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目的探讨根据痰嗜酸粒细胞(EOS)计数调整糖皮质激素(简称激素)剂量,改进哮喘病情控制的临床可行性。方法采用前瞻性随机对照设计,研究期为2005年2月至2006年2月。门诊持续性哮喘患者41例,随机分为2组:EOS 组20例,根据痰 EOS 计数调整激素剂量;指南组21例,根据哮喘诊疗指南(主要包括症状和肺功能)调整激素剂量。筛选期为2周,入组后在15 d、2个月、4个月、6个月时进行随访,其中后3次进行诱导痰检查,并调整激素剂量。主要观察指标是急性发作例次,其他指标包括短效β_2受体激动剂用量、症状评分、呼气峰流速(PEF)变异率和第1秒用力呼气容积(FEV_1)、激素用量、痰 EOS 变化。结果在为期6个月的观察期,急性发作总例次 EOS 组为11例次,指南组为26例次,两组比较差异有统计学意义(t=6.34,P=0.026)。平均每人使用短效β_2受体激动剂的揿数/d、症状评分、PEF 和 FEV_1、吸入激素用量,两组各时间点比较差异均无统计学意义。痰 EOS 比值[中位数(25%～75%)]EOS 组基线值为0.067(0.015,0.169),随访结束时为0.048(0.015,0.150),治疗结束时与基线比较明显降低(F=3.39,P=0.02);指南组分别为0.040(0.014,0.133)和0.045(0.012,0.236),治疗结束时与基线比较差异无统计学意义(F=1.07,P=0.37)。结论根据痰 EOS 计数调整激素剂量可减少哮喘急性发作次数,进一步改善病情控制状态。
Objective To investigate the clinical feasibility of adjusting the dosage of glucocorticoid (Hormone) based on the count of sputum eosinophils (EOS) to improve the control of asthma. Methods A prospective randomized controlled design was conducted. The study period was from February 2005 to February 2006. Thirty-one patients with out-patient persistent asthma were randomly divided into two groups: 20 in the EOS group. The dose of hormones was adjusted according to the sputum EOS count. In the guideline group, 21 patients were treated according to the guidelines for asthma (mainly including symptoms and pulmonary function). The screening period was 2 weeks. After 15 days, 2 months, 4 months and 6 months of follow-up, the induced sputum examination was performed 3 times later and the hormone dose was adjusted. The main outcome measures were acute exacerbation episodes. Other indicators included short-acting β 2 agonist dosage, symptom score, variation of peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV 1), hormonal dosage, sputum EOS Variety. Results During the observation period of 6 months, the total number of acute attacks was 11 cases in EOS group and 26 cases in guide group. The difference between the two groups was statistically significant (t = 6.34, P = 0.026). Average per person using short-acting β 2 receptor agonist number / d, symptom score, PEF and FEV_1, the amount of inhaled hormones, no significant difference between the two groups at any time point. Sputum EOS ratio (median, 25% -75%) EOS baseline was 0.067 (0.015, 0.169) and 0.048 (0.015, 0.150) at the end of follow-up, with a significant decrease from baseline at the end of treatment (F = 3.39 , P = 0.02). There was no significant difference between the guideline group and the baseline for the treatment group (0.040,0.1,0,033) and 0.045 (0.012,0.236), respectively (F = 1.07, P = 0.37). Conclusion Adjusting hormone dose according to sputum EOS count can reduce the number of acute exacerbations of asthma and further improve the condition control.