布地奈德对呼吸道合胞病毒感染相关喘息患儿血清炎性因子水平的影响
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摘要
目的探讨布地奈德对呼吸道合胞病毒(RSV)感染相关喘息患儿血清炎性因子水平的影响。方法选择2015年8月至2017年8月湖南中医药大学第一附属医院儿科收治的RSV感染相关喘息患儿98例,按照随机数字表法分为对照组与观察组,各49例。对照组患儿给予常规拍背吸痰、吸氧、补液、平喘、止咳联合抗病毒类药物治疗,观察组在对照组基础上联合布地奈德混悬液治疗。比较2组患儿治疗2周后的临床疗效;治疗前和治疗2周后检测2组患儿肺功能,记录潮气量、达峰容积比(VPTEF/VE)以及达峰时间比(t PTEF/t E);采用放射免疫吸附法检测血清白细胞介素4(IL-4)、IL-6、IL-10和C反应蛋白含量。结果治疗2周后,观察组临床总有效率显著高于对照组[95. 9%(47/49)比81. 6%(40/49)],差异有统计学意义(P <0. 05)。治疗前,2组患儿肺功能相关指标水平比较差异均无统计学意义(均P> 0. 05)。治疗后,2组患儿潮气量、VPTEF/VE以及t PTEF/t E均高于治疗前,且观察组高于对照组[(8. 7±2. 6) ml/kg比(7. 4±2. 1) ml/kg,(29±7)%比(24±6)%,(30±6)%比(23±4)%],差异均有统计学意义(均P <0. 05)。治疗前,2组患儿血清炎性因子水平比较差异均无统计学意义(均P> 0. 05)。治疗后,2组患儿血清IL-4、IL-6及C反应蛋白水平均低于治疗前,且观察组低于对照组[(7. 6±1. 4) ng/L比(12. 3±2. 4) ng/L,(15. 6±2. 4) ng/L比(21. 3±5. 4) ng/L,(6. 4±1. 1) mg/L比(9. 0±1. 2) mg/L]; IL-10水平均高于治疗前,且观察组高于对照组[(14. 0±3. 0) ng/L比(9. 4±1. 9) ng/L],差异均有统计学意义(均P <0. 05)。结论常规治疗联合布地奈德治疗RSV感染相关喘息效果显著,能够有效抑制气道炎症。
Objective To investigate the effect of budesonide on serum inflammatory factors in children with wheezing due to respiratory syncytial virus infection. Methods A total of 98 children with RSV infection-related wheezing admitted to the First Hospital of Hunan University of Chinese Medicine from August 2015 to August 2017 were enrolled. They were randomly divided into control group and observation group,with 49 cases in each group.The control group was treated with conventional back-sucking,oxygen-absorbing,rehydration,anti-asthmatic,anti-tussive and anti-viral drugs. The observation group was treated with budesonide suspension on the basis of control group. Clinical efficacy,lung function[tidal volume,peak volume ratio( VPTEF/VE),peak time ratio( t PTEF/t E) ],serum levels of interleukin-4( IL-4),IL-6,IL-10 and C-reactive protein( radioimmunosorbent assay) were analyzed. Results After 2 weeks of treatment,the total clinical effective rate in the observation group was significantly higher than that in the control group[95. 9%( 47/49) vs 81. 6%( 40/49) ]( P < 0. 05).Before treatment,there was no significant difference of lung function indexes between groups( P > 0. 05). After treatment,tidal volume,VPTEF/VE and t PTEF/t E significantly increased; the indexes in the observation group were significantly higher than those in the control group[( 8. 7 ± 2. 6) ml/kg vs( 7. 4 ± 2. 1) ml/kg,( 29 ± 7) % vs( 24 ± 6) %,( 30 ± 6) % vs( 23 ± 4) % ]( P < 0. 05). Before treatment,there was no significant difference of serum inflammatory factors between groups( P > 0. 05). After treatment,levels of serum IL-4,IL-6,C-reactive protein decreased and IL-10 level increased; IL-4,IL-6 and C-reactive protein in the observation group were significantly lower than those in the control group[( 7. 6 ± 1. 4) ng/L vs( 12. 3 ± 2. 4) ng/L,( 15. 6 ± 2. 4) ng/L vs( 21. 3 ± 5. 4) ng/L,( 6. 4 ± 1. 1) mg/L vs( 9. 0 ± 1. 2) mg/L]; IL-10 in the observation group was significantly higher than that in the control group[( 14. 0 ± 3. 0) ng/L vs( 9. 4 ± 1. 9) ng/L]( P < 0. 05). Conclusion Budesonide is effective in the treatment of RSV infection-related wheezing and it can significantly inhibit airway inflammation.
