盐酸非索非那定片联合布地奈德鼻喷雾剂治疗变应性鼻炎的疗效
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摘要
目的探讨盐酸非索非那定片联合布地奈德鼻喷雾剂治疗变应性鼻炎(AR)的疗效。方法选择2012年4月至2015年10月在解放军第一八○医院就诊的82例AR患者作为研究对象,按照随机数字法分为对照组和观察组,各41例。对照组给予布地奈德鼻喷雾剂治疗(64μg/次喷鼻、早晚各1次,持续治疗2周),观察组给予盐酸非索非那定片联合布地奈德鼻喷雾剂治疗(盐酸非索非那定片60 mg/次、早晚各1次,布地奈德鼻喷雾剂用法用量同对照组,持续治疗2周)。治疗后,比较两组患者的临床症状评分、嗜酸粒细胞数目及辅助性T细胞(Th)1、Th2细胞因子水平。结果治疗后,两组患者的鼻塞、鼻痒、流涕、喷嚏评分均显著低于治疗前(P<0.01);且观察组低于对照组[(0.68±0.09)分比(1.05±0.15)分、(0.52±0.08)分比(0.89±0.12)分、(0.33±0.06)分比(0.72±0.09)分、(0.51±0.08)分比(1.14±0.18)分](P<0.05)。治疗后,两组患者鼻灌洗液及诱导痰中嗜酸粒细胞数量均显著低于治疗前;且观察组低于对照组[(7.84±0.92)个/高倍镜视野(HP)比(13.31±1.87)个/HP、(4.27±0.66)个/HP比(10.38±1.43)个/HP](P<0.05)。治疗后,两组患者血清的白细胞介素(IL)4、IL-6、IL-10水平均显著低于治疗前,α干扰素(IFN-α)水平显著高于治疗前;且观察组的IL-4、IL-6、IL-10水平低于对照组[(1.49±0.22)mg/L比(2.32±0.42)mg/L、(7.49±1.03)mg/L比(11.32±1.86)mg/L、(2.94±0.36)mg/L比(4.42±0.68)mg/L],IFN-α水平高于对照组[(357.39±51.38)μg/L比(232.25±35.56)μg/L](P<0.05)。结论盐酸非索非那定片联合布地奈德鼻喷雾剂治疗能够改善患者的临床症状、减少嗜酸粒细胞浸润、纠正Th1/Th2的比例失衡,是治疗AR的理想方案。
Objective To study the effect of fexofenadine hydrochloride tablets combined with budesonide nasal spray on eosinophils and T cell subsets function of allergic rhinitis( AR). Methods A total of 82 AR patients in PLA 180 th Hospital for treatment during Apr. 2012 and Oct. 2015 were divided into an observation group and a control group according to the random number method,41 cases each. Patients in the control group were treated with budesonide nasal spray treatment(64 μg/time,q12 h,lasted for two weeks) and those in the observation group were treated with fexofenadine hydrochloride tablets combined with budesonide nasal spray treatment( fexofenadine hydrochloride tablets 60 mg/time,q12 h,budesonide nasal spray usage and dosage was same as the control group,both lasted for 2 weeks). The clinical symptoms scores,eosinophils contents,Th1 and Th2 cytokines contents of the two groups were compared. Results After treatment,the nasal congestion,runny nose,nasal itching,sneezing scores in both groups were significantly lower than those before treatment( P < 0. 01),and scores in the observation group were lower than those in the control group[(0. 68 ± 0. 09) score vs(1. 05 ± 0. 15) score,(0. 52 ± 0. 08) score vs(0. 89 ± 0. 12) score,(0. 33 ± 0. 06) score vs(0. 72 ± 0. 09) score,(0. 51 ± 0. 08) score vs(1. 14 ± 0. 18) score](P < 0. 05). After treatment,the number of eosinophils in nasal lavage fluid and inducedsputum in the two groups were significantly lower than those before treatment,and those in the observation group were lower than those in the control group[(7. 84 ± 0. 92) count/high power field( HP) vs(13. 31 ± 1. 87) count/HP,(4. 27 ± 0. 66) count/HP vs(10. 38 ± 1. 43) count/HP]( P < 0. 05). After treatment,serum contents of interleukin(IL)-4,IL-6,IL-10 in the two groups were lower than those before treatment,interferon(IFN)-α was higher than that before treatment,and contents of IL-4,IL-6,IL-10 in the observation group were lower than those in the control group[(1. 49 ±0. 22) mg/L vs(2. 32 ± 0. 42) mg/L,(7. 49 ± 1. 03) mg/L vs(11. 32 ± 1. 86) mg/L,(2. 94 ± 0. 36) mg/L vs(4. 42 ±0. 68) mg/L]( P < 0. 05),content of IFN-α in the observation group was higher than that in the control group[(357. 39 ±51. 38) μg/L vs(232. 25 ± 35. 56) μg/L]( P < 0. 05). Conclusion Fexofenadine hydrochloride tablets combined with budesonide nasal spray treatment can improve patient's clinical symptoms,eosinophils infiltration,correct imbalanceof Th1/Th2,thus is an ideal strategy in the treatment of AR.
