朱正传,何迎春
ZHU Zhengchuan,HE Yingchun

• 1:莒南县人民医院
• 2:浙江中医药大学附属广兴医院

摘要(Abstract)：

目的:探讨沙美特罗替卡松联合孟鲁司特对哮喘的机制。方法:186例哮喘患者均分为对照组和观察组,对照组给予美特罗替卡松治疗,观察组给予美特罗替卡松联合孟鲁司治疗;分别于治疗前及治疗24周时,采用肺功能测试系统检测2组患者用力肺活量(FVC)、1秒用力呼气容积(FEV1)、计算FEV1/FVC比值,采用双抗体夹心酶联免疫法检测2组患者空腹血清白介素-4(IL-4)、γ干扰素(IFN-γ)水平;分别于治疗前、治疗12周及治疗24周时,采用流式细胞术检测2组患者空腹静脉血T调节性T(Treg)细胞、辅助性T细胞(Th17)细胞百分比,记录2组患者不良反应及治疗24周时的治疗效果。结果:治疗前,2组患者FEV1、FVC、FEV1/FVC、IL-4FN-γ、Treg、Th17比较,差异无统计学意义(P> 0. 05);治疗24周时,观察组患者FEV1、FVC、FEV1/FVC均高于对照组(P <0. 05),IL-4水平高于对照组,IFN-γ水平低于对照组(P <0. 05);治疗12周、24周时,2组患者Treg细胞比例均明显提高,Th17细胞比例均明显降低(P <0. 05);观察组治疗总有效率高于对照组(P <0. 05),不良反应发生率低于对照组(P <0. 05)。结论:沙美特罗替卡松联合孟鲁司特对哮喘疗效明确,其机制可能与效抑制炎症反应、改善肺功能及调节机体免疫功能有关。
Objective: To explore the clinical effect of fluticasone/salmeterol combined with montelukast on asthma. Methods: 186 asthma patients were divided into the control group(fluticasone/salmeterol treatment) and the observation group(fluticasone/salmeterol combined with montelukast treatment). Before treatment and at 24 weeks of treatment,JAEGER Pulmonary Function Testing(PFT)was used to measure FVC,FEV1,and FEV1/FVC ratio; the double-antibody sandwich enzyme-linked immunosorbent assay(ELISA) was used to detect fasting serum interleukin 4(IL-4) and γ-interferon(IFN-γ) in two groups. Before treatment and at 12 and 24 weeks of treatment,flow cytometry was used to detect fasting venous blood Treg and Th17 in two groups to record their adverse reactions and the therapeutic effect at 24 weeks of treatment. Results: Before treatment,there was no significant difference in FEV1,FVC,FEV1/FVC,IL-4 FN-γ,Treg and Th17 between the two groups(P >0. 05). At 24 weeks of treatment,FEV1,FVC and FEV1/FVC were higher in the observation group than in the control group(P < 0. 05); IL-4 level was higher and IFN-γ was lower in the observation group(P < 0. 05). At 12 weeks and 24 weeks of treatment,Treg was significantly increased in both groups,while Th17 was significantly decreased(P < 0. 05). The total effective rate of the observation group was higher than that of the control group(P < 0. 05),and the incidence of adverse reactions was lower than that of the control group(P < 0. 05). Conclusion: fluticasone/salmeterol combined with montelukast have a clear effect on asthma,and its mechanism may be related to inhibiting inflammation,improving lung function and regulating immune function.

关键词(KeyWords)： 哮喘;白细胞介素4;γ干扰素;免疫功能;肺功能
asthma;interleukin-4;γ-interferon;immune function;pulmonary function

Abstract:

Keywords:

基金项目(Foundation): 浙江省中医药科技计划项目(2015ZA163)

作者(Author): 朱正传,何迎春
ZHU Zhengchuan,HE Yingchun

DOI: 10.19367/j.cnki.1000-2707.2018.11.025

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