不同剂量泼尼松联合伏立康唑对变应性支气管肺曲霉病患者肺功能及免疫球蛋白E水平的影响比较

Comparison of the effects of different doses of prednisone combined with voriconazole on lung function and IgE levels in patients with allergic bronchopulmonary aspergillosis

目的比较不同剂量泼尼松联合伏立康唑对变应性支气管肺曲霉病患者肺功能及外周血中免疫球蛋白E(IgE)水平的影响。方法选择2018年1-12月绍兴市中心医院接诊的变应性支气管肺曲霉病患者100例为研究对象,采用随机数字表法将患者分为两组,每组50例。对照组给予大剂量泼尼松(0.5 mg·kg-1·d-1)联合伏立康唑治疗,观察组采用小剂量泼尼松(0.25 mg·kg-1·d-1)联合伏立康唑治疗,两组疗程均为4周。对比治疗后的临床效果,用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC、外周血嗜酸性粒细胞(EOS)、IgE、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)及不良反应发生情况。结果观察组、对照组总有效率分别为94.00%(47/50)、68.00%(34/50),观察组高于对照组(χ2=10.981,P<0.05)。治疗前,两组FVC、FEV1、FEV1/FVC差异均无统计学意义(均P>0.05);治疗后,观察组FVC、FEV1、FEV1/FVC[(3.29±0.21)L、(1.86±0.25)L、(73.81±5.16)%]均高于对照组[(2.61±0.21)L、(1.58±0.28)L、(65.85±5.07)%],差异均有统计学意义(t=16.190、5.274、7.781,均P<0.05)。治疗前,两组外周血EOS、IgE差异均无统计学意义(均P>0.05);治疗后,观察组外周血EOS、IgE[(0.21±0.11)×109/L、(187.36±37.12)U/mL]均低于对照组[(0.34±0.14)×109/L、(689.35±40.16)U/mL],差异均有统计学意义(t=5.163、64.907,均P<0.05)。治疗前,两组TNF-α、IL-6、IL-8差异均无统计学意义(均P>0.05);治疗后,观察组TNF-α、IL-6、IL-8[(13.59±5.14)pg/L、(6.15±3.01)ng/L、(276.25±87.51)ng/L]均低于对照组[(19.48±5.01)pg/L、(10.25±3.52)ng/L、(322.27±99.74)ng/L],差异均有统计学意义(t=5.802、6.259、2.452,均P<0.05)。观察组对照组不良反应发生率分别为6.00%(3/50)、26.00%(13/50),观察组低于对照组(χ2=7.441,P<0.05)。结论在变应性支气管肺曲霉病患者中使用小剂量泼尼松联合伏立康唑效果显著,可有效改善患者肺功能及IgE水平,减少不良反应的发生。

Objective To compare the effects of different doses of prednisone combined with voriconazole on lung function and IgE levels in patients with allergic bronchopulmonary aspergillosis.Methods From January 2018 to December 2018,100 patients with allergic bronchopulmonary aspergillosis who admitted to Shaoxing Central Hospital were selected in this research.The patients were divided into two groups by the random number table method,with 50 cases in each group.The control group received high-dose prednisone combined with voriconazole,while the observation group received low-dose prednisone combined with voriconazole.The clinical effects after treatment were compared,including forced vital capacity(FVC),forced expiratory volume at the first second(FEV1),FEV1/FVC,peripheral blood eosinophilia(EOS),IgE,tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)and adverse reactions.Results After treatment,the total effective rate of the observation group was 94.00%(47/50),which was higher than 68.00%(34/50)in the control group(χ2=10.981,P<0.05).Before treatment,the FVC,FEV1,FEV1/FVC between the two groups showed no statistically significant differences(all P>0.05).After treatment,the FVC,FEV1,FEV1/FVC of the observation group[(3.29±0.21)L,(1.86±0.25)L,(73.81±5.16)%]were higher than those of the control group[(2.61±0.21)L,(1.58±0.28)L,(65.85±5.07)%],the differences were statistically significant(t=16.190,5.274,7.781,all P<0.05).Before treatment,the EOS and IgE levels in peripheral blood showed no statistically significant differences between the two groups(all P>0.05).After treatment,the peripheral blood levels of EOS and IgE[(0.21±0.11)×109/L,(187.36±37.12)U/mL]in the observation group were lower than those in the control group[(0.34±0.14)×109/L,(689.35±40.16)U/mL],the differences were statistically significant(t=5.163,64.907,all P<0.05).Before treatment,the levels of TNF-α,IL-6 and IL-8 showed no statistically significant differences between the two groups(all P>0.05).After treatment,the levels of TNF-α,IL-6 and IL-8 of the observation group[(13.59±5.14)pg/L,(6.15±3.01)ng/L,(276.25±87.51)ng/L]were lower than those of the control group[(19.48±5.01)pg/L,(10.25±3.52)ng/L,(322.27±99.74)ng/L],the differences were statistically significant(t=5.802,6.259,2.452,all P<0.05).The overall incidence of adverse reactions in the observation group was 6.00%(3/50),which was lower than 26.00%(13/50)in the control group(χ2=7.441,P<0.05).Conclusion Low-dose prednisone combined with voriconazole in the treatment of patients with allergic bronchopulmonary aspergillus has significant effect,which can effectively improve the pulmonary function and IgE level of patients,and reduce adverse reactions.