质子泵抑制剂联合甲氧氯普胺和布地奈德治疗胃食管反流病相关哮喘的临床疗效

Proton pump inhibitors in combination with metoclopramide and budesonide for the treatment of gastroesophageal reflux disease associated asthma

目的探讨质子泵抑制剂(PPIs)联合甲氧氯普胺和布地奈德治疗胃食管反流病(GERD)相关哮喘的临床疗效及安全性。方法将130例GERD相关哮喘患者随机分为观察组(PPIs+甲氧氯普胺+布地奈德,n=65)与对照组(甲氧氯普胺+布地奈德,n=65)。对比2组治疗总有效率、症状积分、肺功能指标、食管24 h pH监测情况、血清胃蛋白酶原Ⅰ(PGⅠ)水平、沙丁胺醇使用率和不良反应发生率。结果观察组治疗总有效率高于对照组(81.54%vs 64.62%,P<0.05)。2组治疗后哮喘症状积分及GER症状积分均下降(P<0.05),且观察组下降程度高于对照组(P<0.05)。2组治疗后用力肺活量占预计值百分比、第1秒用力呼气容积占预计值百分比及最大呼气峰流速均增高(P<0.05),且观察组增高幅度更为明显(P<0.05)。2组治疗后pH<4反流次数、最长反流时间、酸性反流指数和血清PGⅠ水平均较治疗前下降(P<0.05),且观察组上述指标数值均明显低于对照组(P<0.05)。2组治疗后沙丁胺醇使用率下降,且观察组下降更显著(P<0.05)。2组治疗过程中均未发生严重不良反应,部分患者出现恶心、头晕、困倦无力等轻度不良反应,均为一过性,未影响检查和治疗。结论PPIs联合甲氧氯普胺和布地奈德治疗GERD相关哮喘的效果优于甲氧氯普胺联合布地奈德,且安全性较高。

AIM To explore the effects and security of proton pump inhibitors(PPIs)in combination with metoclopramide and budesonide for the treatment of gastroesophageal reflux disease(GERD)associated asthma.METHODS Totally 130 GERD patients with asthma randomly were divided into observation group(PPIs+metoclopramide+budesonide,n=65)and control group(metoclopramide+budesonide,n=65).The differences of total effective rate,symptom integral,pulmonary function index,24 h esophageal pH monitoring situation,serum pepsinogenⅠ(PGⅠ)level,salbutamol utilization rate and adverse drug reactions were compared between 2 groups.RESULTS The overall effective rate in the observation group was higher than that in the control group(81.54%vs 64.62%,P<0.05).Asthma symptom score and GERD symptom score were decreased after treatment in 2 groups(P<0.05),but the improvement in the observation group was better than that in the control group(P<0.05).The percentage of forced vital capacity,forced expiratory volume in one second and peak expi-ratory flow in 2 groups were increased after treatment(P<0.05),and the increased degree of the observation group was more significantly than that of the control group(P<0.05).After treatment,number of pH<4 reflux,the longest reflux time,acid reflux index and PGⅠserum level were decreased in 2 groups(P<0.05),and the above indexes in the observation group were significantly lower than those in the control group(P<0.05).The usage rate of albuterol was decreased after treatment in 2 groups,and the decrease in the observation group was more significant(P<0.05).No serious adverse drug reactions occurred during the treatment in 2 groups,and some patients had mild adverse drug reactions such as nausea,dizziness,drowsiness and weakness,which were transient and did not affect the examination and treatment.CONCLUSION PPIs combined with metoclopramide and budesonide are more effective than metoclopramide combined with budesonide in the treatment of GERD-related asthma,and with higher safety.