吸入糖皮质激素对哮喘儿童血清IgE的影响

The influence of glucocorticoid inhalation on serum IgE of asthmatic children.

目的探讨哮喘儿童吸入糖皮质激素（ICS）治疗前后血清总IgE的变化及意义。方法哮喘儿童520例，均给予ICS治疗。≤3岁142例，4—5岁169例，均给予储雾罐吸入丙酸氟替卡松气雾剂治疗；6-14岁209例，选用沙美特罗替卡松粉吸入剂治疗；剂量为200—375μg/d。治疗前与治疗后3个月复查IgE。结果520例患儿治疗前IgE为（496．12±24．75）kU／L，治疗后IgE为（390．71±18．71）kU／L，差异有统计学意义（t=7．337，P〈0．01）。≤3岁组治疗前IgE为（307．05±34．71）kU／L，治疗后IgE为（483．09±41．78）kU／L，差异有统计学意义（t=2．963，P=0.004）；4～5岁组治疗前IgE为（543．46±51．03）kU／L，治疗后IgE为（316．93±29．30）kU／L，差异有统计学意义（t=3．368，P=0．000）；6—14岁组治疗前IgE为（586．30±37．19）kU／L，治疗后IgE为（387．61±27．60）kU／L，差异有统计学意义（t=4．827，P=0．000）。氟替卡松治疗组治疗前IgE为（468．91±32．81）kU／L，治疗后IgE为（359．03±22．79）kU／L，差异有统计学意义（t=5．988，P〈0．01）；沙美特罗替卡松治疗组治疗前IgE为（586．30±37．19）kU／L，治疗后IgE为（387．61±27．60）kU／L，差异有统计学意义（t=4．827，P〈0．01）。治疗前IgE≤300kU／L260例，109例（41．92％，109／260）治疗后IgE升高；〉300kU／L260例，45例（16．15％，45／260）治疗后血清总IgE升高，差异有统计学意义（χ2=37．789，P=0．000）。结论ICS使IgE下降，IgE的检测有利于哮喘患者诊治过程中的病情观察。

Objective To discuss the significance of serum IgE before and after inhale glucocorticoid treatment of children＇s asthma. Methods 520 children with asthma were seleceted from the outpatient. Different type of fluticasone propionate were given to different age groups： Aerosol type by a spacer in less than 5 years old, and inhalant （Seretide） 5 years and the above. The dosage was between 200μg/day to 375 μg/day. IgE was tested before and 3 months after the treatment. Results Serum IgE decreased significantly in 3 months treatment [ from （496.12±24.75 ） kU/L to （390.71±18.71 ） kU/L] （ t = 7. 337, P 〈 0.01 ）. The change of IgE was related to clinical effect and age. The level increased in those less than 3 years [ （307.05±34.71 ） kU/L vs （483.09±41.78） kU/L] （t = 2. 963, P = 0.004）, but decreased between 4 to 5 years old group [ （543.46±51.03 ） kU/L vs （316.93±29.30） kU/L ] （ t = 3. 368, P = 0. 000）, and decreased between 6 to 14 years old group [ （586.30 ± 37.19） kU/L vs （ 387.61 ± 27.60） kU/L ] （ t = 4. 827, P = 0. 000）. In fluticasone group IgE level changed from （468.91 ± 32.81 ） kU/L to （ 359.03 ± 22.79 ） kU/L after treatment （ t = 5. 988, P 〈 0. 01 ）, which decreased from （586.30 ± 37.19） kU/L to （387.6 ± 27.60） kU/L in Salmeterol group （ t = 4.827, P 〈 0.01 ）. In 260 cases of IgE below 300 kU/L 109 cases （41.92% , 109/260） increased while in 260 cases of IgE above 300 kU/L,total IgE level increased in 45 cases （16.15% ,45/260） after treatment,with statistical significance（χ2 =37.789,P =0. 000）. Conclusion Inhale glucocorticoid can make the level of IgE decreased.