氨溴索联合甲泼尼龙治疗儿童哮喘急性发作的临床研究
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摘要
目的探讨氨溴索联合甲泼尼龙治疗儿童哮喘急性发作的临床效果。方法选取2015年1月—2017年1月河南科技大学第一附属医院开元院区收治的哮喘急性发作患儿78例,随机分成对照组(39例)和治疗组(39例)。对照组静脉滴注注射用甲泼尼龙琥珀酸钠,1mg/kg加入5%葡萄糖注射液100m L,1次/d。治疗组在对照组治疗基础上静脉滴注盐酸氨溴索注射液,15 mg加入5%葡萄糖注射液100 mL,2次/d。两组均连续治疗7 d。观察两组患者临床疗效,同时比较治疗前后两组患者症状体征缓解时间、第1秒用力呼气容积占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)值、呼出气一氧化氮(FeNO)水平、儿童哮喘控制测试(C-ACT)评分、γ干扰素(IFN-γ)、白细胞介素-4(IL-4)和辅助性T细胞17(Th17)/调节性T细胞(Treg)比值。结果治疗后,对照组的总有效率为79.5%,显著低于治疗组的94.9%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组患儿喘息、咳嗽、气促、哮鸣音、湿罗音症状体征缓解时间比对照组显著缩短(P<0.05)。治疗后,两组FEV1%、FEV1/FVC值和C-ACT评分均明显增加(P<0.05),FeNO水平显著下降(P<0.05),且治疗后治疗组这些理化指标及C-ACT评分比对照组改善更明显(P<0.05)。治疗后,两组血清IFN-γ浓度显著升高(P<0.05),血清IL-4水平及外周血Th17/Treg比率显著降低(P<0.05),且治疗组IFN-γ、IL-4和Th17/Treg比对照组改善更明显(P<0.05)。结论氨溴索联合甲泼尼龙治疗儿童哮喘急性发作疗效显著,可迅速减轻患儿症状,提高肺通气功能,改善气道炎症,缓解哮喘病情。
Objective to explore the clinical effect of ambroxol combined with methylprednisolone in treatment of acute asthma attack in children. Methods Children(78 cases) with acute asthma attack in Kaiyuan District of the First Affiliated Hospital of Henan University of Science & Technology from January 2015 to January 2017 were randomly divided into control(39 cases) and treatment(39 cases) groups. Children in the control group were iv administered with Methylprednisolone Sodium Succinate for injection, 1 mg/kg added into 5% glucose injection 100 mL, once daily. Children in the treatment group were iv administered with Ambroxol Hydrochloride Injection on the basis of the control group, 15 mg added into 5% glucose injection 100 mL, twice daily. Children in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the relief time of symptoms and signs, FEV1%, FEV1/FVC, FeNO levels, C-ACT scores, IFN-γ, IL-4, and Th17/Treg ratios in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 79.5%, which was significantly lower than 94.9% in the treatment group, and there were differences between two groups(P < 0.05). After treatment, the relief time of wheezing, cough, shortness of breath, wheezing rale, and wet rales in the treatment group was significantly shorter than that in the control group(P < 0.05). After treatment, the FEV1%, FEV1/FVC, and C-ACT scores in two groups were significantly increased(P < 0.05), but the FeNO levels were significantly decreased(P < 0.05), and these physical and chemical indexes and C-ACT scores in the treatmentgroup were significantly better than those in the control group(P < 0.05). After treatment, the serum IFN-γ concentration in two groups was significantly increased(P < 0.05), but serum IL-4 and Th17/Treg ratio of peripheral blood were significantly decreased(P < 0.05), and the IFN-γ, IL-4, Th17/Treg levels in treatment group were significantly better than those in the control group(P < 0.05). Conclusion Ambroxol combined with methylprednisolone has significant curative effect in treatment of acute asthma attack in children, can quickly relieve the symptoms, improve the pulmonary ventilation function, improve the airway inflammation, and alleviate asthma.
