吸入性糖皮质激素治疗儿童支气管哮喘的局部不良反应分析

Analysis of local adverse reactions of inhaled corticosteroids in children with bronchial asthma

目的探讨吸入性糖皮质激素(ICS)治疗儿童支气管哮喘的局部不良反应。方法收集天津市儿童医院2019年10月至2020年10月支气管哮喘患儿160例,其中13例失访,予以剔除,剩余147例(男74例、女73例,年龄<6岁),按照不同种类ICS分为3组(丙酸培氯松45例、布地奈德58例、丙酸氟替卡松44例),收集观察对象临床资料(年龄、性别)。记录连续应用ICS 3个月内局部不良反应,包括口腔念珠菌病、反射性咳嗽、声音嘶哑或发声困难。比较不同种类ICS的局部不良反应。结果147例支气管哮喘患儿反射性咳嗽、声音嘶哑或发声困难、口腔念珠菌病发生率分别为40.1%(59/147)、12.9%(19/147)、29.3%(43/147)。3组支气管哮喘患儿性别、年龄比较,差异均无统计学意义(均P>0.05)。3种药物(丙酸培氯松气雾剂、布地奈德气雾剂、丙酸氟替卡松吸入气雾剂)中,反射性咳嗽发生率分别为44.4%(20/45)、48.3%(28/58)、25.0%(11/44),差异有统计学意义(P<0.05);3组支气管哮喘患儿声音嘶哑或发声困难、口腔念珠菌病发生率比较,差异均无统计学意义(均P>0.05)。结论3种常用ICS在反射性咳嗽方面具有显著差异,相比丙酸培氯松气雾剂和布地奈德气雾剂,应用丙酸氟替卡松吸入气雾剂发生反射性咳嗽较少。

Objective To explore the local adverse reactions of inhaled corticosteroids(ICS)in the treatment of children with bronchial asthma.Methods A total of 160 children with bronchial asthma were collected from Tianjin Children's Hospital from October 2019 to October 2020,of whom 13 cases were lost to follow-up and excluded,and 147 cases were remained(74 males and 73 females,aged<6 years).According to different types of ICS,the children were divided into 3 groups(45 cases with pecloxone propionate,58 cases with budesonide,and 44 cases with fluticasone propionate),and the clinical data(age and sex)of the observed subjects were collected.Local adverse reactions,including oral candidiasis,reflex cough,and hoarseness or dysphonia,were recorded within 3 months of continuous ICS usage.The local adverse reactions of different ICS were compared.Results The incidences of reflex cough,hoarseness or dysphonia,and oral candidiasis were 40.1%(59/147),12.9%(19/147),and 29.3%(43/147),respectively.There were no statistically significant differences in the gender and age among the three groups(both P>0.05).The incidence of reflex cough was 44.4%(20/45),48.3%(28/58),and 25.0%(11/44)among the three drugs(pecloxone propionate aerosol,budesonide aerosol,and fluticasone propionate inhalation aerosol),with a statistically significant difference(P<0.05);there were no statistically significant differences in the incidences of hoarseness or dysphonia and oral candidiasis among the three groups(both P>0.05).Conclusions There is a significant difference in reflex cough among the three commonly used glucocorticoids.Compared with pecloxone propionate aerosol and budesonide aerosol,fluticasone propionate inhalation aerosol has fewer reflective cough.