不同剂量布地奈德雾化吸入对重度哮喘患儿血清细胞因子水平的影响

Influence of different doses budesonide aerosol inhalation on serum cytokines levels in children with severe asthma

目的：探讨不同剂量布地奈德雾化吸入对重度哮喘患儿血清细胞因子水平的影响。方法选择重度哮喘患儿96例，将其按照随机数字表法分为观察组和对照组，每组48例，所有患者均给予常规治疗，对照组在常规治疗基础上给予1 mg／次布地奈德混悬液治疗，每天3次，观察组在常规治疗基础上给予2 mg／次布地奈德混悬液治疗，每天3次，观察治疗前及治疗1周后两组的临床症状；并观察治疗后两组患者血清中IL-4、IFN-γ、IL-10及TNF-α的变化。结果观察组憋喘消失时间（2．10±0．77） d、咳嗽消失时间（5.45±1.20）d、哮鸣音消失时间（3．46±1．03）d、湿性啰音消失时间（5．55±1．35） d，均显著短于对照组的（2.98±1.02）d、（7．48±1．19）d、（5．43±1．06）d、（7．56±1．67）d（t＝4．77、8．32、9．23、6．48，均P＜0．01），治疗4周后观察组临床总有效率为89．6％，显著高于对照组的72．9％（χ2＝4．376，P＜0．05）；治疗后观察组IL-4（4．06±1．77）pg／mL、TNF-α（4．15±1．11）ng／mL、IL-10（12．77±2．05）pg／ml、IFN-γ（26．23±2．78）pg／mL，均较治疗前的（9．02±2．23）pg／mL、（10．21±1．30）ng／mL、（6．66±1．62）pg／mL、（17．33±2．31）pg／mL显著改变（t＝12．07、24．56、16．20、17．25，均P＜0．01），治疗后对照组IL-4（9．11±2．05） pg／mL、TNF-α（6．80±1．23）ng／mL、IL-10（9．88±2．20） pg／mL、IFN-γ（21．22±2．80） pg／mL，较治疗前的（9．11±2．05） pg／mL、（10.38±1．37）ng／mL、（6．71±1．77）pg／mL、（17．30±2．05）pg／mL显著改变（t＝5．36、13．47、7．77、7．83，均P＜0．01），但治疗后观察组IL-4、TNF-α显著低于对照组（t＝7．32、11．08，均P＜0．01），IL-10、IFN-γ显著高于对照组（t＝6．65、8．80，均P＜0．01）；两组不良反应发生率相比差异无统计学意义（χ2＝0．771，P＞0．05）。结论雾化吸入高剂量的布地奈德治疗重度哮喘患儿临床疗效确切，不良反应发生率低，值得临床推广。

Objective To discuss the influence of different doses budesonide aerosol inhalation on serum cytokines levels in children with severe asthma.Methods 96 children with severe asthma aged 4 to 14 years old in our hospital were chosen,and they were randomly divided into the observation group and the control group,48 cases in each group.All patients were given conventional treatment, and the control group was given 1mg/time budesonide treatment on the basis of conventional treatment （3 times a day）,while the observation group was given 2mg/time budesonide treatment （3 times a day）.Before and 1 week after treatment,the clinical symptoms of two groups were observed and compared,as well as the changes of IL-4,IFN-gamma,IL-10 and TNF-α.Results In the obser-vation group,wheezes,coughing,wheezy sound and rales disappearance time were （2.10 ±0.77）d,（5.45 ±1.20）d, （3.46 ±1.03）d,（5.55 ±1.35）,which were significantly shorter than （2.98 ±1.02）d,（7.48 ±1.19）d,（5.43 ± 1.06）d,（7.56 ±1.67）d in the control group （t=4.77,8.32,9.23 and 8.32,all P〈0.01）.4 weeks after treat-ment,the total effective rate of the observation group was 89.6%,which was significantly higher than 72.9% of the control group （χ2 =4.376,P〈0.05）.After treatment,the IL-4,IL-10,TNF-alpha,IFN-gamma levels in the observation group were （4.06 ±1.77）pg/mL,（12.77 ±2.05）pg/mL,（4.15 ±1.11）ng/mL,（26.23 ±2.78）pg/mL, which had significant changes compared with （9.02 ±2.23）pg/mL,（10.21 ±1.30）ng/mL,（6.66 ±1.62）pg/mL, （17.33 ±2.31）pg/mL before treatment（t=12.07,24.56,16.20,17.25,all P〈0.01）.After treatment,the IL-4, IL-10,TNF-alpha,IFN-gamma levels in the control group were （9.11 ±2.05）pg/mL,（6.80 ±1.23）ng/mL, （9.88 ±2.20）pg/mL,（21.22 ±2.80）pg/mL,which had significant changes compared with （9.11 ±2.05）pg/mL,（10.38 ±1.37） ng/mL,（6.71 ±1.77） pg/mL,（17.30 ±2.05） pg/mL before treatment（ t=5.36,13.47,7.77, 7.83,all P〈0.01）.But IL-4,TNF-alpha levels in the treatment group were significantly lower than those in the control group （t=7.32,11.08,all P〈0.01）,while IL-10 and IFN-gamma levels were significantly higher than those in the control group （t=6.65,8.80,all P〈0.01）.The incidence of adverse reactions of the two groups had no statistically significant difference （χ2 =0.771,P〉0.771）.Conclusion High doses of budesonide aerosol inhalation in the treatment of children with severe asthma has obvious clinical curative effects,which could significantly improve the patients＆#39;clinical symptoms,and also has low incidence of adverse reactions,which is worthy of clinical promotion.