高渗盐水雾化吸入治疗中重度毛细支气管炎36例疗效观察
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摘要
目的观察高渗盐水雾化吸入治疗不同程度毛细支气管炎的临床效果,及通过测定外周血白介素-4(IL-4)、γ-干扰素(IFN-γ)、调节性T细胞(Treg)水平的变化,探讨高渗盐水治疗毛细支气管炎可能的免疫调节作用。方法选取2014年10月至2015年4月在安徽省立医院儿科住院诊断为毛细支气管炎患儿,根据毛细支气管炎危重度评分选取中度(A组)及重度(B组)各36例,同时选取健康体检婴幼儿12例(C组)作为健康组,A、B每组再按随机数字表分为三组,每组12例,分别给予高渗盐水(3%氯化钠)、布地奈德、异丙托溴铵雾化吸入治疗。治疗前及治疗后d4记录各患儿危重度评分,采血检测IL-4、IFN-γ、Treg,并与C组比较。结果 A组高渗盐水雾化吸入组治疗后d4患儿临床危重度评分为(3. 4±1. 4)分,较治疗前(6. 1±1. 1)分明显下降,与其余两组比较差异有统计学意义(P <0. 05);该组治疗后外周血IL-4水平为(18. 45±1. 84)μg/L、IFN-γ水平为(7. 65±0. 60) ng/L、Treg比例为(10. 00±0. 86)%较其余两组恢复更快(P <0. 05); B组患儿各指标在治疗后有改善,但三组组间比较差异无统计学意义(P> 0. 05)。结论高渗盐水雾化吸入治疗中度毛细支气管炎临床症状改善更加明显,外周血IL-4、IFN-γ、Treg恢复更快,提示高渗盐水雾化治疗效果优于布地奈德及异丙托溴铵,具有一定的免疫调节作用;高渗盐水雾化吸入治疗重度毛细支气管炎患儿,与布地奈德及异丙托溴铵相比无明显优势。
Objective To observe the effect of hypertonic saline inhalation therapy on children with moderate to severe bronchiolitis,and to elucidate the advantage of hypertonic saline inhalation in bronchiolitis and its potential immunomodulatory mechanism through testing the levels of IL-4,IFN-γ and percentage of regulatory T lymphocyte(Treg) in peripheral blood. Methods Children with bronchiolitis hospitalized in our department during Oct 2014 to April 2015 were selected. Based on clinical evaluation of bronchiolitis,patients were appointed to group A with moderate bronchiolitis and group B with severe bronchiolitis. There were 36 patients in each group,who were then divided randomly into 3 subgroups. Hypertonic saline(3% NaC l),budesonide,and ipratropium atomization inhalation therapy were given to each subgroup separately. The rate of respiration,and clinical manifestations of critical score,as well as the levels of IL-4,IFN-γ,Treg in blood were detected before and after treatment and campared with control group. Results On the fourth day after treatment,clinical evaluation of infants in the group treated with hypertonic saline inhalation were(3. 4 ± 1. 4) points,much lower than(6. 1 ± 1. 1) points before treatment. There were significant differences among the three subgroups(P < 0. 05). In addition,the level of IL-4 was(18. 45 ± 1. 84) μg/L,the level of IFN-γ was(7. 65 ± 0. 60) ng/L and the percentage of Treg was(10. 00 ±0. 86) %,which all became better after hypertonic saline inhalation. The same trend goes to patients in group B but without statistical differences in the subgroups(P > 0. 05). Conclusion Inhalation of hypertonic saline for treating infants with moderate bronchiolitis can improve clinical symptoms with the levels of IL-4,IFN-γ,and the percentage of Treg in peripheral blood lifted compared with budesonide and ipratropium bromide,suggesting that hypertonic saline may have potential immunomodulatory effects. However,it shows no advantage in treating severe bronchiolitis with hypertonic saline inhaled.
Objective To observe the effect of hypertonic saline inhalation therapy on children with moderate to severe bronchiolitis,and to elucidate the advantage of hypertonic saline inhalation in bronchiolitis and its potential immunomodulatory mechanism through testing the levels of IL-4,IFN-γ and percentage of regulatory T lymphocyte(Treg) in peripheral blood. Methods Children with bronchiolitis hospitalized in our department during Oct 2014 to April 2015 were selected. Based on clinical evaluation of bronchiolitis,patients were appointed to group A with moderate bronchiolitis and group B with severe bronchiolitis. There were 36 patients in each group,who were then divided randomly into 3 subgroups. Hypertonic saline(3% NaC l),budesonide,and ipratropium atomization inhalation therapy were given to each subgroup separately. The rate of respiration,and clinical manifestations of critical score,as well as the levels of IL-4,IFN-γ,Treg in blood were detected before and after treatment and campared with control group. Results On the fourth day after treatment,clinical evaluation of infants in the group treated with hypertonic saline inhalation were(3. 4 ± 1. 4) points,much lower than(6. 1 ± 1. 1) points before treatment. There were significant differences among the three subgroups(P < 0. 05). In addition,the level of IL-4 was(18. 45 ± 1. 84) μg/L,the level of IFN-γ was(7. 65 ± 0. 60) ng/L and the percentage of Treg was(10. 00 ±0. 86) %,which all became better after hypertonic saline inhalation. The same trend goes to patients in group B but without statistical differences in the subgroups(P > 0. 05). Conclusion Inhalation of hypertonic saline for treating infants with moderate bronchiolitis can improve clinical symptoms with the levels of IL-4,IFN-γ,and the percentage of Treg in peripheral blood lifted compared with budesonide and ipratropium bromide,suggesting that hypertonic saline may have potential immunomodulatory effects. However,it shows no advantage in treating severe bronchiolitis with hypertonic saline inhaled.
