糖皮质激素吸入治疗对哮喘儿童血清IgE及IL-4的影响

Effect of treatment by inhaling glucocorticoid on the levels of IgE and IL-4 in asthma children

[目的]观察哮喘儿童吸入糖皮质激素（inhaled glucocorticoids，ICS）治疗前后血清总免疫球蛋白E（immuno—globulinE，IgE）、白细胞介素-4（interleukin-4，IL-4）的变化及意义。[方法]选择2005年10月～2007年10月湛江市第二人民医院儿童哮喘门诊哮喘患儿105例，随机分为ICS组及常规治疗组（常规组）。ICS组65例患儿选用储雾罐吸入氟替卡松气雾剂，常规组40例患儿给予酮替芬治疗并酌情应用舒喘灵。常规组与ICS组分别于治疗前和治疗3个月测定其血清kE、I卜4，ICS组继续治疗至1年，复查测定其血清IgE、IL-4水平。另设30例正常儿童作为对照组。[结果]常规组治疗前及治疗3个月血清IgE、IL-4水平分别为（392．77±44．95）ng／L，（377．63±50．83）ng／L和（120．55±20．57）ng／L，（114．69±17．68）ng／L（P〉0．05）；ICS组治疗前、治疗3个月及1年IgE、IL-4分别为（403．61±51．18）ng／L，（280．38±23．46）ng／L、（272．79±24．65）ng／L和（128．31±21．62）ng／L，（87．56±20．87）ng／L，（81．17±19．97）ng／L。对照组治疗前IgE、IL-4水平分别为（97．74±44．95）ng／L，（63．18±13．76）ng／L；治疗前ICS组和常规组IgE、IL-4均高于对照组，差异有显著性（P〈0．05）。[结论]ICS氟替卡松治疗儿童哮喘中等剂量可使血清IgE、IL-4水平下降，IgE、IL-4的检测有利于哮喘患儿诊治过程中的病情变化的观察。

[ Objective] To explore the changes of serum total immunoglobulin E（IgE）, interleukin-4 （IL-4） before and after inhaled glucocorticoid in children with asthma and its significance. [Methods] 105 asthmatic children were selected from our hospital during Oct. 2005 and Oct. 2007. The diagnosis had been carried out following the nationwide cooperation standard of childhood asthma. The patients were categorized into the inhaled glucocorticoid （ICS） treated group （n=65） and the conventional treatment group stochastically （conventional group）（n=40） . Within the ICS group, fluticasone aerosol contained in metered dose inhaler （MDI） was used via a spacer by the patients. The conventional group were given the ketotifen to treat and use judgment to apply salbutanol for the fragrance, does not apply the sugar cortical hormone. The patients of the 2 groups were followed up for 3 months to compare the total IgE levels before and after treatment. However, the ICS group continued being treatment and were observed up to 1 year. In addition normal children used in control group（n=30）. [Resdts] Before and after 3 months treatment, the serum total IgE of conventional group were （ 392. 77 ± 44. 95 ） ng/L, （ 377.63± 50. 83 ） ng/L, and （ 120. 55± 20. 57 ） ng/L, （114. 69±17.68）ng/L. As to the ICS group before treatment, after 3 months treatment, and after 1 year treatment, the serum total IgE,IL-4 were （403. 61±51.18）ng/L,（280. 38±23.46）ng/L, （272.79±24. 65）ng/L and（128. 31±21.62）ng/L, （87.56± 20.87）ng/L,（81.17±19. 97）ng/L, respectively. There were significant difference of total IgE,IL-4 after treatment 1 year was compared with that before treatment （t=17. 647,10. 934, P〈0.01 ）, and were no significant difference of total IgE, IL-4 compared with that of 3 months treatment （t=1. 798,1. 796, P〉0. 05）. Before the treatment, the ICS group and conventional group IgE, IL-4 were higher than the control group, there was a significant difference （P〈0. 05）. [Conclusions] When treating childhood asthma, the medium dosage of fluticasone propionate can decrease serum total IgE, IL-4, the detection of which favors the observation of patients＇ internal allergic status in the course of treatment.