维生素D联合脾氨肽用于小儿支气管哮喘并反复呼吸道感染辅助治疗的疗效观察

Observation on the efficacy of vitamin D combined with splenic aminopeptide in adjuvant treatment of children with bronchial asthma combined with recurrent respiratory tract infection

目的观察维生素D联合脾氨肽用于小儿支气管哮喘(BA)并反复呼吸道感染(RRTI)辅助治疗的临床疗效。方法选择2018年1月—2020年1月本院小儿呼吸科就诊的108例BA合并RRTI患儿作为研究对象,按随机数表法平均分为对照组和观察组两组,每组各54例。对照组患儿在常规治疗的基础上给予脾氨肽治疗,观察组患儿在对照组治疗基础上加用维生素D。比较两组患儿临床症状缓解时间;比较两组患儿治疗前后肺功能[第1秒用力呼气量(FEV1)、用力肺活量(FVC)、最大呼气流速(PEF)]、T细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、免疫球蛋白(IgA、IgG)和气道重塑指标[基质金属蛋白酶-2(MMP-2)、金属蛋白酶组织制剂-2(TIMP-2)、转化生长因子-β1(TGF-β1)]水平;比较两组患儿治疗前1年及治疗后1年内支气管哮喘发作次数和呼吸道感染发作次数;统计不良反应发生率。结果观察组患儿咳嗽、憋喘、气促、肺哮鸣音等症状缓解时间均早于对照组,差异均具有统计学意义(P<0.05);治疗后,两组患儿的FEV1、FVC、PEF水平均上升,差异具有统计学意义(P<0.05);且观察组患儿的FEV1、FVC、PEF水平高于对照组,差异具有统计学意义(P<0.05);治疗后,两组患儿的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均上升,差异具有统计学意义(P<0.05);且观察组患儿的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,差异具有统计学意义(P<0.05);治疗后,两组患儿的IgA、IgG水平均上升,差异具有统计学意义(P<0.05);且观察组患儿的IgA、IgG水平高于对照组,差异具有统计学意义(P<0.05);治疗后,两组患儿的MMP-2、TIMP-2、TGF-β1水平均下降,差异具有统计学意义(P<0.05);且观察组患儿的MMP-2、TIMP-2、TGF-β1水平均低于对照组,差异具有统计学意义(P<0.05);治疗后1年内,两组患儿支气管哮喘和呼吸道感染发作频率较治疗前均下降,差异具有统计学意义(P<0.05);且观察组患儿支气管哮喘和呼吸道感染发作频率低于对照组,差异具有统计学意义(P<0.05);两组患儿不良反应发生率(1.85%,1.85%)无组间差异(P>0.05)。结论维生素D联合脾氨肽用于小儿BA并RRTI辅助治疗可取得良好疗效,能有效改善患儿症状,提高患儿肺功能、免疫功能,且能逆转气道重塑,避免患儿病情反复发作。

Objective To observe the clinical efficacy of vitamin D combined with splenic aminopeptide in adjuvant treatment of children with bronchial asthma(BA)combined with recurrent respiratory tract infection(RRTI).Methods A total of 108 children with BA combined with RRTI who were admitted to the pediatric respiratory department of Luohe second people's hospital from January 2018 to January 2020 were enrolled as study subjects and they were divided into control group(n=54)and observation group(n=54)according to random number table method.The control group was treated with splenic aminopeptide on the basis of conventional treatment,and the observation group was treated with vitamin D on the basis of the control group.Clinical symptom relief time of the two groups,lung function[forced expiratory volume in one second(FEV1),forced vital capacity(FVC),Maximum expiratory velocity(PEF)],T cell subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),immunoglobulin(IgA,IgG)and airway remodeling indexes[Matrix metalloproteinase-2(MMP-2),Tissue inhibitor of metalloproteinase-2(TIMP-2),Transforming growth factor-β1(TGF-β1)]were compared between the two groups before and after treatment.The frequency of attacks of bronchial asthma and respiratory tract infection at one year before treatment and within 1 year after treatment were compared between the two groups.The incidence of adverse reactions was calculated.Results The alleviating time of cough,breathlessness,shortness of breath,wheezing in group B was earlier than that in group A(P<0.05).Compared with before treatment,the levels of FEV1,FVC and PEF in both groups increased(P<0.05),and the levels of FEV1,FVC and PEF in observation group were higher than those in control group after treatment(P<0.05).Compared with before treatment,the levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) increased in both groups,and the levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) in observation group were higher than those in control group after treatment(P<0.05).Compared with before treatment,the levels of IgA and IgG in both groups increased,and the levels of IgA and IgG in observation group were higher than those in control group after treatment(P<0.05).Compared with before treatment,the levels of MMP-2,TIMP-2 and TGF-β1 in 2 groups decreased,and the levels of MMP-2,TIMP-2 and TGF-β1 in observation group were lower than those in control group after treatment(P<0.05).Within 1 year after treatment,the attack frequency of bronchial asthma and respiratory tract infection in both groups decreased compared with before treatment,the attack frequency of bronchial asthma and respiratory tract infection in observation group was lower than that in control group(P<0.05).There was no difference in the incidence of adverse reactions between the two groups(1.85%vs 1.85%),P>0.05.Conclusions Application of Vitamin D combined with spleen aminopeptide in pediatric BA combined with RRTI adjuvant therapy could achieve good efficacy,effectively improve the symptoms of children,improve the lung function,immune function,and could reverse the remodeling of the airway,avoid repeated attacks of the disease in children.