肥胖对哮喘患儿吸入布地奈德疗效、肺功能及血清因子的影响

Effect of obesity on efficacy, pulmonary function and serum factors of children with asthma after inhaled Budesonide

目的观察肥胖对哮喘(BA)患儿吸入布地奈德后的疗效、肺功能及血清因子的影响。方法选取2015年1月-2016年5月该院收治的120例BA患儿,按照体重指数(BMI)将其分为正常体重组(19 kg/m2≤BMI≤25 kg/m2,57例)、超重组(25 kg/m2<BMI≤30 kg/m2,42例)及肥胖组(BMI>30 kg/m2,21例)。所有患儿均采用布地奈德抗哮喘治疗。测定神经生长因子(NGF)、白细胞介素4(IL-4)、免疫球蛋白E(IgE)、γ-干扰素(IFN-γ)、用力肺活量(FVC)、第1秒用力呼吸容积(FEV1)及最高呼吸流量(PEF),观察其疗效、不良反应。结果 (1)疗效:正常体重组总有效率为94.74%,而超重组、肥胖组有效率分别为80.95%、76.19%,3组总有效率比较,差异有统计学意义(P<0.05);(2)肺功能:3组FEV1、FVC治疗前后差值的差异有统计学意义(P<0.05),3组PEF治疗前后差值比较,差异无统计学意义(P>0.05);肥胖组血清FEV1、FVC治疗前后差值均高于超重组、正常体重组(P <0.05),超重组血清FEV1、FVC治疗前后差值均高于正常体重组(P <0.05);(3)血清因子:3组血清NGF、IL-4、IgE、IFN-γ治疗前后差值的差异有统计学意义(P <0.05);肥胖组血清NGF、IL-4、Ig E及IFN-γ治疗前后差值低于超重组、正常体重组(P <0.05),超重组血清NGF、IL-4、Ig E、IFN-γ治疗前后差值高于正常体重组(P <0.05);(4)不良反应:在治疗过程中,正常体重组不良反应发生率为7.02%,超重组、肥胖组的分别为7.14%、9.52%,3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论肥胖BA患儿吸入布地奈德治疗效果较非肥胖BA患儿差,且肺功能和血清NGF、IL-4、IgE及IFN-γ改善程度也较弱。

Objective To investigate the influence of obesity on curative effect of inhaling Budesonide in children with bronchial asthma （BA）. Methods A total of 120 children with BA admitted into our hospital from January 2015 to May 2016 were involved in this study. Patients were divided into normal weight group （19 kg/m2 to 25 kg/m2, n = 57）, overweight group （25 kg/m2 to 30 kg/m2, n = 42）, obesity group （over 30 kg/m2, n = 21） according to body mass index （BMI）. All children were inhaled with Budesonide in treatment of asthma. Nerve growth factor（NGF）, interleukin 4 （IL-4）, immunoglobulin E （IgE）, gamma interferon （IFN-gamma）, forced vital capacity （FVC）,the first second forced breathing volume （FEV1） and supreme respiratory flow （PEF） were determined. Curative efficacy and adverse reactions were recorded. Results Effective rate in normal weight group, overweight group and obesity group was 94.74%, 80.95% and 76.19%, respectively; statistically significant difference among three groups was identified （P 〈 0.05）.Treatment of Budesonide induced significant improvement of FEV1and FVC among three groups （P 〈 0.05） when compared with that prior to therapy, while no difference of PEF was observed before and post treatment.Therapeutic efficacy was compromised obviously in obesity group and overweight group compared with normal weight group （P 〈 0.05）. Treatment of Budesonide induced significant improvement of NGF, IL-4, IgE and IFN-gamma among three groups （P 〈 0.05） when compared with that prior to therapy （P 〈 0.05）. Improvement of NGF, IL-4, IgE and IFN-gamma was shrunkenin obesity group and overweight group when compared with those in normal weight group （P 〈 0.05）. Adverse reactions in normal weight group, overweight group and obesity group was 7.02%, 7.14% and 9.52%, respectively; there was no statistically significant difference incidence of adverse reactions among three groups. Conclusions Obese children with BA experience compromised therapeutic effect of inhaling Budesonide.