Objective To investigate the effect of budesonide on serum inflammatory factors in children with wheezing due to respiratory syncytial virus infection. Methods A total of 98 children with RSV infection-related wheezing admitted to the First Hospital of Hunan University of Chinese Medicine from August 2015 to August 2017 were enrolled. They were randomly divided into control group and observation group,with 49 cases in each group.The control group was treated with conventional back-sucking,oxygen-absorbing,rehydration,anti-asthmatic,anti-tussive and anti-viral drugs. The observation group was treated with budesonide suspension on the basis of control group. Clinical efficacy,lung function[tidal volume,peak volume ratio( VPTEF/VE),peak time ratio( t PTEF/t E) ],serum levels of interleukin-4( IL-4),IL-6,IL-10 and C-reactive protein( radioimmunosorbent assay) were analyzed. Results After 2 weeks of treatment,the total clinical effective rate in the observation group was significantly higher than that in the control group[95. 9%( 47/49) vs 81. 6%( 40/49) ]( P < 0. 05).Before treatment,there was no significant difference of lung function indexes between groups( P > 0. 05). After treatment,tidal volume,VPTEF/VE and t PTEF/t E significantly increased; the indexes in the observation group were significantly higher than those in the control group[( 8. 7 ± 2. 6) ml/kg vs( 7. 4 ± 2. 1) ml/kg,( 29 ± 7) % vs( 24 ± 6) %,( 30 ± 6) % vs( 23 ± 4) % ]( P < 0. 05). Before treatment,there was no significant difference of serum inflammatory factors between groups( P > 0. 05). After treatment,levels of serum IL-4,IL-6,C-reactive protein decreased and IL-10 level increased; IL-4,IL-6 and C-reactive protein in the observation group were significantly lower than those in the control group[( 7. 6 ± 1. 4) ng/L vs( 12. 3 ± 2. 4) ng/L,( 15. 6 ± 2. 4) ng/L vs( 21. 3 ± 5. 4) ng/L,( 6. 4 ± 1. 1) mg/L vs( 9. 0 ± 1. 2) mg/L]; IL-10 in the observation group was significantly higher than that in the control group[( 14. 0 ± 3. 0) ng/L vs( 9. 4 ± 1. 9) ng/L]( P < 0. 05). Conclusion Budesonide is effective in the treatment of RSV infection-related wheezing and it can significantly inhibit airway inflammation.
引文
[1]王慧芳.布地奈德混悬液雾化吸入对儿童呼吸道合胞病毒毛细支气管炎疗效观察[J].山西医药杂志,2014,43(21):2524-2525.Wang HF. Efficacy of inhalation of budesonide suspension in children with respiratory syncytial virus bronchiolitis[J]. Shanxi Medical Journal,2014,43(21):2524-2525.
[2]刘晓红.呼吸道合胞病毒感染发病机制和药物治疗进展[J].中国临床医生,2011,39(3):8-12. DOI:10. 3969/j. issn. 1008-1089. 2011. 03. 003.Liu XH. Advances in pathogenesis and drug treatment of respiratory syncytial virus infection[J]. Chinese Journal for Clinicians,2011,39(3):8-12. DOI:10. 3969/j. issn. 1008-1089. 2011. 03. 003.
