超细或细颗粒吸入糖皮质激素联合福莫特罗对支气管哮喘患者大小气道功能改善作用研究  

Effects of extrafine-particle versus fine-particle inhaled corticosteroids combined with formoterol on large and small airway function in patients with bronchial asthma

作　　者：徐孜翀 张旻 赵磊 殷东宁 包婺平 Xu Zichong;Zhang Min;Zhao Lei;Yin Dongning;Bao Wuping(Department of Respiratory and Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院呼吸与危重症医学科,上海200080

出　　处：《中国医师进修杂志》2023年第7期587-594,共8页Chinese Journal of Postgraduates of Medicine

基　　金：国家自然科学基金(81873402);上海市科委科创项目(20Y11902400);上海市第一人民医院特色人才培养计划-上海领军人才(02.06.01.21.13、02.06.01.21.56);上海市第一人民医院院级特色研究计划(CTCCR-2021B07、CTCCR-2019B02)。

摘　　要：目的:比较超细颗粒或细颗粒吸入糖皮质激素(ICS)联合福莫特罗对支气管哮喘(简称哮喘)患者临床症状、气道炎性反应和气道功能的改善作用。方法:采用前瞻性随机对照研究的方法,选取上海交通大学医学院附属第一人民医院2020年11月至2022年10月111例第1秒用力呼气容积(FEV_(1))占预计值百分比(FEV_(1)%pred)>70%的典型哮喘患者和咳嗽变异型哮喘患者。将患者按照随机数字表法分为观察组57例,采用超细颗粒ICS联合福莫特罗治疗;对照组54例,采用细颗粒ICS联合福莫特罗治疗,均治疗4周。治疗期间10例患者失访,最终完成随访101例,观察组52例,对照组49例。基线期采用哮喘控制测试(ACT)评分评估临床症状,呼出气一氧化氮(FeNO)评价气道炎性反应,行肺通气功能检测及支气管舒张试验。记录症状缓解时间。治疗后重新评估以上各指标。结果:两组治疗后FEV_(1)、呼气流量峰值(PEF)、用力呼出剩余50%肺活量时呼气流量(MEF_(50))、用力呼出剩余25%肺活量时呼气流量(MEF_(25))、最大呼气中段流量(MMEF)和ACT评分均较治疗前明显改善,差异有统计学意义(P<0.01)。观察组ACT改善值明显高于对照组[(5.90±2.25)分比(4.10±2.18)分],差异有统计学意义(P<0.01);两组症状改善时间和FEV_(1)、PEF、MEF_(50)、MEF_(25)、MMEF改善度比较差异无统计学意义(P>0.05)。存在小气道功能障碍78例,其中39例采用超细颗粒ICS联合福莫特罗治疗(观察亚组),39例采用细颗粒ICS联合福莫特罗治疗(对照亚组),观察亚组ACT改善值明显高于对照亚组[(6.05±2.22)分比(3.95±2.19)分],差异有统计学意义(P<0.01);两亚组症状改善时间和FEV_(1)、PEF、MEF_(50)、MEF_(25)、MMEF改善度比较差异无统计学意义(P>0.05)。Spearman相关分析结果显示,MEF_(50)改善度、MEF_(25)改善度和MMEF改善度与基线FEV_(1)舒张改善、FEV_(1)/FVC舒张改善、MEF_(50)舒张改善、MEF_(25)舒张改善、ObjectiveTo compare the effects of extrafine-particle versus fine-particle inhaled corticosteroids(ICS)combined with formoterol on clinical symptoms,airway inflammation and airway function in patients with bronchial asthma(referred to as asthma).MethodsThis prospective,randomized controlled clinical trial enrolled a total of 111 patients diagnose of asthma and cough variant asthma with forced expired volume in one second(FEV_(1))percentage of predicted(FEV_(1)%pred)>70%in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine from November 2020 to October 2022.The patients were divided into observation group(57 cases)and control group(54 cases)by random digits table method.The patients in observation group were treated with extrafine-particle ICS combined with formoterol,while the patients in control group were treated with fine-particle ICS combined with formoterol.Both groups were treated for 4 weeks.During treatment 10 patients lost follow up and a total of 101 patients complete the final study:52 cases in observation group and 49 cases in control group.At baseline,the asthma control test(ACT)score was calculated to evaluate the clinical symptoms,fractional exhaled nitric oxide(FeNO)was applied to evaluate the airway inflammatory level,and the pulmonary function test and bronchodilation test were perfromed.The symptom relief time was record.After treatment,all of the parameters were reevaluated.ResultsThe FEV_(1),peak expiratory flow(PEF),forced expired flow at 50%of forced vital capacity(MEF_(50)),forced expired flow at 25%of forced vital capacity(MEF_(25)),maximal expiratory flow-volume curve(MMEF)and ACT score after treatment in both groups were significantly improved compared to baseline,and there were statistical differences(P<0.01).The improvement of ACT score in observation group was significantly higher than that in control group:(5.90±2.25)scores vs.(4.10±2.18)scores,and there was statistical difference(P<0.01);there were no statistical differences in the symptom relief time and

关 键 词：哮喘 糖皮质激素类 吸入法 福莫特罗 

分 类 号：R562.25[医药卫生—呼吸系统]