单用丙酸氟替卡松和并用沙美特罗对哮喘气道炎症的作用比较

The effects of treatments with fluticasone propionate alone and combination of fluticasone propionate and salmeterol in airway inflammation of patients with asthma

目的比较单用吸入激素(ICS)和并用长效β2激动剂(LABA)对哮喘患者气道炎症的作用;观察哮喘控制水平是否与患者气道炎症控制水平一致。方法研究设计为随机、双盲的对照研究,共入组27例哮喘患者,其中单用丙酸氟替卡松(FP)治疗(FP组)14例,并用沙美特罗治疗(联合治疗组)13例,并在治疗前、治疗12周和治疗24周通过瑞氏染色和ELISA法分别对诱导痰炎性细胞计数、IL-4和IL-5进行检测。结果 (1)同基线相比,第一阶段治疗后,两组患者诱导痰中炎性细胞计数、IL-4和IL-5表达无明显变化(P>0.05);第二阶段治疗后,两组患者诱导痰中嗜酸性细胞数(EOS)、IL-4和IL-5表达显著降低(P<0.05),两组间比较无显著差别(P>0.05);(2)第二阶段治疗结束后,获得良好控制和完全控制患者诱导痰中IL-5、IL-4水平较基线均得到显著降低(P<0.05),而未获得哮喘控制患者上述细胞因子水平较基线无显著变化(P>0.05)。结论联合应用ICS和LABA能提高哮喘的控制水平,这种控制水平的提高得益于LABA的支气管扩张作用而不是增强的抗炎活性。

Objective To compare the effects of treatments with inhaled corticosteroid （ICS） alone and combination of ICS and long acting β2-agonist （LABA） in airway inflammation of patients with asthma, and dertermine whether the asthma control level is in accordance with airway inflammation control level. Methods A double blind, randomized, step-up comparison study was performed in 27 patients with asthma. The patients were assigned to treatment with either inhaled fluticasone propionate（FP） alone （n = 14） （FP group） or combination of FP and salmeterol （n = 13 ） （combination group） twice daily for 12 weeks （ phase Ⅰ ）. If the subjects did not achieve total-controlled effect during the phase Ⅰ treatment period, the dosage of FP would be stepped up（doubled） for another 12 weeks of treatment （phase Ⅱ ）. Otherwise, the dosage would stay unchanged in phase Ⅱ treatment period. Airway inflammatory cells counts were obtained in sputum induction and IL-4 and IL-5 were detected at 0 week, 12 week and 24 week of treatment respectively through Wright＇s staining and ELISA. Results （1） Compared with baseline, no significant change was observed in both groups for inflammatory cells counts, expression of IL-5 and IL--4 in induced sputum after phase Ⅰ treatment（P 〉0.05）. While eosinophils（ EOS）, expression of IL-5 and IL-4 in induced sputum decreased markedly in both groups after phase Ⅱ treatment （ P 〈 0.05 ）, no significant difference between FP group and combination group was observed （ P 〉 0.05 ） ; （2） At the end of phase Ⅱ treatment, EOS, IL- 5, IL-4 in induced sputum in patients who achieved well-controlled and total-controlled asthma decreased significantly from baseline（P 〈 0.05）. While no change mentioned above in patients who did not achieve asthma control was observed （P 〉 0.05）. Conclusion Combination of LABA and ICS may optimize beneficial actions in asthma control by bronchodilation action of LABA, while not by relieving airway inflamma tion with LABA.