不同药物联合治疗小儿喘息临床效果分析  

Analysis of clinical efficacy of different drugs combination in the treatment of wheezing in children

作　　者：杨东月 杨硕[1] 冯雪[1] 田淑娟[1] 党媛媛 吴雪静 陈静 YANG Dongyue;YANG Shuo;FENG Xue;TIAN Shujuan;DANG Yuanyuan;WU Xuejing;CHEN Jing(Department of Pediatrics,Tangshan Maternal and Child Health Hospital,Tangshan 063000,China)

机构地区：[1]唐山市妇幼保健院儿内科,河北唐山063000

出　　处：《长春中医药大学学报》2025年第2期204-209,共6页Journal of Changchun University of Chinese Medicine

基　　金：河北省2023年度医学科学研究课题计划(20231769)。

摘　　要：目的 探讨不同药物联合治疗小儿喘息的临床效果。方法 选取150例喘息患儿作为病例组,以随机数表法将其分为A组(注射用甲泼尼龙琥珀酸钠,n=30)、B组(吸入用布地奈德混悬液,n=30)、C组(注射用甲泼尼龙琥珀酸钠+吸入用布地奈德混悬液,n=30)、D组(吸入用布地奈德混悬液+盐酸左沙丁胺醇,n=30)、E组(注射用甲泼尼龙琥珀酸钠+吸入用布地奈德混悬液+盐酸左沙丁胺醇,n=30),5组均持续治疗1周,比较各组治疗1周后临床疗效,症状控制情况及住院时间,血清内皮素-1(ET-1)、瘦素(Leptin)、脂联素(APN)、25-羟维生素D_(3)[25-(OH)D_(3)]及治疗前和治疗1周后炎症指标水平。另选同期于本院进行体检的健康儿童作为正常组(n=30),对比病例组和正常组血清ET-1、Leptin、APN、25-(OH)D_(3)和炎症指标水平。结果 治疗1周后,E、D、C组总有效率分别为96.67%、96.67%、90.00%,高于B、A组的66.67%、66.67%;E、D组喘息缓解、哮鸣音消失、咳嗽消失及住院时间短于C、B、A组,C组短于B、A组;治疗前,病例组血清ET-1、Leptin、白细胞介素(IL)-4、IL-10水平高于正常组,血清APN、25-(OH)D_(3)、IL-12、IL-33、IL-37、γ-干扰素(IFN-γ)水平低于正常组;与治疗前比较,治疗1周后,A、B、C、D、E组血清ET-1、Leptin水平降低,E、D组低于C、B、A组,C组低于B、A组;血清APN、25-(OH)D_(3)、IL-33、IFN-γ水平升高,E、D组高于C、B、A组,C组高于B、A组;血清IL-10水平升高,但E、D组低于C、B、A组,C组低于B、A组;血清IL-4、IL-12、IL-37水平升高(P<0.05),但组间比较,差异无统计学意义(P>0.05)。结论 喘息患儿血管内皮功能异常和机体处于炎症亢进状态,布地奈德+左沙丁胺醇和甲泼尼龙+布地奈德+左沙丁胺醇治疗方案可提高喘息患儿临床疗效,其机制可能与下调血清ET-1、Leptin、IL-10水平,上调血清APN、25-(OH)D_(3)、IL-33、IFN-γ水平有关。临床也需根据喘息患儿具体情况选择合Objective To explore the clinical efficacy of different drug combination in the treatment of wheezing in children.Methods 150 children with wheezing were selected as the case group and randomly divided into Group A(injection of methylprednisolone sodium succinate,n=30),Group B(inhalation of budesonide suspension,n=30),Group C(injection of methylprednisolone sodium succinate+inhalation of budesonide suspension,n=30),Group D(inhalation of budesonide suspension+levsalbutamol hydrochloride,n=30),and Group E(injection of methylprednisolone sodium succinate+inhalation of budesonide suspension+levsalbutamol hydrochloride,n=30)according to random number table method.Five groups were treated continuously for 1 week.The therapeutic efficacy after 1 week of treatment,symptom control and time of hospitalization,serum levels of endothelin-1(ET1),Leptin,adiponectin(APN),25-hydroxyvitamin D3[25-(OH)D3],and inflammation indexes before treatment and after 1 week of treatment were compared among the groups.Another healthy children who underwent physical examination in our hospital during the same period were selected as the normal group(n=30).The levels of serum ET-1,Leptin,APN,25-(OH)D_(3),and inflammatory indexes were compared between the case group and the normal group.Results After 1 week of treatment,the total effective rates of Group E,Group D and Group C were 96.67%,96.67%and 90.00%,respectively,which were higher than those of the Group B(66.67%)and Group A(66.67%),respectively;The relief of wheezing,disappearance of cough,disappearance of wheezing sounds,disappearance of cough,and time of hospitalization of Group E and Group D were shorter than those of the Group C,Group B and Group A,and Group C was shorter than Group B and Group A.Before treatment,serum levels of ET-1,Leptin,interleukin(IL)-4 and IL-10 in the case group were higher than those in the normal group,and serum levels of APN,25-(OH)D_(3),IL-12,IL-33,and IL-37 and gamma-interferon(IFN-γ)were lower than those in the normal group.Compared with before treatment

关 键 词：喘息 布地奈德 甲泼尼龙 左沙丁胺醇 

分 类 号：R562.2[医药卫生—呼吸系统]