变应性鼻炎合并哮喘患者糖皮质激素鼻吸入治疗对哮喘发作的影响

Effect of glucocorticoid inhalation on asthmatic attack in patients with allergic rhinitis complicated by asthma

目的 研究鼻局部吸入糖皮质激素治疗变应性鼻炎对哮喘发作的影响。探讨糖皮质激素治疗前后检测鼻分泌物和痰液中炎性标志物作为评价变应性鼻炎合并哮喘气道炎症的临床价值。方法 采用酶联免疫吸附法 (ELISA)分别测定鼻吸入糖皮质激素治疗前后鼻分泌物和痰液中白细胞介素 ,IL - 5、IL - 4、IgE水平和FEV1、气道反应性、临床症状及体征计分 ,进行嗜酸细胞 (Eos)计数。结果 糖皮质激素治疗后 ,鼻炎的鼻分泌物中Eos计数由 (10 9± 2 4 )× 10 -2  (3 8± 0 73)× 10 -2 ;IL- 5浓度由 (12 .8± 0 .77)ng/L (3.2± 0 .98)ng/L ;IL - 4浓度由 (5 2 3± 15 8)pg/L (18 5± 3 7)pg/L ;IgE浓度由 (391 2± 15 8)× 10 3 U/ml (2 6 8 4± 11 9)× 10 3 U/ml,差异均有显著性 (P <0 0 1)。同时 ,痰液中Eos计数由 (11 8± 1 9)× 10 -2  (3 9±0 81)× 10 -2 ;IL - 5浓度由 (11.6± 0 .70 )ng/L (3.9± 0 .71)ng/L ;IL - 4浓度由 (79 3± 11 6 )pg/L (32 6± 10 9)pg/L ;IgE浓度由 (35 1 4± 11 8)× 10 3 U/ml (2 4 2 8± 12 1)× 10 3 U/ml,均有显著性差异 (P <0 0 1)。治疗后FEV1提高、气道反应性降低、同时存在的哮喘症状计分改善。对照组以上各项指标差异无显著性意义 (P >0

Objective To evaluate the effect of nasal glucocorticoid inhalation on allergic rhinitis complicated with asthma.Methods The number of eosinophils(Eos) were counted,and the concentrations of IL-5 IL-4 and IgE in sputum and nasal mucus were examined by ELIAS before and after the treatment with glucocorticoid inhalation.Results The percentage of Eos dropped from (10.9±2.4)×10 -2 to (3.8±0.73)×10 -2 in nasal mucus;from(11.8±1.9)×10 -2 to (3.9±0.81)×10 -2 in sputum;the concentration of IL-5 olecreased from (125.8±0.77)ng/L to (3.2±0.98)ng/L in nasal mucas,from (11.6±0.70)/L to (3.9±0.71)ng/L in spulum;the concentration of IL-4 decreased from (52.3±15.8) pg/L to (18.5±3.7) pg/L in nasal mucus;from (79.3±11.6) pg/L to (32.6±10.9) pg/L in sputum;IgE decreased from (391.2±15.8)×10 3 U/ml to (268.4±11.9)×10 3 U/ml in nasal mucus;from(351.4±11.8)×10 3 U/ml to (242.8±12.1)×10 3 U/ml in sputum.There was also an improvement in FEV 1 and significant improvement in asthmatic symptoms.Conclusions Allergic rhnitis is a risk factor in the attack of asthma.Nasal inhalation of glucocorticoid can improve the asthmatic symptoms and pulmonary function for patients with allergic rhinitis complicated by airway resistance or asthma.