大剂量皮质类固醇吸入加补肾中药治疗激素依赖型哮喘的临床研究

Investigation of Treating Steroids Dependent Asthmatic Patients with Kidney-Tonifying Herbs and High Dose Beclomethasone Dipropionate Aerosol

大剂量皮质激素吸入加口服补肾中药对３０例激素依赖型哮喘患者进行撤减治疗，结果表明：完全撤减成功的占７０％，部分撤减成功的占６．７％，临床症状改善的有１６．７％，完全无效的仅占６．７％，治疗后肺功能显著改善与治疗前相比，Ｐ＜０．０５，治疗前平均血浆皮质醇基值为０．１５２±０．０７μｍｏｌ／Ｌ，治疗后升至０．２１６±０．０６７μｍｏｌ／Ｌ，Ｐ＜０．００１；Ｓｙｎａｃｔｈｅｎ试验０ｍｉｎ、６０ｍｉｎ和１２０ｍｉｎ时点上唾液皮质醇值比治疗前显著上升（Ｐ＜０．００１）。提示大剂量皮质激素吸入加口服补肾中药是撤减口服皮质激素的好方法。

The steroids dependent asthmatic(SDA) patients need prolonged oral steroids administration.Because of the significant adverse effects with long-term use of steroids, especially the damage of the hypothalamus-pituitary-adrenocortical(HPA) axis,long-term steroids administration should be avoided or withdrawn gradually.Many modes of withdrawing the oral steroids have be used.But, the results were not satisfactory.So far, recently, investigations have revealed that high dose corticosteroids inhalation, such as beclomethasone dipropionate(BDP),could provide an effective alternative;they were delivered locally in the airway and had minimal systemic absorption as well as side effects. On the other hand, it has been shown that the Kidney-Tonifying herbs(KTH) exert protective effect on the adrenocortical cells of the SDA patients by suppressing the exogenous steroids and could regulate the disorders in different levels on HPA axis in the patients.In order to provide the more effective alternative therapy for the patients,30 SDA patients replaced their oral steroids with KTH and high dose BDP(1500 μg/day)inhalation were investigated.The changes of clinical features, pulmonary function and the Synacthen Test were followed up.The results showed that about 70% of the patients replaced their oral steroids successfully with the new therapy,the clinical features were improved in 16% of the patients and the ineffective rate was only 6.6%;the results also revealed that, after replacement, the pulmonary function of the patients were improved (P<0.05);the data of Synacthen Test indicated,after alternative therapy for 3～6 months, the damaged reserve power and secretive ability of adrenal cortex of the patients were also improved partially (P<0.001).