小剂量布地奈德粉吸入剂治疗轻度支气管哮喘患者的远期疗效

The long term effect of small dose budesonide turbuhaler on mild bronchial asthma

目的 探讨小剂量布地奈德粉吸入剂(商品名：普米克都保)长期吸入治疗轻度支气管哮喘(简称哮喘)的远期疗效和不良反应。方法将52例轻度哮喘患者分为3组。吸入糖皮质激素组(A组)22例：每晚吸入布地奈德粉吸入剂200μg。口服糖皮质激素组(B组)15例：在哮喘发作期给予泼尼松5mg每天1次口服，茶碱控释片(商品名：舒弗美)0．2g每天2次口服；沙丁胺醇(商品名：喘乐宁)气雾剂2揿(每揿100μg)每天3次吸入。非糖皮质激素组(C组)15例：发作期只给茶碱控释片0．2g每天2次口服，沙丁胺醇气雾剂2揿每天3次吸入。全部病例连续治疗3年，停药后随访1年。在此4年间，检测各组患者治疗前、后一秒钟用力呼气容积(FEV1)、气道阻力(Raw)、气道传导率(Gaw)、气道高反应性(BHR)、临床疗效、血浆皮质醇浓度以及促肾上腺皮质激素(ACTH)刺激后的反应等。结果 (1)治疗前A、B、C3组绝大多数病例的BHR均在3—4级，分别为91％(20／22)、100％(15／15)、93％(14／15)。治疗后A组18例(82％)转为1—2级；B组13例(87％)仍为3～4级；C组15例(100％)病例为3～5级。A、B、C3组间比较差异有统计学意义(P均<0．01)。(2)A、B、C3组Raw治疗前分别为(623±103)％、(605±90)％、(638±108)％，治疗后分别为(158±24)％、(340±61)％、(420±81)％，3组间比较差异有统计学意义(P均<0．01)。(3)A、B、C3组Gaw治疗前分别为(22±4)％、(27±6)％、(27±5)％，治疗后分别为(83±15)％、(42±9)％、(31±6)％，3组间比较差异有统计学意义(P均<0．01)。(4)A组FEV．治疗前、后分别为(2．3±0．4)、(2．9±0．4)L，B组为(2．3±0．4)、(2．6±0．4)L，C组为(2．3±0．4)、(2．7±0．4)L。3组间比较差异有统计学意义(P均<0．01)。(5)以哮喘症状被控制作为疗效标准，A、B、C3组有效率分别为91％、530%，和330%，3组间比较差异有统计学意义(P均<0．01)。(6)A、B组治疗前、后血浆皮质醇浓度分别为(326±103)、(318±78)、(308±29)、(299±98)nmol／L。治疗前、后血浆皮质醇浓度比较差异无统计学意义(P均>0．05)。用ACTH激发后，A、B组血浆皮质醇治疗前、后的反应值分别为(365±102)、(373±102)、(343±79)、(346±103)nmol／L，治疗前、后比较差异无统计学意义(P均>0．05)。结论 长期小剂量布地奈德粉吸入剂治疗轻度哮喘可有效地降低患者BHR和Raw，提高Gaw而改善肺功能，预防哮喘急性发作，从而使哮喘患者长期处于稳定状态。且不会引起下丘脑-垂体-肾上腺轴(HPAA)抑制的不良反应。

Objective To investigate the long term efficacy as well as the side-effects of small dose budesonide turbuhaler in mild bronchial asthma. Methods Fifty-two patients with mild asthma were randomly divided into groups A,B and C. Twenty-two cases in group A received 200 μg budesonide turbuhaler by inhalation every night. Fifteen cases in group B received oral prednisone 5 mg/d and theophyllin control release tablet 0.2 g twice daily,as well as ventolin aerosol inhalation 200 μg three times daily during asthmatic attack. Fifteen cases in group C received no glucocorticoids,but theophyllin control release tablet 0.2 g twice daily as well as ventolin aerosol inhalation(200 μg/d) were given during asthmatic attack. All three groups received treatment consecutively for 3 years,and followed for one year after stopping treatment. During the total 4 years,pulmonary function measurements(FEV 1,Raw,Gaw),bronchial hyperreactivity(BHR),clinical effects,plasma cortisol level and the activated reaction of ACTH were evaluated. Results (1)Before the treatment,BHR of the three groups were similar,with most cases graded Ⅲ-Ⅳ,being 91%(20/22),100%(15/15) and 93%(14/15) respectively. After the treatment,the BHR of 18(82%) cases of group A was reduced to grades Ⅰ-Ⅱ. However,13 cases (87%) of group B still remained at grades Ⅲ-Ⅳ and 15 cases (100%) of group C were still at grades Ⅲ-Ⅳ. The results of the three groups showed a significant difference(P<0.01). (2)Compared to measurements before the treatment,Raw was (623±103)% s (158±24)% in group A,(605±90)% s (340±61)% in group B,and (638±108)% s (420±81)% in group C,the difference among the three groups being significant(P<0.01). (3)Compared to the measurements before the treatment,Gaw was (22±4)% s (83±15)% in group A,(27±6)% s (42±9)% in group B,and (27±5)% s (31±6)% in group C,the difference among the three groups being significant(all P<0.01 respectiely). (4)Compared with the measurements before the treatment,FE 1 was (2.3±0.4)L s (2.9±0.4)L in group A,(2.3±0.4)L s (2.6±0.4)L in group B,and (2.3±0.4)L s (2.7±0.4)L in group C, the difference among the three groups being significant(P<0.01). (5)With asthmatic symptom control as the criteria of therapeutical effects,the effectie rate of group A,B and C were 91%,53% and 33% respectiely,which showed significant difference among the three groups(all P<0.01 respectiely). (6)The plasma cortisol leels of group A and B were (326±103)nmol/L and (308±29)nmol/L before treatment,compared with (318±78)nmol/L and (299±98)nmol/L after treatment,the difference in group A or in group B was not significant(all P>0.05). When the measurements before and after treatment were compared,the cortisol leels of group A and B were (365±102)nmol/L s (373±102)nmol/L and (343±79)nmol/L s (346±103)nmol/L respectiely after the stimulation of ACTH,which showed no significant changes een after the stimulation of ACTH(all P>0.05). Conclusions Long term small dose budesonide turbuhaler inhalation could effectiely decrease BHR and the Raw,while increase the Gaw of asthmatic patients,hence improing the pulmonary function and preenting acute attack. In addition,it did not induce suppression of HPAA axis function in the patients.