Objective To study the effect of fexofenadine hydrochloride tablets combined with budesonide nasal spray on eosinophils and T cell subsets function of allergic rhinitis( AR). Methods A total of 82 AR patients in PLA 180 th Hospital for treatment during Apr. 2012 and Oct. 2015 were divided into an observation group and a control group according to the random number method,41 cases each. Patients in the control group were treated with budesonide nasal spray treatment(64 μg/time,q12 h,lasted for two weeks) and those in the observation group were treated with fexofenadine hydrochloride tablets combined with budesonide nasal spray treatment( fexofenadine hydrochloride tablets 60 mg/time,q12 h,budesonide nasal spray usage and dosage was same as the control group,both lasted for 2 weeks). The clinical symptoms scores,eosinophils contents,Th1 and Th2 cytokines contents of the two groups were compared. Results After treatment,the nasal congestion,runny nose,nasal itching,sneezing scores in both groups were significantly lower than those before treatment( P < 0. 01),and scores in the observation group were lower than those in the control group[(0. 68 ± 0. 09) score vs(1. 05 ± 0. 15) score,(0. 52 ± 0. 08) score vs(0. 89 ± 0. 12) score,(0. 33 ± 0. 06) score vs(0. 72 ± 0. 09) score,(0. 51 ± 0. 08) score vs(1. 14 ± 0. 18) score](P < 0. 05). After treatment,the number of eosinophils in nasal lavage fluid and inducedsputum in the two groups were significantly lower than those before treatment,and those in the observation group were lower than those in the control group[(7. 84 ± 0. 92) count/high power field( HP) vs(13. 31 ± 1. 87) count/HP,(4. 27 ± 0. 66) count/HP vs(10. 38 ± 1. 43) count/HP]( P < 0. 05). After treatment,serum contents of interleukin(IL)-4,IL-6,IL-10 in the two groups were lower than those before treatment,interferon(IFN)-α was higher than that before treatment,and contents of IL-4,IL-6,IL-10 in the observation group were lower than those in the control group[(1. 49 ±0. 22) mg/L vs(2. 32 ± 0. 42) mg/L,(7. 49 ± 1. 03) mg/L vs(11. 32 ± 1. 86) mg/L,(2. 94 ± 0. 36) mg/L vs(4. 42 ±0. 68) mg/L]( P < 0. 05),content of IFN-α in the observation group was higher than that in the control group[(357. 39 ±51. 38) μg/L vs(232. 25 ± 35. 56) μg/L]( P < 0. 05). Conclusion Fexofenadine hydrochloride tablets combined with budesonide nasal spray treatment can improve patient's clinical symptoms,eosinophils infiltration,correct imbalanceof Th1/Th2,thus is an ideal strategy in the treatment of AR.
引文
[1]王燕楠,僧东杰,韩富根.儿童变应性鼻炎与哮喘的相关性及发展趋势[J].世界最新医学信息文摘,2015,15(75):92.
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[7]胡永成.孟鲁司特钠联合布地奈德鼻喷剂治疗变应性鼻炎的疗效及对患者血清炎性因子的影响[J].北方药学,2015,12(2):45.
[8]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南(2015年,天津)[J].中华耳鼻咽喉头颈外科杂志,2016,51(1):6-24.
[9]燕志强,张俊,李得本,等.变应性鼻炎患者鼻黏膜中组胺H4受体的差异性表达[J].临床耳鼻咽喉头颈外科杂志,2010,24(20):928-930.
[10]张卫东,李晓丽,王艳丽.盐酸非索非那定片联合布地奈德鼻喷雾剂治疗变应性鼻炎临床观察[J].中国现代医学杂志,2015,25(12):84-86.
[11]李林格,冯娟,胡斌,等.实验变应性鼻炎模型小鼠构建以及与Th1/Th2失衡的相关性[J].中国组织工程研究,2015,19(40):6515-6519.
[12]黄敏,邓小梅.嗜酸性粒细胞对过敏性鼻炎的检测价值[J].保健医学研究与实践,2014,11(3):29-31.
[13]徐丽,关兵,张俊中,等.变应性鼻炎患者组织及血液中的白介素-25表达和意义[J].实用临床医药杂志,2015,19(21):202-203.
[14]徐丽,张俊中,关兵,等.IL-25和嗜酸粒细胞在变应性鼻炎及鼻息肉组织中的表达及意义[J].临床耳鼻咽喉头颈外科杂志,2014,28(18):1403-1406.
[15]Nishimura T,Kaminuma O,Saeki M,et al.Essential contribution of CD+4T cells to antigen-induced nasal hyperresponsiveness in experimental allergic rhinitis[J].PLo S One,2016,11(1):e0146686.
