三步序贯法对哮喘患者激素撤减过程激素用量、Th1/Th2、HPA轴功能的影响

Effect of three-step sequential method on the dosage of hormones, Th1/Th2 and HPA axis function in patients with asthma during hormone withdrawal

目的:探讨三步序贯法对哮喘患者激素撤减过程激素用量、Th1/Th2及下丘脑-垂体-肾上腺皮质(HPA)轴功能的影响.方法:随机数字法将83例哮喘患者分为观察组(42例)与对照组(41例),观察组于激素(泼尼松)撤减过程中采取三步序贯法+布地奈德粉吸入剂(200μg/次,2次/d)治疗,对照组则行布地奈德粉吸入剂(400μg/次,2次/d)治疗,评价治疗前后临床症状积分、激素用量、肺功能、气道反应性、Th1/Th2及HPA轴功能变化.结果:两组治疗后临床症状总积分、口服激素用量、Th2比治疗前均显著下降,FEV1、FVC、组胺浓度(FEV1比基础值下降至20%时)、Th1/Th2、血浆ACTH、COR水平均显著上升,观察组治疗后上述指标均明显优于对照组;两组治疗期间均无明显不良反应发生.结论:三步序贯法能明显减少哮喘患者激素撤减过程口服激素用量,恢复HPA轴功能,有效调整Th1/Th2细胞因子,抑制气道高反应性,继而显著改善患者肺功能,减轻其临床症状.

Objective To investigate the effect of three-step sequential method on the dosage of hormones,Th1/Th2 and hypothalamic-pituitary-adrenal(HPA)axis function in patients with asthma during hormone withdrawal.Methods A total of 83 cases of asthma patients were divided into the observation group(42 cases)and control group(41 cases)by random number table method.The observation group were treated with three-step sequential method and budesonide inhalant(200μg/,twice/d)during hormone(prednisone)withdrawal while the control group were treated with budesonide inhalant(400μg/,twice/d).Changes in scores of clinical symptoms,the dosage of hormones,pulmonary function,airway reactivity,Th1/Th2 and HPA axis function before and after treatment were evaluated.Results After treatment,the total score of clinical symptoms,the dosage of oral hormones and Th2 decreased significantly in the two groups,while FEV1,FVC,histamine concentration(when the basic value of FEV1 ratio decreased to 20%),Th1/Th2,plasma ACTH and COR levels increased significantly.After treatment,the above-mentioned indexes were significantly better in experimental group than the control group.There was no obvious adverse reactions in the two groups during treatment.Conclusion The three-step sequential method can significantly reduce the dosage of oral hormones in patients with asthma during hormone withdrawal,restore HPA axis function,effectively regulate Th1/Th2 cytokines,inhibit airway hyperresponsiveness,significantly improve pulmonary function,and relieve the clinical symptoms.