Factors

作　　者：冯文玲 李静[2] 郦昱琨 颜明智 赵军[2] FENG Wenling;LI Jing;LI Yukun;YAN Mingzhi;ZHAO Jun(College of Pharmacy,Xinjiang Medical University,Urumqi,Xinjiang,China 830054;The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,China 830011)

机构地区：[1]新疆医科大学药学院,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院,新疆乌鲁木齐830011

出　　处：《中国药业》2023年第11期92-97,共6页China Pharmaceuticals

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题[SKL-HIDCA-2020-JZ3]。

摘　　要：目的为规律使用吸入性糖皮质激素(ICS)联合长效β受体激动剂(LABA)的成人支气管哮喘的临床药物治疗提供参考。方法选取新疆医科大学第一附属医院2021年1月至12月收治的规律使用ICS联合LABA的成人支气管哮喘患者226例,按哮喘控制测试(ACT)量表评分分为未控制组(≤19分,72例)和控制组(20~25分,154例)。查阅病历,回顾性收集患者的基本信息、服用哮喘药物前的合并症、合并用药及基础肺功能信息。检测哮喘相关基因的基因型,采用ACT量表评估患者用药3个月及以上的哮喘控制水平。通过单因素和Logistic回归分析影响哮喘控制水平的相关因素,分析基因多态性对哮喘控制的影响。结果单因素分析结果显示,年龄、吸烟史、非甾体抗炎药用药史、钙通道阻滞剂用药史、合并慢性阻塞性疾病、体质量指数(BMI)≥28 kg/m^(2)及基础肺功能第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值百分比(FEV_(1)%pred)、用力肺活量(FVC)、FEV_(1)占用力肺活量百分比(FEV_(1)/FVC)、最大呼气流量(PEF)与哮喘控制水平有关(P<0.05);多因素分析结果显示,吸烟史、BMI≥28 kg/m^(2)、非甾体抗炎药用药史、基础肺功能PEF是影响哮喘控制水平的独立危险因素(P<0.05)。72例成人哮喘患者基因型频率研究结果显示,糖皮质激素诱导转录蛋白1(CRHR1)基因rs242941位点基因多态性与哮喘控制有关。结论影响规律使用ICS联合LABA的成人哮喘控制水平的因素包括吸烟、BMI≥28 kg/m^(2)、基础肺功能、用药史、基因多态性,可根据相关影响因素制订个体化的干预措施,以改善支气管哮喘控制水平。Objective To provide a reference for the clinical medication for adults with bronchial asthma regularly treated with inhaled glucocorticoids(ICS)combined with long-actingβagonist(LABA).Methods A total of 226 adults with bronchial asthma regularly treated with ICS combined with LABA from January to December 2021 in the First Affiliated Hospital of Xinjiang Medical University in the Xinjiang Uygur Autonomous Region were selected and divided into the uncontrolled group(≤19 points,72 cases)and the control group(20-25 points,154 cases)according to the asthma control test(ACT)scale.The patients'basic information,comorbidities before taking asthma medication,combined medication and baseline pulmonary function information were retrospectively collected by reviewing medical records,the genotype of asthma-related genes was tested,and the ACT scale was used to evaluate the asthma control level of patients who had been taking medication for three months or more.The relevant factors affecting asthma control levels were analyzed through the univariate analysis and Logistic regression analysis,and the influence of gene polymorphism on asthma control was analyzed.Results The results of univariate analysis showed that age,smoking history,medication history of non-steroidal anti-inflammatory drugs(NSAID),medication history of calcium channel blockers,combined chronic obstructive disease,body mass index(BMI)≥28 kg/m^(2),forced expiratory volume in the first second(FEV_(1))of baseline pulmonary function,FEV_(1)%pred,forced vital capacity(FVC),FEV_(1)%/FVC,the peak expiratory flow(PEF)were related to the asthma control level(P<0.05).The results of multivariate analysis showed that smoking history,BMI≥28 kg/m^(2),medication history of NSAID,and basic pulmonary function PEF were independent risk factors affecting asthma control level(P<0.05).The genotypic frequency of 72 adult with asthma showed that the genetic polymorphism at the corticotropin releasing hormone receptor 1(CRHR1)rs242941 was associated with asthma control.Concl

关 键 词：吸入性糖皮质激素 长效Β受体激动剂 支气管哮喘 控制水平 影响因素 基因多态性 

分 类 号：R969.4[医药卫生—药理学] R974.3[医药卫生—药学]