维生素D辅助布地奈德联合复方异丙托溴铵对哮喘患儿肺功能及免疫功能的影响

Effects of vitamin D combined with budesonide and ipratropium bromide on pulmonary function and immune function in children with asthma

目的探讨维生素D辅助布地奈德联合复方异丙托溴铵治疗对哮喘患儿肺功能及免疫功能的影响。方法82例哮喘患儿随机分为2组各41例。对照组采用布地奈德联合复方异丙托溴铵联合治疗,研究组在对照组基础上加用维生素D治疗。比较2组患儿疗效、肺功能指标[呼气峰值流速(PEF)、第1秒用力呼气容积(FEV 1)、用力肺活量(FVC)]、主要临床症状(咳嗽、喘息、肺部啰音)消失时间、血清25-羟基维生素D 3[25-(OH)-D 3]、总免疫球蛋白E(IgE)以及CD4^+、CD8^+、CD4^+/CD8^+水平。分析维生素D与PEF、FEV 1、FVC、IgE、CD4^+、CD8^+、CD4^+/CD8^+的相关性。结果研究组总有效率显著高于对照组(P<0.01)。研究组治疗后PEF、FEV 1、FVC均显著优于对照组(P<0.05)。研究组咳嗽及肺部啰音的消失时间显著短于对照组(P<0.05)。研究组血清25-OH-D 3、CD4^+、CD4^+/CD8^+水平显著高于对照组(P<0.05或P<0.01),IgE、CD8^+水平显著低于对照组(P<0.01)。Pearson相关性分析显示,维生素D水平与IgE水平呈负相关,与CD4^+/CD8^+水平呈正相关。结论在布地奈德联合复方异丙托溴铵雾化吸入治疗的基础上,给予维生素D可提高治疗有效率,改善肺功能相关指标,增强患儿机体免疫力,缓解气道炎症反应。

Objective To explore effects of vitamin D combined with budesonide and ipratropium bromide on pulmonary function and immune function in children with asthma. Methods Totally 82 children with asthma were randomly divided into two groups,with 41 cases in each group.The control group was treated with budesonide combined with compound ipratropium bromide,while the study group was treated with vitamin D on the basis of the control group. The curative effect,lung function indexes [peak expiratory flow(PEF),maximum expiratory volume in the first second(FEV1),forced vital capacity(FVC) ],disappearance time of main clinical symptoms(cough,wheeze,lung rale),serum 25-hydroxyvitamin D3[25-(OH)-D3],total immunoglobulin E(IgE),CD4+,CD8+,CD4+/CD8+levels were compared between the two groups. Correlation between vitamin D and PEF,FEV1,FVC,IgE,CD4+,CD8+,CD4+/CD8+were analyzed. Results The total effective rate in the study group was significantly higher than that in the control group(P < 0. 05).After treatment,PEF,FEV1 and FVC in the study group were significantly better than those in the control group(P < 0. 05). The disappearance time of cough and lung rale in the study group was significantly shorter than that in the control group(P < 0. 05). The levels of serum 25-OH-D3,CD4+,CD4+/CD8+in the study group were significantly higher than those in the control group(P < 0. 05),and the levels of IgE and CD8+in the study group were significantly lower than those in the control group(P < 0. 05). Pearson correlation analysis showed that vitamin D level was negatively correlated with IgE level and positively correlated with CD4+/CD8+. Conclusion On the basis of budesonide combined with compound ipratropium bromide aerosol inhalation therapy,vitamin D can improve the efficiency,improve the relevant indicators of pulmonary function,enhance the immunity of children and alleviate airway inflammation.