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目的:观察左西替利嗪(LCZ)治疗儿童变应性鼻炎并发过敏性哮喘的临床效果及安全性,为合理选用抗组胺药物提供参考。方法:选择2014年6月至2016年5月在随州市妇幼保健院住院的258例变应性鼻炎并发过敏性哮喘急性发作的患儿为研究对象,采用随机数字表法分为LCZ组、地氯雷他定(DLT)组和安慰剂(PLB)组各86例。三组患儿分别口服LCZ溶液0.250mg/kg、DLT糖浆0.125 mg/kg和5%葡萄糖溶液0.500 m L/kg,每晚1次,同时根据病情严重程度给予糖皮质激素、支气管舒张剂、白三烯调节剂、呼吸支持和抗感染等治疗。于治疗前和治疗后第1天、第7天、第14天、第28天时记录三组患儿变应性鼻炎表现、呼吸系统症状和体征并进行临床评分,比较静脉血嗜酸粒细胞(EOS)计数和血清总Ig E(TIg E)水平、呼气峰流速/预计值(PEF/PDV)和第1秒用力呼气量/用力肺活量(FEV1/FVC)、血气分析结果等,观察药物不良反应发生情况。结果:LCZ组、DLT组和PLB组患儿各失访7例、5例和8例,纳入研究试验者LCZ组79例、DLT组81例、PLB组78例。入院时三组患儿性别、年龄、体质量等一般资料比较差异无统计学意义(P>0.05)。三组患儿治疗第1天时临床评分均下降,PEF/PDV和FEV1/FVC改善,血气分析好转,治疗前后比较差异有统计学意义(P<0.05);治疗第7天和第14天时临床评分、EOS计数、TIg E水平、PEF/PDV、FEV1/FVC、血气分析结果等三组间及组间两两比较差异均有统计学意义(P<0.05)。三组不良反应较少,且LCZ组不良反应发生率低于DLT组,差异有统计学意义(P<0.05)。结论:LCZ溶液和DLT糖浆治疗过敏反应效果较好,可有效缓解变应性鼻炎并发过敏性哮喘患儿的病情,LCZ临床疗效和安全性较DLT高。
Objective: To observe the clinical efficacy and safety of levocetirizine (LCZ) in the treatment of allergic rhinitis in children with allergic asthma, and provide a reference for the rational selection of antihistamines. Methods: From June 2014 to May 2016, 258 children with allergic rhinitis and acute exacerbation of allergic asthma hospitalized in Suizhou Maternal and Child Health Hospital were selected as study subjects, and randomly divided into LCZ group The loratadine (DLT) group and placebo (PLB) group of 86 cases. Three groups of children were orally given LCZ solution 0.250mg / kg, DLT syrup 0.125 mg / kg and 5% glucose solution 0.500 m L / kg, 1 night, at the same time according to the severity of the given glucocorticoid, bronchodilator, white Triene modulator, respiratory support and anti-infection treatment. Three groups of children with allergic rhinitis, respiratory symptoms and signs and clinical scores were recorded before treatment and on the 1st, 7th, 14th and 28th day after treatment. Venous blood eosinophils ( EOS), total TI E (TIg E), peak expiratory flow / predicted value (PEF / PDV), forced expiratory volume in 1 second, FEV 1 / FVC and blood gas analysis. Adverse reactions occurred. Results: There were 7 cases, 5 cases and 8 cases in LCZ group, DLT group and PLB group. There were 79 cases in LCZ group, 81 cases in DLT group and 78 cases in PLB group. There were no significant differences in the general data of gender, age, body weight and other three groups at admission (P> 0.05). The clinical scores of the three groups were decreased on the first day of treatment, PEF / PDV and FEV1 / FVC were improved, blood gas analysis improved, the difference was statistically significant before and after treatment (P <0.05); on the seventh and fourteenth day, , EOS count, TIg E level, PEF / PDV, FEV1 / FVC, blood gas analysis results between the three groups and between groups were statistically significant (P <0.05). Three adverse reactions were less, and the incidence of adverse reactions in LCZ group was lower than that in DLT group, the difference was statistically significant (P <0.05). Conclusion: LCZ solution and DLT syrup are effective in treating allergic reactions and can effectively relieve allergic rhinitis in children with allergic asthma. The clinical efficacy and safety of LCZ are higher than that of DLT.