摘要
目的监测支气管哮喘(简称哮喘)患者联合治疗过程中症状积分、气道反应性[(以比气道传导率下降35%的乙酰甲胆碱浓度(PC_(35)sGaw)为代表)]、第一秒用力呼气容积占预计值百分比(FEV_1占预计值%)和呼气峰流量占预计值百分比(PEF%)的动态变化,探讨上述指标对评估病情、调整治疗方案的指导意义。方法将65例轻至中度慢性持续期哮喘患者分为 A(22例)、B(22例)、C(21例)3组。初始治疗均为吸入糖皮质激素(ICS)+长效β_2受体激动剂(LABA)联合治疗[即沙美特罗/氟替卡松50μg/250μg、50μg/100μg]。A 组维持固定剂量不变,B 组根据哮喘症状积分和肺功能进行降级或停药,C 组根据症状积分、肺功能结合气道反应性进行降级或停药。定期随访18个月,记录哮喘症状积分,测定 FEV_1占预计值%、PEF%和 PC_(35)sGaw。比较3种疗法的哮喘控制率。结果 65例轻至中度哮喘患者中有46例按研究方案完成治疗和随访,其中 A、B、C 组分别为15、15、16例。哮喘患者症状积分、FEV_1占预计值%和 PEF%在治疗后1～3个月内明显改善,与治疗前比较差异有统计学意义(t 值分别为9.54、13.17、14.27、12.4、6.72、6.59、8.31、5.22、5.96,P 均<0.01)。继续治疗期间大多数患者症状积分、FEV_1占预计值%和 PEF%维持在一相对稳定水平,持续性改善不明显,但 B 组部分患者症状控制不良,肺功能指标有所下降。气道反应性在治疗1～3个月内迅速降低(A、B、C 组的 t 值分别为9.71、12.04、14.31,P 均<0.01),随后缓慢降低,治疗9个月后维持在较低水平。4例患者气道反应性阴转,其中1例在停药后又转为轻度阳性。疗程结束时 A 组哮喘控制率为93.3%。B 组有86.7%的患者降级治疗,40%停药,但有40%需要复治或重新升级治疗。疗程结束时 B 组哮喘控制率为53.3%,与 A 组比较差异有统计学意义(X^2=10.35,P<0.01)。C 组降级和停药的比例(62.5%、25%)低于 B 组,时间也晚于 B 组,但仅有1例需要复治,临床结束时哮喘控制率为93.8%(与 A 组相似),与 B 组比较差异有统计学意义(X^2=10.35,P<0.01)。结论(1)ICS 联合 LABA 治疗能够迅速控制哮喘患者症状,改善肺功能,降低气道反应性;(2)根据哮喘临床控制水平调整治疗方案可能导致降级和停药过早,哮喘易于复发;(3)PC_(35)sGaw 是反映哮喘气道炎症较为敏感的指标,可作为评价疗效、指导治疗方案调整的指标之一。
Objective To monitor the changes of symptom scores, airway hyperreponsiveness （AHR, represented by PC35 sGaw）, FEV1% and PEF% in patients with mild and moderate persistent asthma who received combined therapy of inhaled corticosteroids（ICS） and long-acting 62 agonists （LABA） and to evaluate the clinical significance of PC35 sGaw and other parameters in guiding the adjustment of asthma stepwise therapy. Methods Patients with asthma were allocated randomly to group A （22 subjects） , B （22 subjects） , and C （21 subjects）. The initial regimens for all patients in the first three months included ICS （fluticasone） plus LABA （salmeterol）. For patients in group A, a fixed dosage was maintained for 18 months, while those in group B received tailored dosage or withdrawal of therapy according to the clinical control level （well or total control）. The regimens for patients in group C included step-down or withdrawal according to PC35 sGaw besides the clinical control. All subjects were followed-up for 18 months and the symptom scores, PC35 sGaw, FEV1% and PEF% were measured and analyzed. The asthma clinical control levels of the three groups at end point were compared. Results A total of 65 subjects were enrolled and 46 completed the study. From the first to the third month after treatment, the symptom scores, FEV1% and PEF% improved significantly （t =9.54, 13.17, 14.27, 12.4, 6.72, 6.59, 8.31,5.22, and 5.96, respectively, all P 〈0. 01 ）, and then maintained at relatively normal levels in a narrow range without significant progressive improvement during the later phases of the study. Meanwhile AHR declined abruptly in the first three months （ t = 9. 71, 12. 04, and 14. 31 in group A, B, C, respectively, all P 〈 0. 01 ）, followed by a slow but continuous improvement from the third to ninth month, and then maintained at a very low level. AHR disappeared in 4 cases but relapsed in 1 case after therapy withdrawal. The asthma clinical control level at the end point of group A, group B and group C were 93. 3% , 53. 3% and 93.8% , respectively （ group A and group C versus group B, P 〈 0. 01, respectively; group A versus group C, P 〉 0. 05 ）. There were fewer patients who underwent step-down therapy or withdrawal in group C compared to group B. However, patients in group C gained better asthma control and experienced less exacerbations compared to those in group B. Conclusions （1）Combined therapy with ICS plus LABA significantly improves symptoms, lung function and AHR of asthmatic patients. （2） Adjustment of therapy based only on clinical parameters may lead to early step-down or withdrawal and therefore asthma exacerbations. （3）PC35 sGaw, an index of AHR, may be valuable in assessing asthma severity, evaluating the efficacy of treatment and guiding medication adjustment.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2007年第7期498-503,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
哮喘
治疗
呼吸功能试验
Asthma
Therapy
Respiratory function tests
