雾化吸入高剂量布地奈德治疗重度哮喘患儿的临床疗效及对其血清细胞因子水平的影响

Clinical efficacy of high dose of budesonide aerosol inhalation on severe asthma and serum cytokine levels

目的 探讨雾化吸入高剂量布地奈德治疗重度哮喘（BA）患儿的临床疗效及对其血清细胞因子水平的影响。 方法 选取重度BA患儿114例，根据治疗方案不同分为两组，每组57例。在常规治疗基础上对照组给予1 mg/次布地奈德雾化吸入治疗，观察组给予2 mg/次高剂量布地奈德雾化吸入治疗。统计两组临床疗效及不良反应发生率，对比治疗前后肺功能指标[1 s用力呼气容积/用力肺活量（FEV1/FVC）、1 s用力呼气容积占预计值的百分比（FEV1%）、呼气峰值流速（PEF）]、血清细胞因子[肿瘤坏死因子（TNF-α）、白细胞介素-17（IL-17）、白细胞介素-33（IL-33）、白细胞介素-10（IL-10）]及免疫功能指标[T淋巴细胞亚群（CD3＋、CD4＋、CD4＋/CD8＋）]水平。 结果 观察组治疗总有效率（94.74%）高于对照组（82.46%），差异有统计学意义（P〈0.05）。治疗前，两组FEV1%、FEV1/FVC、PEF水平比较差异未见统计学意义（P〉0.05）；治疗后，观察组FEV1%、FEV1/FVC、PEF水平高于对照组，差异有统计学意义（P〈0.05）。治疗前，两组TNF-α、IL-17、IL-33、IL-10水平比较差异未见统计学意义（P〉0.05）；治疗后，观察组TNF-α、IL-17、IL-33水平低于对照组，IL-10高于对照组，差异有统计学意义（P〈0.05）。治疗前，两组CD3＋、CD4＋、CD4＋/CD8＋水平差异未见统计学意义（P〉0.05）；治疗后，观察组CD3＋、CD4＋、CD4＋/CD8＋水平高于对照组，差异有统计学意义（P〈0.05）。观察组不良反应发生率（12.28%）与对照组（8.77%）比较，差异未见统计学意义（P〉0.05）。 结论 给予重度BA患儿高剂量布地奈德雾化吸入治疗，可有效改善患儿肺功能，调节血清细胞因子水平，提高免疫功能，临床效果显著，且具有一定安全性。

Objective To investigate the clinical efficacy of high dose of budesonide aerosol in- halation on severe asthma （BA） in children and its effect on serum cytokine levels. Methods A total of 114 cases of severe BA were selected, and they were divided into observation group and control group ac- cording to the therapeutic regimen, with 57 cases in each group. The control group was given 1 mg/time budesonide aerosol inhalation treatment on the basis of routine treatment, the observation group was given 2 mg/time high dose of budesonide inhalation treatment. The clinical efficacy and incidence of adverse reactions, the lung function indexes[ 1 second rate （FEV1/FVC）, forced expiratory volume and percent- age of predicted value （FEVI%）, peak expiratory flow rate （PEF） ] , serum cytokines [ tumor necrosis factor alpha （TNF-alpha） and interleukin-17 （ IL-17 ）, interleukin-33 （ IL-33 ）, interleukin-10 （IL-10） ] and immune function indexes [ T lymphocyte subsets （ CD3 ＋ , CD4 ＋ , CD4 ＋/CD8 ＋ ） ] levels were com- pared. Results The total effective rate of the observation group was 82.46%, which was higher than that of the control group （94.74%）, and the difference was significant （P 〈 0. 05 ）. Before treatment, the differences among FEV1%, FEV1/FVC PEF levels were not significant （ P 〉 0. 05 ） ; after treatment, the FEV1%, FEV1/FVC, PEF levels in the observation group, the differences were significant （P 〈 0. 05 ）. Before group were higher than treatment, there was no those in the control significant difference in TNF-α, IL-17, IL-33, IL-10 levels between the two groups （P 〉 0. 05）. After treatment, TNF-α, IL-17, IL-33 levels were lower in the observation group than those in the control group, and IL-IO level was higher than that in the control group, the differences were significant （ P 〈 0. 05 ）. Before treatment, there was no significant difference in CD3 ＋ , CIM ＋ , CD4 ＋/CD8 ＋ levels between the two groups （ P 〉 0.05）; after treatment, CD3 ＋, CD4 ＋, CD4 ＋/CD8 ＋ levels were higher in the observation group than those in the control group, the differences were significant （ P 〈 0. 05 ）. The incidence of adverse reac- tions was 12.28% in the observation group, and 8.77% in the control group, the difference was not sig- nificant （P 〉 0. 05）. Conclusions High dose of budesonide inhalation therapy for children with severe BA can effectively improve the pulmonary function in children, regulate the serum cytokine levels, im- prove the immune function, and has remarkable clinical effect and safety.