双盲对照吸入倍氯米松一年对气道高反应性与哮喘的防治作用

Prophylactic and therapeutic effects of beclomethasone inhalation on bronchial hyperresponsiveness and asthma: a randomized, double blind, parallel group controlled trial

目的探讨长期吸入糖皮质激素对哮喘患者的治疗作用和对无症状的气道高反应性（ＢＨＲ）者发生哮喘的预防作用。方法以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２～１８岁，吸入倍氯米松干粉剂（ＢＤＰ，６００μｇ／ｄ）或安慰剂１年对气道反应性及哮喘症状的作用。结果试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显著下降（分别为０．３８５±０．４２４、１．１８７±０．６０３μｍｏｌ组胺，Ｐ＜０．０２），只有３０％哮喘者仍有喘息，而对照组则有８６％仍有喘息（Ｐ＝０．０７６）；无症状ＢＨＲ学生的ｌｇＰＤ２０－ＦＥＶ１在ＢＤＰ组及对照组间差异无显著性，但ＢＤＰ组不出现喘息症状，而对照组则有３例出现喘息（１５％）；ＢＨＲ者吸入ＢＤＰ组的累积症状计分显著低于对照组（分别为１．５０±２．５４分、５．５８±６．２２分，Ｐ＜０．０１）。结论ＢＤＰ能降低哮喘患者的ＢＨＲ及减轻其症状。

Objective To better understand the effects of corticosteroid inhalation on asthma and asymptomatic bronchial hyperresponsiveness (BHR). Methods A double blind, randomized study was conducted to compare the effects of beclomethasone dry powder (BDP, 600 μg/day) inhalation with placebo on BHR and asthmatic symptoms in 59 students (12～18 yrs) for one year. Results After one year of treatment, lg PD 20 FEV 1 increased significantly in asthmatics in the BDP group (0.385±0.424 vs 1.187±0.603 μmol histamine). Thirty percent of asthmatics in BDP group and 86% in the control group developed symptoms in this year ( P =0.076). There was no significant difference in lgPD 20 FEV 1 between the BDP and the control group in asymptomatic BHR students. However, none in the BDP group of asymptomatic BHR students developed asthmatic symptoms compared with 3 cases (15%) in control group. The accumulative symptom score showed significant difference between the BDP group and the control group in asymptomatic BHR students (1.50±2.54 vs 5.58±6.22, P < 0.01). Conclusion The results suggested that BDP could significantly relieve the severity of BHR and symptoms in asthmatics, and could have some prophylactic effects on the development of asthma in those with asymptomatic BHR.