血清S1P水平在哮喘患儿治疗药物调整中的临床研究

Clinical study of serum S1P level in treatment of asthmatic children

目的探讨1-磷酸鞘氨醇(Sphingosine 1-phosphate,S1P)对于指导儿童支气管哮喘药物调整的价值。方法选取我院于2015年1月~2017年12月收治的80例非急性支气管哮喘患儿为研究对象,随机分为常规组和联合组各40例,另选取在我院体检的40例健康儿童作为对照组。两组患儿均给予吸入糖皮质激素和长效β2受体激动剂治疗,常规组根据哮喘调控水平调节治疗剂量,联合组则在常规组基础上参考血清S1P水平调整治疗剂量。比较两组患儿治疗1、3、6、9、12月后的C-ACT、肺功能指标[第一秒用力呼气容积(FEV 1)、最大呼气中期流速(MMEF)]以及药物调整情况;同时分析联合组血清S1P表达水平,及与C-ACT、肺功能指标之间的相关性。结果两组患儿血清S1P水平均高于健康对照组,差异均具有统计学意义(P<0.05);治疗过程中(治疗6个月时)常规组患儿剂量调整次数以及急性发作例数均高于联合组(P<0.05);两组患儿C-ACT、FEV 1、MMEF水平呈上升趋势(P<0.05),且联合组患儿C-ACT、FEV 1、MMEF整体上升程度高于常规组(P<0.05);治疗前期(治疗3个月内)血清S1P水平与C-ACT、FEV 1、MMEF均呈负相关(P<0.05),治疗后期(治疗3月~12月)血清S1P水平与三者无明显相关性(P>0.05)。结论哮喘治疗过程中监测血清S1P水平可有助于调整给药剂量。

Objective To investigate the value of Sphingosine 1-phosphate(S1P)in guiding drug adjustment in children with bronchial asthma.Methods 80 children with non-acute bronchial asthma who were admitted to our hospital from January 2015 to December 2017 were enrolled in the study,and they were randomly divided into the conventional standard group and the combined standard group,40 cases each.30 healthy children served as the control group.Both groups were given inhaled corticosteroids and long-actingβ2 receptor agonists.The conventional standard group adjusted the dose according to the level of asthma control.The standard group adjusted the treatment plan based on the serum S1P results on the basis of the routine standard group.The C-ACT and lung function indexes[first-second forced expiratory volume(FEV 1),maximum expiratory mid-flow velocity(MMEF)]and drug adjustment were compared between the two groups after 1,3,6,9 and 12 months of treatment.The serum S1P expression level in the standard group after treatment was also measured,and the correlation between serum S1P level and C-ACT and lung function indexes was analyzed.Results Serum S1P levels in the two groups were higher than those in the healthy control group,and the difference was statistically significant(P<0.05).During the course of treatment(at 6 months of treatment),the number of degraded and upgraded treatments and the number of acute episodes in the routine standard group were higher than those in the combined standard group(P<0.05).The levels of C-ACT,FEV 1 and MMEF in the two groups showed an upward trend(P<0.05),and the overall increase of C-ACT,FEV 1,and MMEF in the combined group was higher than that in the conventional group(P<0.05).Serum S1P level was negatively correlated with C-ACT,FEV 1 and MMEF(P<0.05)in the early stage(within 3 months of treatment),and there was no significant correlation between serum S1P level and the three indicators at the end of treatment(treatment for 3 months to 12 months)(P>0.05).Conclusion Monitoring serum S1P level during asthma treatment can help to adjust the dose administered.