维生素D联合丙酸氟替卡松吸入气雾剂治疗儿童支气管哮喘的效果及对睡眠质量的影响

Effect of vitamin D combined with fluticasone propionate aerosol on bronchial asthma in children and its influence on sleep quality

目的 探讨维生素D联合丙酸氟替卡松吸入气雾剂治疗儿童支气管哮喘的效果及对患儿睡眠质量的影响。方法 200例支气管哮喘患儿,随机分为对照组和观察组,每组100例。对照组患儿采用丙酸氟替卡松吸入气雾剂治疗,观察组患儿采用维生素D联合丙酸氟替卡松吸入气雾剂治疗。比较两组患儿治疗前后肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC]、免疫功能指标[白细胞分化抗原4(CD4^(+))、白细胞分化抗原8(CD8^(+))及CD4^(+)/CD8^(+)]、睡眠质量、炎性指标[白细胞介素-4(IL-4)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)]及临床疗效。结果 治疗1、3个月后,观察组患儿FEV1、FVC、FEV1/FVC分别为(1.92±0.35)L、(2.46±0.58)L、(78.05±3.65)%和(2.14±0.34)L、(2.51±0.54)L、(81.15±3.12)%,均明显高于对照组的(1.64±0.37)L、(2.25±0.31)L、(72.89±2.54)%和(1.75±0.26)L、(2.30±0.24)L、(73.45±2.51)%,差异具有统计学意义(P<0.05)。治疗1、3个月后,观察组患儿CD4^(+)、CD4^(+)/CD8^(+)分别为(39.65±6.59)%、(1.62±0.42)和(40.21±5.61)%、(1.70±0.51),高于对照组的(33.89±5.37)%、(1.16±0.37)和(34.52±5.48)%、(1.21±0.42);CD8^(+)分别为(24.53±4.25)%、(22.36±4.11)%,低于对照组的(29.08±4.81)%、(27.69±4.98)%,差异具有统计学意义(P<0.05)。治疗1、3个月后,观察组患儿匹兹堡睡眠质量指数量表(PSQI)评分及IL-4、IFN-γ、TNF-α水平分别为(2.04±0.25)分、(42.31±1.25)ng/L、(135.42±7.51)ng/L、(1.02±0.26)ng/ml和(1.86±0.21)分、(40.36±1.24)ng/L、(130.28±6.54)ng/L、(1.01±0.14)ng/ml,均低于对照组的(3.27±0.32)分、(54.92±1.65)ng/L、(151.36±8.12)ng/L、(1.41±0.28)ng/ml和(3.07±0.24)分、(50.64±1.59)ng/L、(148.26±7.54)ng/L、(1.28±0.22)ng/ml,差异具有统计学意义(P<0.05)。观察组患儿治疗总有效率为95.0%,高于对照组的81.0%,差异具有统计学意义(P<0.05)。结论 采用维生素D联合丙酸氟替卡松吸入气雾剂治疗儿童支气管哮喘,对于患儿炎性反应、睡眠质量、肺功能改善及治疗效果均具有积极作用,值得临床推广使用。

Objective To discuss the effect of vitamin D combined with fluticasone propionate aerosol on bronchial asthma in children and its influence on sleep quality.Methods A total of 200 children with bronchial asthma were randomly divided into control group and observation group,with 100 cases in each group.Children in the control group were treated with fluticasone propionate aerosol,and children in the observation group were treated with vitamin D combined with fluticasone propionate aerosol.Both groups were compared in terms of pulmonary function indexes[forced expiratory volume in one second (FEV1),forced vital capacity(FVC) and FEV1/FVC],immune function indexes[cluster of differentiation 4 positive (CD4^(+)),cluster of differentiation 8 positive (CD8^(+)) and CD4^(+)/CD8^(+)],sleep quality,inflammatory indicators[interleukin-4(IL-4),interferon-γ (IFN-γ),tumor necrosis factor-α (TNF-α)]before and after treatment,and clinical efficacy.Results After 1 and 3 months of treatment,the FEV1,FVC,and FEV1/FVC of the observation group were (1.92±0.35) L,(2.46±0.58) L,(78.05±3.65)%and (2.14±0.34) L,(2.51±0.54) L,(81.15±3.12)%,which were significantly higher than (1.64±0.37) L,(2.25±0.31) L,(72.89±2.54)%and (1.75±0.26) L,(2.30±0.24) L,(73.45±2.51)%of the control group,and the differences were all statistical significance (P<0.05).After 1 and 3 months of treatment,the CD4^(+),CD4^(+)/CD8^(+)in the observation group were (39.65±6.59)%,(1.62±0.42) and (40.21±5.61)%,(1.70±0.51),which were higher than (33.89±5.37)%,(1.16±0.37) and(34.52±5.48)%,(1.21±0.42) in the control group;the CD8^(+)in the observation group were (24.53±4.25)%and(22.36±4.11)%,which were lower than (29.08±4.81)%and (27.69±4.98)%in the control group;the differences were all statistically significant (P<0.05).After 1 and 3 months of treatment,the Pittsburgh Sleep Quality Index(PSQI) score,IL-4,IFN-γ and TNF-α in the observation group were (2.04±0.25) points,(42.31±1.25) ng/L,(135.42±7.51) ng/L,(1.02±0.26) ng/ml and (1.86±0.21) min,(40.36±1.24) ng/L,(130.28±6.54) ng/L,(1.01±0.14) ng/ml,which were lower than (3.27±0.32) points,(54.92±1.65) ng/L,(151.36±8.12) ng/L,(1.41±0.28) ng/ml and (3.07±0.24) points,(50.64±1.59) ng/L,(148.26±7.54) ng/L,(1.28±0.22) ng/ml in the control group,and the differences were all statistically significant (P<0.05).The total effective rate of children in the observation group was 95.0%,which was higher than 81.0%in the control group,and the difference was statistically significant (P<0.05).Conclusion The application of vitamin D combined with fluticasone propionate aerosol in the treatment of bronchial asthma has positive effects on children’s inflammatory response,sleep quality,pulmonary function improvement and therapeutic effect,and it is worthy of clinical promotion and application.