H_1受体拮抗剂鼻喷剂联合吸入激素对哮喘合并变应性鼻炎的疗效及其作用机制研究

Effectiveness of the Combination of H_1 Blocker Nasal Spray and Inhaled Corticosteroids in Treating Asthma Accompanied with Allergic Rhinitis and Its Underlying Mechanism

目的观察H1受体拮抗剂氮卓斯汀鼻喷剂联合吸入激素对哮喘合并变应性鼻炎的疗效,探讨其作用机制。方法 61例中、重度哮喘伴变应性鼻炎患者在规律经口吸入沙美特罗/氟替卡松粉吸入剂(50μg/250μg),2次/d,每次1吸的基础上随机给予下列治疗:A组(22例)氮卓斯汀鼻喷剂2次/d,每次两鼻孔各1喷;B组(20例)布地奈德鼻喷剂2次/d,每次两鼻孔各1喷;C组(19例)氮卓斯汀鼻喷剂2次/d,每次两鼻孔各1喷,联合布地奈德鼻喷剂2次d,每次两鼻孔各1喷。疗程均为3个月。观察3组患者的哮喘症状评分并测定诱导痰嗜酸粒细胞占有核细胞的百分比及诱导痰上清液中嗜酸粒细胞阳离子蛋白(ECP)、细胞间黏附分子-1(ICAM-1)、白介素13(IL-13)的水平变化。结果治疗后A组哮喘症状评分、诱导痰嗜酸粒细胞占有核细胞的百分比及诱导痰上清液中ECP、ICAM-1的水平与B组比较,差异均无统计学意义(P>0.05),C组治疗后哮喘症状评分及诱导痰上清液中ECP水平与A组比较,差异均有统计学意义(P<0.05)。结论在吸入激素的基础上联合应用H1受体拮抗剂鼻喷剂可抑制气道嗜酸粒细胞及ECP、ICAM-1水平,有效治疗哮喘合并变应性鼻炎,且不良反应较轻。对于顾忌鼻用激素的副作用而又认为联用两种鼻喷剂麻烦的患者可选择H1受体拮抗剂氮卓斯汀鼻喷剂联合吸入激素治疗。

Objective To investigate the effectiveness of the combination of H1 blocker nasal spray and inhaled corticosteroids in treating asthma accompanied with allergic rhinitis and explore its underlying mechanism.Methods In this study,61 patients with moderate to severe asthma accompanied with allergic rhinitis were randomized to receive either azelastine nasal spray（1 spray per nostril,twice daily）（group A）,beclomethasone nasal spray（1 spray per nostril,twice daily）（group B）,or combination with azelastine nazal spray（1 spray per nostril,twice daily） and beclomethasone nasal spray（1 spray per nostril,twice daily）（group C） on the basis of inhaled samelterol/fluticasone（50 μg/250 μg twice a day） for 3 months.The symptom scores of asthma and the amount of eosinophils in induced sputum were recorded.Eosinophilic cationic protein（ECP）,ICAM-1,and interleukin 13（IL-13） in the induced sputum supernatants were measured before and after the treatment.Results After treatment,the symptom score,induced sputum eosinophils,and induced sputum ECP/ICAM-1 levels were not significantly different between group A and group B（P0.05）;However,there was significantly better improvement in symptom score and induced sputum ECP in group C than in group A（P0.05）.Conclusion On the basis of inhaled corticosteroid,azelastine nasal spray can remarkably improve asthma symptoms and reduce induced sputum ECP and ICAM-1 levels and eosinophils in patients with asthma and allergic rhinitis.