[3]薛秀丽,池红井,冀楠,等.维生素D在喘息性支气管炎发病中的作用[J].河北医学,2016,22(12):2068-2070. DOI:10.3969/j. issn. 1006-6233. 2016. 12. 055.Xue XL,Chi HJ,Ji N,et al. Application of vitamin D in the attack of asthmatic bronchitis[J]. Hebei Medicine,2016,22(12):2068-2070. DOI:10. 3969/j. issn. 1006-6233. 2016. 12. 055.
[4]刘霞,刘晓红,张忠浩,等.小儿呼吸道合胞病毒性肺炎的临床特点[J].中国医刊,2015,50(11):92-94. DOI:10. 3969/j.issn. 1008-1070. 2015. 11. 031.Liu X,Liu XH,Zhang ZH,et al. Clinical characteristics of respiratory syncytial virus pneumonia in children[J]. Chinese Journal of Medicine,2015,50(11):92-94. DOI:10. 3969/j.issn. 1008-1070. 2015. 11. 031.
[5]吉大章,冯婉莉,冼建妹,等.吸入糖皮质激素治疗儿童呼吸道合胞病毒相关喘息的机制及疗效[J].中国小儿急救医学,2012,19(4):425-427. DOI:10. 3760/cma. j. issn. 1673-4912.2012. 04. 031.Ji DZ,Feng WL,Xian JM,et al. The mechanism and efficacy of inhaled corticosteroids in the treatment of respiratory syncytial virus related wheezing in children[J]. Chinese Pediatric Emergency Medicine,2012,19(4):425-427. DOI:10. 3760/cma. j. issn.1673-4912. 2012. 04. 031.
[6]苏慧霞.血清白介素-4和干扰素-γ及尿白三烯E4在婴幼儿喘息性疾病中的变化及意义[J].河北医药,2016,38(7):1031-1033. DOI:10. 3969/j. issn. 1002-7386. 2016. 07. 022.Su HX. The changes and significance of serum interleukin-4,interferon gamma and urinary leukotriene E4 in infants with wheezing diseases[J]. Hebei Medical Journal,2016,38(7):1031-1033.DOI:10. 3969/j. issn. 1002-7386. 2016. 07. 022.
[7] Nair H,Nokes DJ,Gessner BD,et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children:a systematic review and meta-analysis[J]. Lancet,2010,375(9725):1545-1555. DOI:10. 1016/S0140-6736(10)60206-1.
[8]田林瑞,李海燕.雾化吸入布地奈德混悬液对婴幼儿合胞病毒肺炎预后的影响[J].海南医学,2012,23(6):33-34. DOI:10.3969/j. issn. 1003-6350. 2012. 06. 014.Tian LR,Li HY. Effect of nebulized budesonide suspension on prognosis of infantile syncytial virus pneumonia[J]. Hainan Medical Journal,2012,23(6):33-34. DOI:10. 3969/j. issn. 1003-6350. 2012.06. 014.
[9]张定梅,朱勋,姚婷婷,等.广东省2009—2012年呼吸道合胞病毒的流行病学特征[J].中山大学学报:医学科学版,2013,34(2):292-298.Zhang DM,Zhu X,Yao TT,et al. Respiratory syncytial virus epidemiology character from 2009 to 2012 in Guangdong province[J].Journal of Sun Yat-sen University(Medical Sciences),2013,34(2):292-298.
[10]吴海丽,李贤斌.气雾型布地奈德联合孟鲁司特钠治疗小儿咳嗽变异性哮喘疗效及对肺功能和血清炎症因子的影响[J].海南医学院学报,2016,22(5):467-469,473. DOI:10. 13210/j.cnki. jhmu. 20151203. 006.Wu HL,Li XB. Efficacy of aerosol budesonide combined with montelukast in treatment of children with cough variant asthma and its influence on lung function and serum inflammatory factor[J].Journal of Hainan Medical University,2016,22(5):467-469,473. DOI:10. 13210/j. cnki. jhmu. 20151203. 006.
