长期吸入布地奈德治疗尘螨过敏性哮喘的疗效分析

Efficacy of inhaled budesonide in long-term treatment of dust mite allergic asthma

目的观察布地奈德长期规律吸入对治疗轻、中度慢性持续期尘螨过敏性哮喘的疗效，并探讨可能的疗效预测指标。方法50例轻、中度慢性持续期尘螨过敏性哮喘患者，规律吸人布地奈德1年，治疗前后分别进行哮喘控制评分（asthmacontrolquestionnaire，ACQ）、肺功能测定、尘螨特异性IgE测定、外周血嗜酸粒细胞百分比（EOS％）测定、IL-4、IL—12水平测定。结果①组间细胞因子比较：哮喘组治疗前血清IL-4、IL—12分别为（47．98±19．94）ng／L、（43．74±14．91）ng／L，健康对照组分别为（25．53±16．60）ng／L、（73．10±16．81）ng／L，哮喘组IL-4高于健康对照组，IL-12低于健康对照组，差异有统计学意义（P〈0．05）。②布地奈德长期治疗效果：哮喘组中有46例顺利完成了为期12个月的治疗。治疗前后比较发现治疗后ACQ评分、血EOS％、户尘螨sIgE、粉尘螨sIgE、尘螨总sIgE、血清IL-4明显降低，血清IL-12、FEV1、FEV1／FVC、FEV1％pred、PEF％pred明显升高，差异均有统计学意义（P〈0．05）。以FEV。改善率12％为治疗有效判断指标，布地奈德长期吸人总体有效率86．96％。③基线ACQ评分、EOs％、IL-12与布地奈德疗效的关系：以基线ACQ评分〈7、EOS％≥5％、IL-12≥32ng／L作为布地奈德长期疗效的预测指标，其灵敏度分别为75％、70％、87．5％，阴性预测值分别为33．33％、25％、50％。结论轻、中度尘螨过敏性哮喘患者吸入布地奈德治疗1年疗效显著，基线血清IL-12不高是长期吸入激素治疗效果差的良好预测指标。

Objective To observe the efficacy of inhaled budesonide in the long-term therapy of mild-moderate dust mite allergic asthma and to explore the possible predictors for budesonide efficacy. Methods 50 outpatients were screened and recruited with mild-moderate dust mite allergic asthma. Before and after the test, ACQ scores, dust mite-specific IgE, EOS% and pulmonary function were respectively measured and the IL-4, IL-12 levels in serum were measured. Results （i） Differences of eytokines among groups： IL 4, IL-12 serum levels were different between the 2 groups： asthma group.. （47.98± 19.94） ng/L, （43. 74±14. 91） rig/L, health control group： （25.53±16.60） ng/L,（73.10± 16.81） ng/L. In asthma group, IL-4 serum level was significantly higher than that of health control group, however IL-12 serum level was significantly lower （ P 〈0.05）. （DEfficacy of long-term inhaled budesonide：46 patients completed a long-term therapy lasting 12 months. The differences of the baseline ACQ score, blood EOSG, house dust mite sIgE, dermatophagoides eulinae sIgE, total dust mite sIgE, serum IL 4, IL-12, FEVI, FEV1/FVC, FEVI %pred, PEF1pred between the previous and latter were all statistically significant （ P 〈0.05）. The overall effective rate of long-term inhaled budesonide was 86.96% by the standard of FEV1 improved 12%. （3） Relationship between baseline ACQ score, EOS1, IL-12 and the efficacy of budesonide：IL-12 had the highest sensitivity （87.5%） compared with ACQ score （75G） and EOSG （70%）, and was the highest negative predictive value （50G） compared with ACQ score （33.33%） and EOS1 （25%）. Conclusions Long-term inhaled budesonide showed significant effect in mild-moderate dust mite allergic asthma. Low baseline IL-12 serum level was a good predictor for poor corticosteroid effect.