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不同治疗方案对学龄期中度持续性支气管哮喘患儿的临床疗效对比
顾丽英, 唐华, 陈洁, 符佩华
上海市浦东新区周浦医院药剂科
摘要:
目的探讨不同治疗方案对学龄期中度持续性支气管哮喘患儿的临床疗效。方法将108例学龄期中度持续性哮喘患儿按照外周血嗜酸性粒细胞计数(EOS)和百分比是否正常分为EOS增多组63例和EOS正常组45例,再将两组患儿按照治疗方案的差异分为糖皮质激素(ICS)+β2受体激动剂(LABA)和ICS+白三烯受体拮抗剂(LTRA)亚组。ICS+LABA亚组使用沙美特罗替卡松气雾剂,应用带口含器的储物罐吸入,每次1吸,2次/d。ICS+LTRA亚组使用丙酸氟替卡松吸入气雾剂,应用带口含器的储物罐吸入,每次1吸,2次/d,并嚼服孟鲁司特钠咀嚼片5mg/次,1次/d。比较两组患儿应用不同方案治疗前和治疗12周后日间哮喘评分、夜间哮喘评分、儿童哮喘测试(C-ACT)评分、血清半胱氨酸白三烯(CysLTs)、IL-5水平、肺功能指标的变化。结果两组患儿无论用何种方案,治疗后日间哮喘评分、夜间哮喘评分、C-ACT评分、血清CysLTs、IL-5水平和肺功能指标均较治疗前显著改善(均P<0.05)。EOS增多组中ICS+LTRA亚组夜间哮喘评分、C-ACT评分、血清CysLTs、IL-5水平、用力肺活量、第1秒用力呼气容积的改善幅度显著大于ICS+LABA亚组(均P<0.05)。EOS正常组中两亚组上述各指标的改善幅度比较差异均无统计学意义(均P>0.05)。结论对于外周血EOS增多的哮喘患儿,ICS+LTRA方案较ICS+LABA方案更有利于哮喘的控制;对于外周血EOS正常的患儿,两种治疗方案均可应用。
关键词:  哮喘 学龄期儿童 糖皮质激素 β2 受体激动剂 白三烯受体拮抗剂
DOI:10.12056/j.issn.1006-2785.2018.40.2.2017-999
分类号:
基金项目:
Comparison of clinical efficacy of different treatment regimens for school-age children with moderate persistent asthma
Zhoupu Hospital of Shanghai Pudong New District
Abstract:
Objective To compare the clinical efficacy of different treatment regimens for moderate persistent bronchial asthma in school-age children. Methods One hundred and eight school-age children with moderate persistent asthma were divided into EOS increased group(n=63) and EOS normal group(n=45) according to the peripheral blood eosinophil (EOS) count. The patients were treated with ICS+LABA or ICS + LTRA. After 12 weeks of treatment, the daytime asthma score, nocturnal asthma score, C-ACT score, pulmonary function, serum cysteinyl leukotrienes(CysLTs) and interleukin -5 (IL-5) levels were compared before and after treatment. Results The daytime asthma score, nocturnal asthma score, C-ACT score, lung function and serum CysLTs and IL-5 levels were significantly improved in both groups after treatment (all P<0.05). For EOS increased group the nocturnal asthma score, C-ACT score, forced vital capacity (FVC), forced expiratory volume (FEV1), serum CysLTs and IL-5 levels in ICS+LTRA subgroup were significantly higher than those in ICS + LABA subgroup(all P<0.05). There were no significant differences in the improvement of the above indexes in the two subgroups of EOS normal group (all P > 0.05). Conclusion For asthma children with increased EOS in the peripheral blood, the ICS+LTRA regimen is more effective than the ICS+LABA regimen in asthma control; while for those with peripheral blood EOS normal, both treatment options can be applied.
Key words:  Asthma School-age children Glucocorticoid Beta 2 receptor agonist Leukotriene