多项指标对慢性持续期哮喘联合治疗方案调整效果评价

The evaluation of multiple markers on the treatment effects in chronic persistent asthma with combined drug therapy

目的:评价哮喘患者气道反应性(AR)〔以第1秒用力呼气容积(FEV1)比基础值下降≥20%时的组胺剂量(PD20FEV1)为代表〕,哮喘控制测试(ACT)评分、血嗜酸细胞计数(EOS)、血清免疫球蛋白E(IgE)及哮喘症状评分、FEV1占预计值的百分比(FEV1%pred)、晨间呼气流量占预计值百分比(PEF%pred)的动态变化等指标,对哮喘患者应用吸入性糖皮质激素(ICS)+长效β2受体激动剂(LABA)联合治疗方案调整的指导作用。方法:对34例门诊慢性持续期轻、中度哮喘患者应用ICS+LABA进行联合治疗,并应用上述指标进行治疗方案的调整。结果:1.经ICS+LABA联合治疗,症状评分、FEV1%pred、PEF%pred值、ACT评分、AR程度及血嗜酸粒细胞(EOS)计数均明显改善。9个月、12月、15个月及18个月完全控制率分别为26.4%、42.8%、58.8%和60%。2.共有30例进行了降级治疗,7例因症状复发恢复原治疗级别,其中应用AR、血EOS计数监测的患者仅有2例出现反复,1例停药6个月复查AR、血EOS计数值仍正常。结论:运用上述指标调整治疗方案可使门诊慢性持续期轻、中度哮喘患者达到哮喘最佳控制研究(GOAL)研究相似的疗效。

Objective： To evaluate the effect of airway responsiveness （AR）, asthma control test （ACT） scores, blood eosinophil（EOS） count, serum immunoglobulin E （IgE）, asthma symptom scores, forced expiratory volume in one second accounting for percentage of predicted volume（FEV1% pred） and morning peak expiratory flow accounting for percentage of predicted volume（PEF% pred） on the treatment of chronic persistent asthma with inhaled corticosteroid（ICS） plus long-acting β2 agonist（LABA）. Method： 34 cases of asthma patients （mild or moderate） with ICS ＋ LABA were enrolled, and above parameters were used to adjust treatment program. Result： 1. AR,ACT scores FEV1 % pred, PEF% pred, asthma symptom scores and EOS count were significantly improved after ICS combined LABA therapy. The full control rate in 9 months, 12 months, 15 months and 18 months was 26.4%, 42.8%, 58.8% and 60% respectively. 2. A total of 30 cases were step-downed in treatment, 7 cases restored original level due to recurrence of symptoms, only 2 cases occurred repeatedly in AR and EOS count monitor patients, and AR and EOS count was still normal in 1 case after discontinuing therapy in 6 months. Conclusion： The use of above parameters in adjusting treatment program of chronic persistent asthma （mild or moderate） may achieve similar effect to GOAL study.