摘要
目的:探讨硫酸特布他林雾化液、布地奈德混悬液联合多索茶碱注射液对咳嗽变异性哮喘患儿血清嗜酸性粒细胞计数(EOS)、嗜酸细胞阳离子蛋白(ECP)、免疫球蛋白E(IgE)、白细胞介素4(IL-4)水平的影响。方法:选取2017年1月~2019年10月本院收治的160例咳嗽变异性哮喘患儿作为研究对象,按照随机数字表法分为A组、B组、C组和D组,每组40例。D组常规进行抗感染、缓解电解质紊乱、祛痰等干预治疗,并采用布地奈德混悬液1 mg经4 ml 0.9%氯化钠注射液稀释后雾化吸入,轻中度患儿bid,重度患儿q6h;A组在D组基础上雾化吸入时加用硫酸特布他林雾化液5 mg,bid;B组在D组基础上加用多索茶碱注射液300 mg静脉滴注,qd;C组在D组基础上加用硫酸特布他林雾化液吸入和多索茶碱注射液静脉滴注。2周为1个疗程,4组患儿均治疗1个疗程后进行疗效评价。检测比较4组治疗前和治疗后血清EOS、ECP、IgE、IL-4水平变化,同期检测比较4组肺功能指标第1秒用力呼气容积占预计值百分比(FEV 1%)、用力肺活量占预计值百分比(FVC%)。统计比较4组咳嗽消失时间、喘息消失时间、胸闷消失时间、呼吸困难消失时间以及治疗期间不良反应发生率。治疗后患儿均随访至少6个月,统计比较4组随访期间疾病复发状况。结果:A组、B组和C组治疗总有效率均高于D组,治疗后血清EOS、ECP、IgE、IL-4水平均低于D组,治疗后FEV 1%、FVC%肺功能指标水平均高于D组,咳嗽消失时间、喘息消失时间、胸闷消失时间、呼吸困难消失时间均短于D组,复发率低于D组(P<0.05)。A组和B组治疗总有效率均低于C组,治疗后血清EOS、ECP、IgE、IL-4水平均高于C组,治疗后FEV 1%、FVC%肺功能指标水平均低于C组,咳嗽消失时间、喘息消失时间、胸闷消失时间、呼吸困难消失时间均长于C组,复发率高于C组(P<0.05)。A组和B组疗效、血清EOS、ECP、IgE、IL-4水平、肺功能、临床症状消失时间以及复发率均无统计学差异(P>0.05)。与同组治疗前比较,4组治疗后的血清EOS、ECP、IgE、IL-4水平均降低,而治疗后FEV 1%、FVC%肺功能指标水平均升高(P<0.05)。4组胃肠道不适、皮疹等不良反应发生率无统计学差异(P>0.05)。结论:硫酸特布他林雾化液、布地奈德混悬液联合多索茶碱注射液治疗咳嗽变异性哮喘患儿疗效良好,可有效提高患儿肺功能,缓解临床症状,降低血清EOS、ECP、IgE、IL-4水平,且安全可靠。
Objective:To investigate the effect of terbutaline sulfate solution for nebulization,budesonide suspension and doxofylline injection on serum eosinophil count(EOS),eosinophil cationic protein(ECP),immunoglobulin E(IGE)and interleukin-4(IL-4)of children with variant asthma.Methods:160 cases of children with variant asthma admitted to the hospital from January 2017 to October 2019 were randomly divided into group A,group B,group C and group D,40 cases per group.Group D received routine intervention of antibiotic anti infection treatment,alleviating electrolyte disorder,expectoration,etc.and also budesonide suspension(1 mg),which was diluted with 4 ml 0.9%sodium chloride injection and then inhaled by atomization.Patients with mild and moderate diseases were treated by bid and those with severe diseases were treated by q6h.Based on Group D,group A added additional 5 mg terbutaline sulfate(bid)when inhaled by atomization;Group B added additional 300 mg doxofylline injection(iv,qd)on the basis of group D;Group C added 5 mg terbutaline sulfate(bid)when inhaled by atomization and 300 mg doxofylline injection(qd)on the basis of group D.Two weeks account for one course of treatment.All four groups of children were treated for one course of treatment and had treatment efficacy evaluation.The serum EOS,ECP,IgE and IL-4 levels before and after treatment in the four groups were detected and compared.The pulmonary function indexes such as forced expiratory volume in the first second as a percentage of the predicted value(FEV 1%)and forced vital capacity as a percentage of the predicted value(FVC%)before and after treatment in the four groups were detected and compared.The disappearance time of cough,wheezing,chest distress,dyspnea and the rate of adverse reactions among the four groups were compared.After treatment,the patients were followed up for at least 6 months,and the recurrence rate were compared.Results:Compared with those of group D,the total effective rate of treatment in group A,group B and group C were higher,levels of serum EOS,ECP,IgE and IL-4 after treatment in group A,group B and group C were lower,the levels of FEV 1%,FVC%and other lung function indexes after treatment in group A,group B and group C were higher,the disappearance time of cough,wheezing,chest tightness and dyspnea in group A,group B and group C were shorter,and the recurrence rate in group A,group B and group C were lower(P<0.05).Compared with those of group C,the total effective rate of treatment in group A and group B were lower,the levels of serum EOS,ECP,IgE and IL-4 after treatment in group A and group B were higher,the levels of pulmonary function indexes such as FEV 1%,FVC%after treatment in group A and group B were lower,the disappearance time of cough,wheezing,chest distress and dyspnea in group A and group B were longer,and the recurrence rate in group A and group B were higher(P<0.05).There was no significant difference in therapeutic effect,serum EOS,ECP,IgE,IL-4 level,pulmonary function index,clinical symptom disappearance time and recurrence rate between group A and group B(P>0.05).Compared with before treatment,the serum EOS,ECP,IgE,IL-4 levels after treatment of the four groups decreased,and the levels of lung function indexes such as FEV 1%,FVC%after treatment of the four groups increased(P<0.05).The rate of gastrointestinal discomfort,rash and other adverse reactions in the four groups had no significant difference(P>0.05).Conclusion:The combination of terbutaline sulfate solution for nebulization,budesonide suspension and doxofylline injection shows good effects in the treatment of children with variant asthma,which can effectively improve the lung function,relieve the clinical symptoms,reduce the levels of EOS,ECP,IgE and IL-4,and is safe.
作者
李红军
胡东阳
张谦
LI Hong-jun;HU Dong-yang;ZHANG Qian(Department of Pediatrics,Xuchang Central Hospital,Xuchang 461000,China)
出处
《中国合理用药探索》
CAS
2020年第9期65-70,共6页
Chinese Journal of Rational Drug Use
基金
河南省科技攻关项目(1920014A)。