Objective to explore the clinical effect of ambroxol combined with methylprednisolone in treatment of acute asthma attack in children. Methods Children(78 cases) with acute asthma attack in Kaiyuan District of the First Affiliated Hospital of Henan University of Science & Technology from January 2015 to January 2017 were randomly divided into control(39 cases) and treatment(39 cases) groups. Children in the control group were iv administered with Methylprednisolone Sodium Succinate for injection, 1 mg/kg added into 5% glucose injection 100 mL, once daily. Children in the treatment group were iv administered with Ambroxol Hydrochloride Injection on the basis of the control group, 15 mg added into 5% glucose injection 100 mL, twice daily. Children in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the relief time of symptoms and signs, FEV1%, FEV1/FVC, FeNO levels, C-ACT scores, IFN-γ, IL-4, and Th17/Treg ratios in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 79.5%, which was significantly lower than 94.9% in the treatment group, and there were differences between two groups(P < 0.05). After treatment, the relief time of wheezing, cough, shortness of breath, wheezing rale, and wet rales in the treatment group was significantly shorter than that in the control group(P < 0.05). After treatment, the FEV1%, FEV1/FVC, and C-ACT scores in two groups were significantly increased(P < 0.05), but the FeNO levels were significantly decreased(P < 0.05), and these physical and chemical indexes and C-ACT scores in the treatmentgroup were significantly better than those in the control group(P < 0.05). After treatment, the serum IFN-γ concentration in two groups was significantly increased(P < 0.05), but serum IL-4 and Th17/Treg ratio of peripheral blood were significantly decreased(P < 0.05), and the IFN-γ, IL-4, Th17/Treg levels in treatment group were significantly better than those in the control group(P < 0.05). Conclusion Ambroxol combined with methylprednisolone has significant curative effect in treatment of acute asthma attack in children, can quickly relieve the symptoms, improve the pulmonary ventilation function, improve the airway inflammation, and alleviate asthma.
引文
[1]时国朝,侯小霞.临床症状在哮喘诊断及评估中的作用[J].诊断学理论与实践,2016,15(3):209-211.
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[5]中华医学会儿科学分会呼吸学组《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-753.
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[8]文辉,周金艳,李云.儿童哮喘流行病学现状及其危险因素研究进展[J].医学综述,2013,19(4):667-670.
[9]刘恩梅,黄海霞.儿科糖皮质激素的全身合理应用:儿科全身性糖皮质激素应用概述[J].中国实用儿科杂志,2012,27(11):803-805.
[10]窦国朝.氨溴索的药理作用及临床应用研究新进展[J].中国处方药,2017,15(5):22-23.
[11]刘秀蜀,黄轶喆,邓灵东.肺功能检测在儿童哮喘的临床应用[J].中国现代药物应用,2015,9(11):86-87.
[12]丁静,赵德育,吴美思.支气管哮喘患儿呼出气一氧化氮的变化及其与肺功能的相关性[J].中华实用儿科临床杂志,2015,30(22):1729-1731.
[13]杨一民,曾谷兰,李雅心,等.儿童支气管哮喘控制测试的临床应用[J].中华实用儿科临床杂志,2017,32(16):1248-1252.
[14]高阳,杨帆.支气管哮喘患者外周血Th1、Th2与Th17细胞表达水平及临床意义[J].解放军医药杂志,2017,29(1):76-79.
[15]苗青,王燕,任亦欣,等.支气管哮喘患儿外周血不同T淋巴细胞亚群的表达及其临床意义[J].中国妇幼保健,2017,32(18):4438-4441.
[2]李昌崇,朱丽丽.儿童支气管哮喘急性发作期治疗进展-各国支气管哮喘防治指南比较[J].中华实用儿科临床杂志,2017,32(16):1209-1214.
[3]郑秀凤,潘启超.糖皮质激素的临床药理学进展[J].国外医学内科学分册,1982,9(6):298-302.
[4]董晓莉,高武红.氨溴索口服液联合酮替芬治疗小儿哮喘的疗效观察[J].现代药物与临床,2017,32(3):439-442.
[5]中华医学会儿科学分会呼吸学组《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-753.
[6]孙传兴.临床疾病诊断依据治愈好转标准[M].第2版.北京:人民军医出版社,2002:43-44.
[7]Liu A H,Zeiger R,Sorkness C,et al.Development and cross-sectional validation of the Childhood Asthma Control Test[J].J Allergy Clin Immunol,2007,119(4):817-825.
[8]文辉,周金艳,李云.儿童哮喘流行病学现状及其危险因素研究进展[J].医学综述,2013,19(4):667-670.
[9]刘恩梅,黄海霞.儿科糖皮质激素的全身合理应用:儿科全身性糖皮质激素应用概述[J].中国实用儿科杂志,2012,27(11):803-805.
[10]窦国朝.氨溴索的药理作用及临床应用研究新进展[J].中国处方药,2017,15(5):22-23.
[11]刘秀蜀,黄轶喆,邓灵东.肺功能检测在儿童哮喘的临床应用[J].中国现代药物应用,2015,9(11):86-87.
[12]丁静,赵德育,吴美思.支气管哮喘患儿呼出气一氧化氮的变化及其与肺功能的相关性[J].中华实用儿科临床杂志,2015,30(22):1729-1731.
[13]杨一民,曾谷兰,李雅心,等.儿童支气管哮喘控制测试的临床应用[J].中华实用儿科临床杂志,2017,32(16):1248-1252.
[14]高阳,杨帆.支气管哮喘患者外周血Th1、Th2与Th17细胞表达水平及临床意义[J].解放军医药杂志,2017,29(1):76-79.
[15]苗青,王燕,任亦欣,等.支气管哮喘患儿外周血不同T淋巴细胞亚群的表达及其临床意义[J].中国妇幼保健,2017,32(18):4438-4441.