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目的探讨不同剂量布地奈德雾化吸入治疗对哮喘患者临床症状及肺功能的影响。方法选择2013年4月—2015年4月收治的120例哮喘患者作为研究对象。随机分为对照组、研究组Ⅰ、研究组Ⅱ各40例。对照组给予口服强的松(2 mg/kg)及硫酸沙丁胺醇雾化吸入治疗,研究组Ⅰ在对照组基础上给予0.5 mg布地奈德联合雾化吸入治疗,研究组Ⅱ在对照组基础上予以1 mg布地奈德联合雾化吸入治疗,各组均连续治疗2周。比较观察两组患者的临床症状评分和治疗前后炎症因子水平、一秒用力呼气容积/用力肺活量(forced expiratory volume in one second/forced vital capacity,FEV1%)、呼气峰值流速/预计值(peak expiratory flow,PEF%)水平以及不良反应发生情况。计量资料组间比较采用方差分析,两两比较采用LSD-t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果治疗后,研究组Ⅰ、研究组Ⅱ和对照组临床症状评分分别为(1.58±0.58)、(1.31±0.54)、(2.40±0.73)分,均优于治疗前的(7.62±1.45)、(7.59±1.48)、(7.52±1.56)分,差异均有统计学意义(均P<0.05)。治疗后,研究组Ⅰ、研究组Ⅱ和对照组患者IL-4水平分别为(40.14±8.67)、(32.73±6.47)、(47.22±9.82)ng/L,均较治疗前的(57.23±7.11)、(57.76±7.53)、(55.95±8.07)ng/L有不同程度下降,IFN-γ水平分别为(30.13±5.27)、(33.79±5.62)、(25.34±4.68)ng/L,均较治疗前的(21.53±5.14)、(20.61±4.67)、(21.36±4.84)ng/L显著升高,差异均有统计学意义(均P<0.05)。治疗后,研究组Ⅰ、研究组Ⅱ和对照组FEV1%、PEF%水平分别为(80.02±14.84)%、(88.79±11.35)%、(72.13±15.65)%、(74.15±13.89)%、(83.07±15.12)%、(65.12±18.03)%,均优于治疗前的(58.41±22.25)%、(58.56±23.49)%、(59.58±21.43)%、(46.45±22.54)%、(45.95±21.66)%、(47.29±23.92)%,差异均有统计学意义(均P<0.05)。研究组Ⅰ、研究组Ⅱ不良反应发生率分别为2.5%、4.0%,显著低于对照组的30.0%,差异有统计学意义(P<0.05)。结论采用大剂量布地奈德雾化吸入治疗哮喘疗效确切,能够显著降低促炎因子水平,同时能够有效提高抗炎因子水平,改善患者肺功能状态,降低不良反应发生率,安全性好,值得临床推广应用。
Objective To investigate the effects of different doses of budesonide inhalation on clinical symptoms and pulmonary function in patients with asthma. Methods 120 patients with asthma admitted from April 2013 to April 2015 were selected as the study subjects. Randomly divided into control group, study group Ⅰ, study group Ⅱ each 40 cases. The control group was given oral prednisone (2 mg / kg) and salbutamol sulfate atomization inhalation. The study group I was given 0.5 mg budesonide combined with inhalation therapy on the basis of the control group. The study group Ⅱ was given on the basis of the control group 1 mg budesonide combined with inhalation therapy, each group were treated for 2 weeks. The clinical symptom scores and the levels of inflammatory cytokines before and after treatment were compared between the two groups. The forced expiratory volume in one second / forced vital capacity (FEV1%), peak expiratory flow / predicted peak expiratory flow, PEF%) levels and the incidence of adverse reactions. Data were compared between groups using analysis of variance, pairwise comparison using LSD-t test, the group was compared using paired t test, count data usingχ2 test, P <0.05 for the difference was statistically significant. Results After treatment, the scores of clinical symptoms in study group Ⅰ, study group Ⅱ and control group were (1.58 ± 0.58), (1.31 ± 0.54) and (2.40 ± 0.73) points, respectively, which were better than those before treatment (7.62 ± 1.45) (7.59 ± 1.48), (7.52 ± 1.56) points, the difference was statistically significant (all P <0.05). After treatment, the levels of IL-4 in study group Ⅰ, study group Ⅱ and control group were (40.14 ± 8.67), (32.73 ± 6.47) and (47.22 ± 9.82) ng / L respectively, (57.76 ± 7.53) and (55.95 ± 8.07) ng / L respectively. The levels of IFN-γ were (30.13 ± 5.27), (33.79 ± 5.62) and (25.34 ± 4.68) ng / L, Before treatment (21.53 ± 5.14), (20.61 ± 4.67) and (21.36 ± 4.84) ng / L, the difference was statistically significant (all P <0.05). After treatment, FEV1% and PEF% of study group Ⅰ, study group Ⅱ and control group were (80.02 ± 14.84)%, (88.79 ± 11.35)%, (72.13 ± 15.65)%, (74.15 ± 13.89)% (58.41 ± 22.25)%, (58.56 ± 23.49)%, (59.58 ± 21.43)%, (46.45 ± 22.54)%, (45.95 ± 21.66)%, (47.29 ± 23.92)%, respectively, with significant difference (all P <0.05). The incidences of adverse reactions in study group I and study group II were 2.5% and 4.0%, respectively, which were significantly lower than those in the control group (30.0%, P <0.05). Conclusion High-dose budesonide inhalation for asthma is effective and can significantly reduce the level of proinflammatory cytokines. At the same time, it can effectively increase the level of anti-inflammatory cytokines, improve pulmonary function, reduce the incidence of adverse reactions, and is safe Promote the application.