引文
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[10]刘梅梅,邓莉莉,刘剑锋,等.雾化吸入高张盐水对病毒相关性支气管炎患儿气道炎症细胞的影响[J].临床儿科杂志,20l0,28(9):849-851.
[11]ZHANG LJ,MENDOZA-SASSI RA,WAINWRIGHT C,et al.Nebulized hypertonic saline solution for acute bronchiolitis in infants[J].Cochrane Database Syst Rev,2008,8(4):CD006458.DOI:10.1002/14651858.CD006458.pub2.
[12]KHANAL A,SHARMA A,BASNET S,et al.Nebulised hypertonic saline(3%)among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial[J].BMC Pediatr,2015,136(15):115.
[13]FLORES P,MENDES AL,NETO AS.A randomized trial of nebulized 3%hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants[J].Pediatr Pulmonol,2016,51(4):418-425.
[14]RALSTON SL,LIEBERTHAL AS,MEISSNER HC,et al.Clinical practice guideline:the diagnosis,management,and prevention of bronchiolitis[J].Pediatrics,2014,134(5):e1474-e1502.DOI:10.1542/peds.2014-2742.
[15]佘巍巍,林武洲.重度哮喘缓解期患者吸入高渗盐水诱导痰的安全性和副反应评价[J].临床肺科杂志,2010,15(11):1595-1596.
[2]SARRELL EM,TAL G,WITZLING M,et al.Nebulized 3%hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms[J].Chest,2002,122(6):2015-2020.
[3]FERMANDES RM,BAILY LM,VANDERMEER B,et al.Glucocorticoids for acute viral bronchiolitis in infants and young children[J].Cochrane Database Syst Rev,2010,(10):CD004878.DOI:10.1002/14651858.CD004878.pub3.
[4]谢志超,张玉明,东莞市人民医院下呼吸道感染住院儿童呼吸道合胞病毒流行特点分析[J].安徽医药,2016,20(1):139-140.
[5]REEVES EP,WILLIALLISON M,O'NEM SJ,et a1.Nebulized hypertonic saline decreases IL-8 in sputum of patients wittI cystic fibrosis[J].Am J Respir Crit Care Med,201l,183(11):1517-1523.
[6]陈德晖,钟帼钰,罗炜,等.广州地区5~15岁健康儿童高渗盐水诱导痰细胞学检查及其分类正常参考值的初步建立[J].中华儿科杂志,2012,50(7):525-530.
[7]WALSH P,BEHRENS N,CARVALLO CFR,et al.A Randomized Placebo Controlled Trial of Ibuprofen for Respiratory Syncytial Virus Infection in a Bovine Model[J].PLo S One,2016,11(4):e0152913.DOI:10.1371/journal.pone.0152913.
[8]CHRISTIAANSEN AF,SYED MA,TEN EYCK PP,et al.Altered Treg and cytokine responses in RSV-infected infants[J].Pediatr Res,2016,80(5):702-709.
[9]李宾,吴福玲,冯学斌,等.呼吸道合胞病毒毛细支气管炎患儿外周血CD4+CD25+调节性T细胞与Th17细胞功能变化及意义[J].细胞与分子免疫学杂志,2012,28(4):426-428.
[10]刘梅梅,邓莉莉,刘剑锋,等.雾化吸入高张盐水对病毒相关性支气管炎患儿气道炎症细胞的影响[J].临床儿科杂志,20l0,28(9):849-851.
[11]ZHANG LJ,MENDOZA-SASSI RA,WAINWRIGHT C,et al.Nebulized hypertonic saline solution for acute bronchiolitis in infants[J].Cochrane Database Syst Rev,2008,8(4):CD006458.DOI:10.1002/14651858.CD006458.pub2.
[12]KHANAL A,SHARMA A,BASNET S,et al.Nebulised hypertonic saline(3%)among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial[J].BMC Pediatr,2015,136(15):115.
[13]FLORES P,MENDES AL,NETO AS.A randomized trial of nebulized 3%hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants[J].Pediatr Pulmonol,2016,51(4):418-425.
[14]RALSTON SL,LIEBERTHAL AS,MEISSNER HC,et al.Clinical practice guideline:the diagnosis,management,and prevention of bronchiolitis[J].Pediatrics,2014,134(5):e1474-e1502.DOI:10.1542/peds.2014-2742.
[15]佘巍巍,林武洲.重度哮喘缓解期患者吸入高渗盐水诱导痰的安全性和副反应评价[J].临床肺科杂志,2010,15(11):1595-1596.