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吸入糖皮质激素治疗轻度持续性哮喘儿童的鉴别指标与疗效

  • 叶滨

* 通信作者: 叶滨, 单位:

摘要


目的:探究吸入糖皮质激素治疗轻度持续性哮喘儿童的鉴别指标与疗效。

方法:将年龄在6-18岁的轻度持续性哮喘患者随机分成四个治疗组,分别为综合治疗组,常规治疗组,吸入糖皮质激素治疗组,安慰剂治疗组,同时接受44周临床治疗与观察。常规治疗为每日两次每次40mg二丙酸倍氯米松(以下称为倍氯米松),吸入糖皮质激素治疗为每日一喷40μg倍氯米松和一喷舒喘宁,综合治疗为常规治疗加上吸入糖皮质激素治疗。每日日记卡记载的

结果包括口服糖皮质激素后哮喘首次发作时间和哮喘控制天数。哮喘控制天数是无沙丁胺醇过敏反应,无日间或夜间症状,无不定期哮喘相关疾病就医,或无因哮喘而出现的缺课的天数。

结果:一些基线特征与更严重的哮喘自然病史有一定的关系,皮肤试验

结果阳性(P<0.05),可逆性支气管哮喘(P<0.05)或实验中不能达到哮喘完全控制(P<0.001)的患儿,其哮喘控制天数要少于同组对应的患儿。在综合治疗组和常规治疗组与使用安慰剂治疗组对比中,IgE水平和口服糖皮质激素病史中至少一个显著互动项有关系。在接受常规治疗(与采用安慰剂治疗进行对比)的患儿中,皮肤测试

结果呈阳性的患儿很少频发发作,而皮肤测试

结果为阴性的患儿就相对频繁发作多一些。在接受综合治疗(与采用安慰剂治疗进行对比)的患儿中, IgE水平≥350K/mL的患儿要比IgE水平<350K/mL的患儿频繁发作的次数更少一些。在登记之前那年未采用口服糖皮质激素治疗哮喘的患儿要比采用口服糖皮质激素治疗哮喘的患儿频发发作的次数更少一些。四个特性与3个治疗组中的性别,皮肤测试

结果状态,IgE水平和实验中哮喘控制中至少一个显著互动项有关系。在接受吸入糖皮质激素治疗(与采用安慰剂组对比)的患儿中,哮喘控制程度的互动项是显著的。

结论:带有过敏性炎症生理指标和/或更大哮喘负担的患儿通常要比没有这些生理指标的患儿能够通过吸入糖皮质激素治疗取得更好的疗效。这些现有的指标可以帮助我们去区分哪些患儿有望通过每日吸入糖皮质激素治疗可以取得良好的疗效。

关键词:哮喘;儿童;吸入型皮质激素;分层分析

ABSTRACT


Objective: To explore the therapeutic effect of inhaled corticosteroids in the treatment of children with mild persistent asthma. Method: Age in ages 6 to 18 patients with mild persistent asthma were randomly divided into four treatment groups, respectively, in the combined therapy group, routine treatment group, inhaled corticosteroid therapy group, placebo group, and accept 44 weeks clinical observation and treatment. Conventional treatment for twice daily with 40 mg per dipropionate beclomethasone dipropionate (hereinafter referred to as beclomethasone), inhalation of glucocorticoid treatment for daily spraying 40 u g times beclomethasone and spray a salbutamol and comprehensive treatment of routine treatment plus inhaled glucocorticoid therapy. Daily diary card records include the first asthma attack time and the number of days of asthma control. Asthma control days is without salbutamol allergic reaction, no diurnal or nocturnal symptoms, without unscheduled asthma related disease medical treatment, or due to asthma and the emergence of absence from school days. Result: Some baseline characteristics and more severe asthma natural history has a certain relationship, the results of skin test positive (P < 0.05), reversible bronchial asthma (P < 0.05) or experiment can not achieve complete control of asthma in children (P < 0.001), the asthma control days to less than the same group of children. In the combination therapy group and the conventional treatment group compared with the placebo treatment group, the IgE level and the oral corticosteroid history of at least one significant interaction. In children receiving routine treatment (with the placebo comparison) and skin test results were positive children rarely frequent seizures, and skin test results for children with negative is relatively frequent attack more. In receiving comprehensive treatment (with the placebo comparison) in children and in children with IgE level greater than or equal to 350K/mL to IgE < 350K/mL in children with frequent episodes of times less than. The number of children with asthma who did not use oral corticosteroids before registration was less frequent than those treated with oral corticosteroids. The relationship between the four characteristics and the gender, skin test results status, and IgE levels in the 3 treatment groups was associated with at least one significant interaction term in asthma control. The interaction between asthma control and asthma control was significant in children receiving inhaled corticosteroids (compared with placebo).

Conclusion  : Children with allergic inflammation and / or greater asthma burden are generally better able to achieve better efficacy than those without these physiological parameters by inhaled corticosteroids. These existing indicators can help us to distinguish which children are expected to achieve good therapeutic effect through daily inhaled corticosteroid treatment.

Key words: Asthma; children; inhaled corticosteroids; stratified analysis

引用本文 / How to Cite This Article

叶滨.吸入糖皮质激素治疗轻度持续性哮喘儿童的鉴别指标与疗效[J]. 国际精神病学杂志, , (): -

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