[11] Ye Q,Shao WX,Shang SQ,et al. Epidemiological characteristics and immune status of children with respiratory syncytial virus[J]. J Med Virol,2015,87(2):323-329. DOI:10. 1002/jmv. 24047.
[12]李新鹏.布地奈德福莫特罗联合呼吸康复训练治疗慢性阻塞性肺疾病的疗效观察[J].中国临床医生杂志,2017,45(5):41-43. DOI:10. 3969/j. issn. 2095-8552. 2017. 05. 014.Li XP. Effect of budesonide formoterol combined with respiratory rehabilitation training on chronic obstructive pulmonary disease[J].Chinese Journal for Clinicians,2017,45(5):41-43. DOI:10.3969/j. issn. 2095-8552. 2017. 05. 014.
[13]施弦,郁峰.布地奈德联合孟鲁司特对支气管哮喘患儿炎性因子及免疫功能的影响[J].中国医药,2018,13(1):55-58. DOI:10. 3760/cma. j. issn. 1673-4777. 2018. 01. 015.Shi X,Yu F. Effect of budesonide combined with montelukast on inflammatory factors and immune function in children with bronchial asthma[J]. China Medicine,2018,13(1):55-58. DOI:10. 3760/cma. j. issn. 1673-4777. 2018. 01. 015.
[14]王馨平,吴昭萍,李光清,等.雾化吸入布地奈德联合口服泼尼松治疗嗜酸细胞性支气管炎的临床效果[J].中国医药,2017,12(12):1822-1826. DOI:10. 3760/cma. j. issn. 1673-4777.2017. 12. 017.Wang XP,Wu ZP,Li GQ,et al. Clinical effect of budesonide inhalation combined with oral prednisone on eosinophilic bronchitis[J].China Medicine,2017,12(12):1822-1826. DOI:10. 3760/cma.j. issn. 1673-4777. 2017. 12. 017.
[15]靳庆娥,乌姗娜,刘玉华,等.探讨婴幼儿呼吸道合胞病毒感染及与白介素4的相关性[J].中华实验和临床病毒学杂志,2016,30(6):570-572. DOI:10. 3760/cma. j. issn. 1003-9279.2016. 06. 017.Jin QE,Wu SN,Liu YH,et al. Analysis on respiratory syncytial virus infection in infants and young children and the relationship with interleukin-4[J]. Chinese Journal of Experimental and Clinical Virology,2016,30(6):570-572. DOI:10. 3760/cma. j. issn. 1003-9279. 2016. 06. 017.
[16] Oliver JM,Tarleton CA,Gilmartin L,et al. Reduced FcepsilonRImediated release of asthma-promoting cytokines and chemokines from human basophils during omalizumab therapy[J]. Int Arch Allergy Immunol,2010,151(4):275-284. DOI:10. 1159/000250436.
[17]雷泽宝,雷振东,刘丽芳,等.布地奈德与沙丁胺醇对支气管肺炎患儿的疗效及血清IL-6、TNF-α水平变化分析[J].中国医刊,2017,52(4):74-76. DOI:10. 3969/j. issn. 1008-1070. 2017.04. 025.Lei ZB,Lei ZD,Liu LF,et al. To investigate the effects of budesonide and salbutamol on children with bronchial pneumonia curative effect and serum IL-6,TNF-αlevels[J]. Chinese Journal of Medicine,2017,52(4):74-76. DOI:10. 3969/j. issn. 1008-1070. 2017. 04. 025.
