多因素干预毛细支气管炎后喘息的疗效及对血嗜酸性粒细胞和免疫球蛋白E的影响

Curative effect of multiple factors intervention breathing after capillary bronchitis and the influence of blood eosinophil and immunoglobulin E

目的 探讨多因素干预对毛细支气管炎后喘息的疗效及对血嗜酸性粒细胞（EOS）和免疫球蛋白E（IgE）的影响.方法 收集2009年6月～2012年8月浙江省丽水市人民医院儿科门诊及病房收治的毛细支气管炎患儿122例,将其分为对照组27例、干预Ⅰ组28例、干预Ⅱ组32例、干预Ⅲ组35例.四组治疗包括常规的抗病毒、抗感染、解痉、平喘、必要时吸痰等对症治疗.临床治愈后,对照组无干预措施;干预Ⅰ组予布地奈德混悬液,雾化吸入,1次/d,疗程1个月;干预Ⅱ组予孟鲁司特钠咀嚼片,1次/d,睡前口服,疗程3个月;干预Ⅲ组在干预Ⅰ组和干预Ⅱ组基础上加用匹多莫德口服液口服,1支/次,1次/d,疗程2个月.随访1年,记录各组喘息次数及哮喘发生情况,同时监测血清总IgE和EOS计数的变化.结果 6、12个月随访结果显示,于预Ⅰ、Ⅱ、Ⅲ组的喘息次数明显低于对照组,差异有统计学意义（均P＜ 0.05）,哮喘发生率亦明显低于对照组（均P＜0.05）,其中随访12个月,干预Ⅲ组喘息次数[（0.8±0.3）次]低于干预Ⅰ组[（1.7±0.4）次]、干预Ⅱ组[（1.6±0.3）次],差异均有统计学意义（t=2.58,2.93,P＜0.05）,干预Ⅲ组哮喘发生率（11.42％）低于干预Ⅰ组（32.14％）、干预Ⅱ组（21.87％）,差异均有统计学意义（x2=4.75,3.88,P＜0.05）.干预Ⅰ、Ⅱ、Ⅲ组血清总IgE低于对照组（均P＜0.05）,且干预Ⅲ组低于干预Ⅰ、干预Ⅱ组（均P＜ 0.05）,其中随访12个月,干预Ⅰ、Ⅱ、Ⅲ组血清总IgE[（123.55±122.43）、（126.69±95.81）、（65.30±68.20） μg/L]明显低于治疗前[（290.21±122.12）、（291.10±142.25）、（286.20±152.10）μg/L],差异均有高度统计学意义（t=3.40,3.62,5.32,均P＜0.01）;对照组随访前后有下降,但差异无统计学意义（t=1.56,P＞0.05）.EOS计数干预后有下降,仅干预Ⅲ组随访6、12个月[（0.34±0.11）×10^9/L、（0.29±0.07）×10^9/L]低于治疗前[（0.56±0.09）×10^9/L],差异均有统计学差义（t=2.34,2.72,P＜ 0.05）.结论 采用布地奈德雾吸、孟鲁司特和匹多莫德口服等综合干预措施,可降低血清IgE水平,降低气道高反应性,减少临床治愈后发生反复喘息和哮喘的概率,有效改善婴儿毛细支气管炎的预后,值得广泛推广应用.

Objective To study the curative effect of multiple factors intervention breathing after capillary bronchitis and the influence of blood eosinophils（EOS） and the impact of immunoglobulin E（Ig E）. Methods 122 cases patients with capillary bronchitis from June 2009 to August 2012 in Pediatric Department Outpatient and hospitalization of the People＇s Hospital of Lishui City were collected and divided into control group of 27 cases and the intervention group Ⅰof 28 cases, the intervention group Ⅱof 32 cases, intervention group Ⅲ of 35 cases. Treatment of four groups including conventional antiviral, anti-inflammatory, spasmolysis, smooth wheezing, sputum suction and other symptomatic treatment when necessary. After clinical cure, the control group was given no intervention; intervention group Ⅰ was given the Budesonide Suspension Liquid, aerosol inhalation, one time a day, one month; intervention Ⅱ group was given Montelukast Chewable Tablets, one time a day, before sleeping, oral, treatment course was 3 months; intervention Ⅲgroup on the basis of intervention group Ⅰ and the intervention Ⅱ was added Pidotimod Oral Liquid, one time a day,treatment course was 2 months. Follow-up of 1 year,the number of wheezing and asthma were recorded,and the change of serum total Ig E and EOS count were monitored. Results 6 months and 12 months follow-up, breathing times in intervention group Ⅰ, Ⅱ, Ⅲ were obviously lower than those in the control group, differences were statistically significant（all P 〈0.05）, the incidence of asthma were significantly lower than those in the control group（all P 〈0.05）; among them were followed up for 12 months, breathing number times in intervention group Ⅲ [（0.8±0.3） times]was lower than that in intervention group Ⅰ [（1.7±0.4） times] and intervention Ⅱ group [（1.6±0.3） times], with statistically significant differences（t = 2.58, 2.93, all P 〈0.05）, asthma incidence in intervention group Ⅲ（11.42%） was lower than that in intervention group Ⅰ（32.14%） and intervention Ⅱ group（21.87） %, differences were statistically significant（χ2=4.75, 3.88, all P 〈0.05）. 6 months and 12 months follow-up, serum total Ig E in intervention Ⅰ, Ⅱ, Ⅲ group were lower than those in the control group（all P 〈0.05）, and intervention Ⅲ was lower than that in intervention Ⅰ, Ⅱgroup（all P 〈0.05）; including 12 months follow-up, serum total Ig E in intervention Ⅰ, Ⅱ, Ⅲ group [（123.55±122.43）,（126.69 ±95.81）,（65.30 ±68.20） μg/L] were significantly lower than those before treatment [（290.21 ±122.12）,（291.10 ±142.25）,（286.20±152.10） μg/L], there were significant differences statistically significant（t = 3.40, 3.62, 5.32, all P〈 0.01）; there was a decrease in the control group before and after the follow-up, but no statistical significance（t = 1.56,P 〉0.05）. EOS count after intervention had dropped, only intervention Ⅲ group [（0.34±0.11）×10^9/L,（0.29±0.07）×10^9/L]were lower than those before treatment（0.56±0.09）×10^9/ L], with statistically difference of righteousness（t = 2.34, 2.72,P 〈0.05）. Conclusion Budesonide fog suction, Montelukast and Pidotimod oral comprehensive intervention measures,such as more can reduce serum Ig E levels, reduce airway hyperresponsiveness, reduce the risk of recurrent wheeze and asthma in the aftermath of the clinical cure, effectively improve the prognosis of infant capillary bronchitis and is worth wide application.