布地奈德对RSV毛支患儿鼻咽分泌物中MCP-4 MDC水平的影响

Effect of budesonide on RSV bronchiolitis and the regulation of glucocorticoids on MCP-4,MDC in nasopharyngeal secretions

目的观察雾化吸入布地奈德对呼吸道合胞病毒(RSV)毛细支气管炎(毛支)患儿的治疗效果和对鼻咽分泌物(NPS)中MCP-4、MDC水平的影响,探讨布地奈德治疗RSV毛细支气管炎的机制。方法收集RSV检测阳性的毛支住院患儿57例,分成布地奈德雾化吸入组(激素组29例)和非激素组(28例)。急性期、恢复期分别抽取NPS,采用酶联免疫吸附法测定RSV毛支患儿NPS中MCP-4、MDC水平。结果在急性期,RSV毛支患儿激素组NPS中MCP-4、MDC含量与非激素组比较均有下降,但无显著性差异(P均>0.05);恢复期激素组NPS中MCP-4含量与非激素组比较有显著下降(P<0.01),而MDC含量比较无显著性差异(P>0.05)。雾化吸入布地奈德可以改善RSV毛支患儿临床症状,但不能缩短住院时间。在急性期,中、重度患儿组NPS中MCP-4、MDC含量均显著高于轻度组。结论布地奈德雾化吸入能明显改善RSV毛支患儿的症状,其治疗作用可能与减少NPS中MCP-4水平有关。NPS中的MCP-4、MDC水平可反映毛支的病情严重程度。

Objective To observe the effect of inhalational glucocorticoids（budesonide）on RSV bronchiolitis aral the regulation of glucoeorticoids on MCP- 4, MDC in NPS （naspharyngeal secretions）. Methods NPS sanples were obtained from RSV bronchiolitis patients in the acute and rehabiliation stage. According to the clinical symptoms,57 samples were divided into mild bronchiolitis group and severe bronchiolitis group. All the patients had not taken any glucocorticoid within 2 weeks before the hospital adraission, and half of them were treated by glucocorticoid （budesonide）randomly. ELISA was used to determine the concentrations of MCP - 4, MDC in NPS. Results Compared with control group, in the acute phase, the level of MCP - 4 and MDC of NPS in glucocorticoids treating group were deereaced, but there was no significant difference （ P 〉 0.05）. In the restoration stage, the level of MCP - 4 in glueocorticoids treating group were markedly lower them those in eontrol group（ P 〈 0.01 ） ; the level of MDC in glucoeorticoids treating group were lower than those in control group, there were no difference （ P 〉 0.05）. Not oaly in the acute phase but in the restoration stage, the clinical evalution scores of RSV bronehiolitis in glucocorticoids treating group were not significantly lower than those of eontrel group. However, on the third day , the clinical evalution scores of RSV bronchiolitis in glucocorticoids treating group were significantly lower than those of control group, Inhalational glucocorticoids（budesonide）on RSV bronchiolitis can＇t decrease significantly the length of stay in the hospital. Conclusions The beneficial effect of inhalational glucocotticoids on RSV bronchiolitis may be at least in part due to their direct inhibitor,, effect on MCP - 4 generation, level of MCP - 4 and MDC can reflect the severity of RSV Bronchiolitis.