哮喘儿童吸入糖皮质激素治疗前后IgE的观察及其护理

Nursing and Changes of Serum Total Immunoglobulin E before and after Glucocorticoid Inhalation in Children with Asthma

目的探讨哮喘患儿吸入糖皮质激素(ICS)治疗前后总IgE变化及其护理。方法入选病例为本院儿科门诊哮喘患儿320例。随机分成对照组(155例)和ICS组(165例)。对照组主要以非特异性免疫调节剂治疗;ICS组<5岁(101例)患儿吸入氟替卡松气雾剂,≥5岁(64例)患儿吸入美特罗替卡松。对照组和治疗组分别于治疗前和治疗3个别月采用全自动过敏原定量分析仪测定其血清IgE,ICS组继续治疗至1年,复查其血清IgE水平。结果对照组治疗前及治疗3个月IgE水平分别为(360.43±35.58)ng/L、(391.27±37.48)ng/L(P>0.05),ICS组治疗前、治疗3个月及治疗1年IgE分别为(560.43±43.58)ng/L、(452.43±30.18)ng/L及(430.43±25.53)ng/L,治疗前与治疗3个月比较,差异有统计学意义(P<0.01),治疗3个月与治疗1年比较,差异无统计学意义(P>0.05)。ICS治疗3个月,<5岁患儿65例(64.4%)控制,≥5岁患儿49例(76.6%)控制,二者比较差异无统计学意义(P>0.05);但IgE水平下降(76例,75.2%vs38例,59.4%)比较差异有统计学意义(P<0.05)。结论ICS糖皮质激素可使哮喘儿童血清IgE水平降低,IgE水平下降在哮喘急性期明显,缓解期下降缓慢。良好的护理措施对改善患儿的临床症状及延长缓解期是必要的。

Objective To study the changes of serum total immunoglobulin E before and after glucocorticoid inhalation in children with asthma.Methods Three hundred and twunty asthmatic children were selected from our hospital between Dee.2006 and Nov. 2008.The dignosis had been carried out following the nationwide cooperation standard of childhood asthma.The patients were categorized into the inhaled corticosteriods（ICS） treated group （n=165） and control group （n=155）.The nonspecific immunity regulator was mainly used in control group. Within the ICS group,fluticasone aerosol contained in metered dose inhaler （MDI） was used via a spacer by the patients who were no more than 5 years old （n=101）,and advair diskus was used by the patients who were more than 5 years old （n=64）.During the treatment,the patients of the control and the ICS 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.Results Before and after 3 months treatment,the serum total IgE of control group were（360.43 ± 35.58）ng/L,（391.27±37.48）ng/L（P〉0.05）,respectively.As to the ICS group before treatment, after 3 months treatment ,and after 1 year treatment, the serum total IgE were（560.43±43.58）ng/L,（452.43±30.18）ng/Land（430.43±25.53）ng/L, respectively. There were significant difference of total IgE after treatment 1 year was compared with that before treatment（P〈0.01）,there was no significant difference of total IgE after treatment I year was compared with that 3 months treatment（P〉0.05）.After 3 months treatment in ICS group,there were out of 65（64.4%）of 101 patients whose symptoms were controlled by therapy the MDI containing fluticasone aerosol;and there were 49（76.6%） out of 64 patients whose symptoms were controlled by the therapy of advair diskus.Therefore, there was no significent difference（P〉0.05） in cilinical performance between 2 groups.After the treatment of 3 months,the serum total IgE of 76 patients（75.2%）hed decreased with the therapy of the MDI containing fluticosone aerosol,and that of 38 patients （59.4%）bed decreased with the therapy of advair diskus.Hence,as for the decrease of the serum total IgE level,there was a difference between 2 groups.Conclusion When treating chilhood asthma,the medium dosage of flutieasone proprionate can decrease serum total IgE,the detection of which favors the observation of patient＇ s internal allergic status in the course of treatment .The decrease of serum total lgE is obvious in the asthma acute phase,but slow in the asthma remission phase.Both of the 2 different ICS dosages have effective clinic therapeutic performance.However,in the aspect of decreasing serum total IgE,advair diskua is inferior to the MDI containing flutieasone aerosaol.