罗氟司特治疗糖皮质激素抵抗型支气管哮喘42例疗效评价

Efficacy of Roflumilast for Treating 42 Cases of Steroid Resistant Bronchial Asthma

目的：评价新型磷酸二酯酶-4（PDE-4）抑制剂罗氟司特治疗糖皮质激素抵抗型支气管哮喘的临床疗效。方法选择2012年1月至2013年12月糖皮质激素抵抗型支气管哮喘患者84例，按照随机数字表法分为对照组和治疗组，各42例。对照组给予氨茶碱400 mg/d口服和沙美特罗100μg/d吸入，急性发作时予沙丁胺醇200~800μg/d吸入；治疗组在上述治疗基础上联合使用罗氟司特片500μg/d。两组疗程均为30 d。评价临床疗效，记录治疗前后哮喘临床评分、血清炎性细胞因子的水平及肺功能指标的变化，以及不良反应的发生情况。结果治疗30 d后，治疗组总有效率为85.71%，显著高于对照组的35.71%（ P〈0.05）；两组患者临床哮喘评分、炎性细胞因子水平、肺功能指数均较治疗前有改善（ P〈0.05），且治疗组改善更显著（ P〈0.05）；两组不良反应发生率无明显差异（ P＞0.05）。结论罗氟司特治疗糖皮质激素抵抗型支气管哮喘的临床疗效好，且不良反应少，值得临床推广。

Objective To evaluate the clinical efficacy of roflumilast as a new phosphodiesterase -4 inhibitor in treating glucocorti-coid-resistant bronchial asthma. Methods 84 patients with glucocorticoid-resistant bronchial asthma from January 2012 to December 2013 were selected and randomly divided into the control group and the treatment group according to the random number table, 42 cas-es in each group. The control group was treated with oral aminophylline 400 mg/d and inhalation of salmeterol 100 μg/d, in acute at-tack, inhaling salbutamol 200-800μg/d. The treatment group was combined with roflumilast 500μg/d on the basis of above mentioned treatment. The course of treatment in the two groups was 30 d. The clinical effects were evaluated. The asthma clinical scores, serum levels of inflammatory cytokines and change of pulmonary function before and after treatment were recorded. The occurrence situation of adverse reactions was recorded. Results The total effective rate after 30 d treatment in the treatment group was 85. 71%, which was significantly higher than 35. 71% in the control group （ P〈0. 05 ） . The clinical asthma score, serum levels of inflammatory cytokines and lung function indices after treatment in the two groups were improved compared with before treatment （ P〈0. 05 ） , moreover the improve-ment in the treatment group was more significant, the differences between the two groups had statistical significance （ P〈0. 05 ） . The oc-currence rate of adverse reactions had no statistically significant difference （ P〉0. 05 ） . Conclusion Roflumilast has better clinical effi-cacy in treating glucocorticoid-resistant bronchial asthma and less adverse reactions, and deserves to be clinically promoted.