药物基因检测指导儿童哮喘个体化治疗的临床观察

Clinical observation of pharmacogenetic testing to guide individualized treatment of asthma in children

目的观察与评价药物基因检测指导儿童哮喘个体化治疗的临床疗效。方法选取2019年1-4月福建省福州儿童医院变态反应科门诊非急性发作期轻-中度过敏性哮喘儿童,根据哮喘药物基因检测结果,分为吸入型糖皮质激素治疗实验组和白三烯调节剂治疗实验组各20例,进行相应的哮喘个体化治疗,随访6个月,分别与未进行基因检测给予吸入型糖皮质激素和白三烯调节剂治疗的对照组在呼出气一氧化氮(FeNO)、儿童哮喘控制测试(C-ACT)评分、肺功能FEV1%、PEF、FEF25%、FEF50%、FEF75%、呼吸道感染次数、儿童误学天数等指标进行比较分析。结果 1、吸入型糖皮质激素治疗实验组C-ACT评分和肺功能FEV1%、PEF、FEF25%指标疗效明显优于对照组,差异有统计学意义(P<0.05);实验组FeNO和肺功能FEF50%、FEF75%指标与对照组差异无统计学意义(P>0.05)。2、白三烯调节剂治疗实验组C-ACT评分和肺功能FEV1%,PEF指标疗效明显优于对照组,差异有统计学意义(P<0.05);实验组FeNO和肺功能FEF25%、FEF50%、FEF75%指标与对照组差异无统计学意义(P>0.05)。3、随访6月,吸入型糖皮质激素治疗实验组感染次数和误学天数较对照组明显下降,差异有统计学意义(t=4.461,7.259,P<0.05),白三烯调节剂治疗实验组与对照组间感染次数和误学天数差异无统计学意义(P>0.05)。结论药物基因检测是实现哮喘个体化治疗的方向,但目前国内临床相关资料有限,有待大样本量研究以提供更可靠的临床数据。

Objective To observe and evaluate the clinical efficacy of individualized treatment of childhood asthma under the guidance of pharmacogenetic testing. Methods Children with acute exacerbation of mild-moderate allergic asthma were enrolled in this study from Department of Allergy of Fuzhou Children′s Hospital from January to April in 2019.According to the results of pharmacogenetic testing,children were divided into inhaled glucocorticoid experimental group and leukotriene modulator experimental group,with 20 cases in each group.Corresponding individual asthma treatment was carried out in two groups.The indicators were compared with the control group without genetic testing after follow-up for six months,including fractional exhaled nitric oxide(FeNO),children asthma control test(C-ACT) score,pulmonary function FEV1%,PEF,FEF25%,FEF50%,FEF75%,the number of respiratory infections and the number of children′s missing days of school. Results 1、 The inhaled glucocorticoid treatment experimental group was significantly better than the control group in C-ACT score and pulmonary function FEV1%,PEF,FEF25% indicators(P<0.05).FeNO and pulmonary function FEF50%,FEF75% in the experimental group were not significantly different from those in the control group(P>0.05).2、The leukotriene modulator treatment experimental group had a significantly better C-ACT score and pulmonary function FEV 1%,and the PEF index was significantly better than the control group(P<0.05).FeNO and lung function FEF25%,FEF50%,FEF75% in the experimental group were not statistically different from those in the control group(P>0.05).3、 During the follow-up for 6 months,the number of infections and missing days of school in the inhaled glucocorticoid treatment experimental group were significantly lower than those in control group(t=4.461,7.259,P<0.05),but the differences were not significant between the leukotriene modulator treatment experimental group and the control group(P>0.05). Conclusions Pharmacogenetic testing is the direction to achieve individualized treatment of asthma.Currently there are limited clinical data in China,so large sample studies are warranted to provide more reliable clinical data.