[16]Rolland JM,Prickett S,Gardner LM,et al.T cell targeted strategies for improved efficacy and safety of specific immunotherapy for allergic disease[J].Antiinflamm Antiallergy Agents Med Chem,2013,12(3):201-222.
[17]林瀚青,张涛.白细胞介素13/STAT6信号转导通路在变应性鼻炎中的作用[J].国际耳鼻咽喉头颈外科杂志,2017,41(2):63-65.
[18]张仲林,钟玲,袁明勇,等.Th1/Th2/Th17/Treg细胞因子在变应性鼻炎发病中的免疫机制研究[J].医学综述,2014,20(16):2906-2909.
[19]唱得龙,贾建平,张伟,等.T细胞亚群及相关细胞因子在变应性鼻炎患者外周血中的表达及意义[J].中国眼耳鼻喉科杂志,2016,16(5):319-321.
[20]武大伟,宋倩,王建亭.Th17/Treg细胞失衡在嗜酸粒细胞性慢性鼻-鼻窦炎伴鼻息肉黏膜重塑中的作用[J].临床耳鼻咽喉头颈外科杂志,2014,28(20):1628-1632.
[2]田春会.变应性鼻炎发病机制研究进展[J].医学理论与实践,2016,29(10):1292-1293.
[3]邱宝珊,王士贞,梁晓阳,等.肾阳虚型变应性鼻炎动物模型的建立[J].中国中西医结合耳鼻咽喉科杂志,2002,10(1):16-19.
[4]张茜.通窍鼻炎颗粒联合孟鲁司特钠、布地奈德治疗变应性鼻炎临床疗效及对炎性因子的影响[J].海南医学院学报,2016,22(11):1170-1172.
[5]徐晓丽.布地奈德鼻喷雾剂与西替利嗪片联合应用治疗变应性鼻炎的临床研究[J].中国现代药物应用,2016,10(16):151-152.
[6]闫燕,李鹏,刘丹丹.孟鲁司特钠、布地奈德鼻喷剂、枸地氯雷他定联合治疗变应性鼻炎的疗效及对炎性因子的影响[J].中国药师,2016,19(10):1900-1901,1921.
[7]胡永成.孟鲁司特钠联合布地奈德鼻喷剂治疗变应性鼻炎的疗效及对患者血清炎性因子的影响[J].北方药学,2015,12(2):45.
[8]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南(2015年,天津)[J].中华耳鼻咽喉头颈外科杂志,2016,51(1):6-24.
[9]燕志强,张俊,李得本,等.变应性鼻炎患者鼻黏膜中组胺H4受体的差异性表达[J].临床耳鼻咽喉头颈外科杂志,2010,24(20):928-930.
[10]张卫东,李晓丽,王艳丽.盐酸非索非那定片联合布地奈德鼻喷雾剂治疗变应性鼻炎临床观察[J].中国现代医学杂志,2015,25(12):84-86.
[11]李林格,冯娟,胡斌,等.实验变应性鼻炎模型小鼠构建以及与Th1/Th2失衡的相关性[J].中国组织工程研究,2015,19(40):6515-6519.
[12]黄敏,邓小梅.嗜酸性粒细胞对过敏性鼻炎的检测价值[J].保健医学研究与实践,2014,11(3):29-31.
[13]徐丽,关兵,张俊中,等.变应性鼻炎患者组织及血液中的白介素-25表达和意义[J].实用临床医药杂志,2015,19(21):202-203.
[14]徐丽,张俊中,关兵,等.IL-25和嗜酸粒细胞在变应性鼻炎及鼻息肉组织中的表达及意义[J].临床耳鼻咽喉头颈外科杂志,2014,28(18):1403-1406.
[15]Nishimura T,Kaminuma O,Saeki M,et al.Essential contribution of CD+4T cells to antigen-induced nasal hyperresponsiveness in experimental allergic rhinitis[J].PLo S One,2016,11(1):e0146686.
[16]Rolland JM,Prickett S,Gardner LM,et al.T cell targeted strategies for improved efficacy and safety of specific immunotherapy for allergic disease[J].Antiinflamm Antiallergy Agents Med Chem,2013,12(3):201-222.
[17]林瀚青,张涛.白细胞介素13/STAT6信号转导通路在变应性鼻炎中的作用[J].国际耳鼻咽喉头颈外科杂志,2017,41(2):63-65.
[18]张仲林,钟玲,袁明勇,等.Th1/Th2/Th17/Treg细胞因子在变应性鼻炎发病中的免疫机制研究[J].医学综述,2014,20(16):2906-2909.
[19]唱得龙,贾建平,张伟,等.T细胞亚群及相关细胞因子在变应性鼻炎患者外周血中的表达及意义[J].中国眼耳鼻喉科杂志,2016,16(5):319-321.
[20]武大伟,宋倩,王建亭.Th17/Treg细胞失衡在嗜酸粒细胞性慢性鼻-鼻窦炎伴鼻息肉黏膜重塑中的作用[J].临床耳鼻咽喉头颈外科杂志,2014,28(20):1628-1632.