[2]刘晓红.呼吸道合胞病毒感染发病机制和药物治疗进展[J].中国临床医生,2011,39(3):8-12. DOI:10. 3969/j. issn. 1008-1089. 2011. 03. 003.Liu XH. Advances in pathogenesis and drug treatment of respiratory syncytial virus infection[J]. Chinese Journal for Clinicians,2011,39(3):8-12. DOI:10. 3969/j. issn. 1008-1089. 2011. 03. 003.
[3]薛秀丽,池红井,冀楠,等.维生素D在喘息性支气管炎发病中的作用[J].河北医学,2016,22(12):2068-2070. DOI:10.3969/j. issn. 1006-6233. 2016. 12. 055.Xue XL,Chi HJ,Ji N,et al. Application of vitamin D in the attack of asthmatic bronchitis[J]. Hebei Medicine,2016,22(12):2068-2070. DOI:10. 3969/j. issn. 1006-6233. 2016. 12. 055.
[4]刘霞,刘晓红,张忠浩,等.小儿呼吸道合胞病毒性肺炎的临床特点[J].中国医刊,2015,50(11):92-94. DOI:10. 3969/j.issn. 1008-1070. 2015. 11. 031.Liu X,Liu XH,Zhang ZH,et al. Clinical characteristics of respiratory syncytial virus pneumonia in children[J]. Chinese Journal of Medicine,2015,50(11):92-94. DOI:10. 3969/j.issn. 1008-1070. 2015. 11. 031.
[5]吉大章,冯婉莉,冼建妹,等.吸入糖皮质激素治疗儿童呼吸道合胞病毒相关喘息的机制及疗效[J].中国小儿急救医学,2012,19(4):425-427. DOI:10. 3760/cma. j. issn. 1673-4912.2012. 04. 031.Ji DZ,Feng WL,Xian JM,et al. The mechanism and efficacy of inhaled corticosteroids in the treatment of respiratory syncytial virus related wheezing in children[J]. Chinese Pediatric Emergency Medicine,2012,19(4):425-427. DOI:10. 3760/cma. j. issn.1673-4912. 2012. 04. 031.
[6]苏慧霞.血清白介素-4和干扰素-γ及尿白三烯E4在婴幼儿喘息性疾病中的变化及意义[J].河北医药,2016,38(7):1031-1033. DOI:10. 3969/j. issn. 1002-7386. 2016. 07. 022.Su HX. The changes and significance of serum interleukin-4,interferon gamma and urinary leukotriene E4 in infants with wheezing diseases[J]. Hebei Medical Journal,2016,38(7):1031-1033.DOI:10. 3969/j. issn. 1002-7386. 2016. 07. 022.
[7] Nair H,Nokes DJ,Gessner BD,et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children:a systematic review and meta-analysis[J]. Lancet,2010,375(9725):1545-1555. DOI:10. 1016/S0140-6736(10)60206-1.
[8]田林瑞,李海燕.雾化吸入布地奈德混悬液对婴幼儿合胞病毒肺炎预后的影响[J].海南医学,2012,23(6):33-34. DOI:10.3969/j. issn. 1003-6350. 2012. 06. 014.Tian LR,Li HY. Effect of nebulized budesonide suspension on prognosis of infantile syncytial virus pneumonia[J]. Hainan Medical Journal,2012,23(6):33-34. DOI:10. 3969/j. issn. 1003-6350. 2012.06. 014.
[9]张定梅,朱勋,姚婷婷,等.广东省2009—2012年呼吸道合胞病毒的流行病学特征[J].中山大学学报:医学科学版,2013,34(2):292-298.Zhang DM,Zhu X,Yao TT,et al. Respiratory syncytial virus epidemiology character from 2009 to 2012 in Guangdong province[J].Journal of Sun Yat-sen University(Medical Sciences),2013,34(2):292-298.
