不同剂量糖皮质激素治疗老年哮喘急性发作的对比研究

Comparative of Different Doses of Corticosteroids in Elderly Asthma Acute Attack Patients

目的:探讨不同剂量吸入型糖皮质激素(ICS)治疗老年哮喘急性发作的疗效及安全性分析。方法:将108例老年哮喘急性发作患者随机分为A组(34例)、B组(38例)和C组(36例),分别吸入布地奈德200μg/d、400μg/d、800μg/d;治疗3个月后再随机分为低剂量组(200μg/d,n=)和高剂量组(400μg/d)进行维持治疗,并随访观察12个月。结果:治疗3个月后,三组的临床症状评分、肺功能较治疗前均有显著改善,差异有统计学意义(P<0.05);B组、C组治疗后的临床症状评分、肺功能及症状消失时间均显著优于A组,而B组、C组之间差异无统计学意义(P>0.05);A组和B组不良反应的发生率分别为5.9%,10.5%,显著低于C组30.6%,差异有统计学意义(P<0.05);维持治疗期间,低剂量组复发率为21.2%,高剂量组为20.4%,差异无统计学意义(P>0.05)。结论:老年哮喘急性发作患者给予ICS 400μg/d治疗剂量及200μg/d维持剂量即可取得较好的治疗效果,可减少不良反应,提高患者的耐受性。

Objective： To explore the clinical effect and safety of different doses corticosteroids on the treatment of elderly bronchial asthma acute attack patients. Methods： 108 patients with bronchial asthma acute attack were randomly divided into three groups including A group （n=34）, B group （n=38） and C group （n=36）, which inhaled budesonide for 200μg/d, 400μg/d and 800μg/d, respectively. After 3 months treatment, the patients were divided randomly into two groups including low dose group （200μg/d, n=54）, high dose group （400μg/d, n=54）, which inhaled 200μg/d and 400 μg/d of maintenance doses budesonide, and all the cases were fol- lowed-up for 12 month. Results： After treatment for 12 months, the symptoms scores, lung function were significantly different from those before treatment. There was significantly difference between B group and A group in the symptoms scores, lung function and the time of the symptoms disappeared （P〈0.05）. The situation was the same between C group and A group, and there was significant differ- ence between B group and C group （P〉0.05）. The rate of side effect in A group and B group were 5.9% and 10.5%, respectively, which was significantly lower in A group than C group （P〈0.05）. During the maintenance treatment, the recurrence rate in low dose group and high dose group was not statistically different （21.2% vs.20.4%）. Conclusions： The treatment doses of 400~g/d and maintenance doses of 2001.Lg/d for elderly bronchial asthma acute attack patients could be effective to reduce the side effect and improve patients＇ tolerance.