[10]吴海丽,李贤斌.气雾型布地奈德联合孟鲁司特钠治疗小儿咳嗽变异性哮喘疗效及对肺功能和血清炎症因子的影响[J].海南医学院学报,2016,22(5):467-469,473. DOI:10. 13210/j.cnki. jhmu. 20151203. 006.Wu HL,Li XB. Efficacy of aerosol budesonide combined with montelukast in treatment of children with cough variant asthma and its influence on lung function and serum inflammatory factor[J].Journal of Hainan Medical University,2016,22(5):467-469,473. DOI:10. 13210/j. cnki. jhmu. 20151203. 006.
[11] Ye Q,Shao WX,Shang SQ,et al. Epidemiological characteristics and immune status of children with respiratory syncytial virus[J]. J Med Virol,2015,87(2):323-329. DOI:10. 1002/jmv. 24047.
[12]李新鹏.布地奈德福莫特罗联合呼吸康复训练治疗慢性阻塞性肺疾病的疗效观察[J].中国临床医生杂志,2017,45(5):41-43. DOI:10. 3969/j. issn. 2095-8552. 2017. 05. 014.Li XP. Effect of budesonide formoterol combined with respiratory rehabilitation training on chronic obstructive pulmonary disease[J].Chinese Journal for Clinicians,2017,45(5):41-43. DOI:10.3969/j. issn. 2095-8552. 2017. 05. 014.
[13]施弦,郁峰.布地奈德联合孟鲁司特对支气管哮喘患儿炎性因子及免疫功能的影响[J].中国医药,2018,13(1):55-58. DOI:10. 3760/cma. j. issn. 1673-4777. 2018. 01. 015.Shi X,Yu F. Effect of budesonide combined with montelukast on inflammatory factors and immune function in children with bronchial asthma[J]. China Medicine,2018,13(1):55-58. DOI:10. 3760/cma. j. issn. 1673-4777. 2018. 01. 015.
[14]王馨平,吴昭萍,李光清,等.雾化吸入布地奈德联合口服泼尼松治疗嗜酸细胞性支气管炎的临床效果[J].中国医药,2017,12(12):1822-1826. DOI:10. 3760/cma. j. issn. 1673-4777.2017. 12. 017.Wang XP,Wu ZP,Li GQ,et al. Clinical effect of budesonide inhalation combined with oral prednisone on eosinophilic bronchitis[J].China Medicine,2017,12(12):1822-1826. DOI:10. 3760/cma.j. issn. 1673-4777. 2017. 12. 017.
[15]靳庆娥,乌姗娜,刘玉华,等.探讨婴幼儿呼吸道合胞病毒感染及与白介素4的相关性[J].中华实验和临床病毒学杂志,2016,30(6):570-572. DOI:10. 3760/cma. j. issn. 1003-9279.2016. 06. 017.Jin QE,Wu SN,Liu YH,et al. Analysis on respiratory syncytial virus infection in infants and young children and the relationship with interleukin-4[J]. Chinese Journal of Experimental and Clinical Virology,2016,30(6):570-572. DOI:10. 3760/cma. j. issn. 1003-9279. 2016. 06. 017.
[16] Oliver JM,Tarleton CA,Gilmartin L,et al. Reduced FcepsilonRImediated release of asthma-promoting cytokines and chemokines from human basophils during omalizumab therapy[J]. Int Arch Allergy Immunol,2010,151(4):275-284. DOI:10. 1159/000250436.
[17]雷泽宝,雷振东,刘丽芳,等.布地奈德与沙丁胺醇对支气管肺炎患儿的疗效及血清IL-6、TNF-α水平变化分析[J].中国医刊,2017,52(4):74-76. DOI:10. 3969/j. issn. 1008-1070. 2017.04. 025.Lei ZB,Lei ZD,Liu LF,et al. To investigate the effects of budesonide and salbutamol on children with bronchial pneumonia curative effect and serum IL-6,TNF-αlevels[J]. Chinese Journal of Medicine,2017,52(4):74-76. DOI:10. 3969/j. issn. 1008-1070. 2017. 04. 025.