王惠欣
WANG Huixin

• 1:北京市房山区中医医院呼吸科

摘要(Abstract)：

目的:观察吸入布地奈德及福莫特罗联合口服孟鲁司特钠对咳嗽变异性哮喘(CVA)患者血清IL-6、TNF-α表达水平及肺功能的影响。方法:196例CVA患者分为对照组及治疗组,两组均采取CVA常规治疗,对照组吸入布地奈德及福莫特罗,治疗组在对照组基础上口服孟鲁司特钠,治疗10周;比较两组患者疗效、血清IL-6及TNF-α表达水平、1 s末用力呼气容积与用力肺活量比值(FEV1/FVC)、呼气峰流量变异率(PEFR)、Pa CO2、Pa O2及BODE指数,并对治疗组患者血清IL-6、TNF-α与FEV1/FVC、BODE指数进行相关性分析。结果:疗程结束时,治疗组疗效明显优于对照组(P <0. 05),FEV1/FVC、Pa O2显著高于对照组(P <0. 05),Pa CO2、PE-FR、BODE指数、血清IL-6和TNF-α水平显著低于对照组(P <0. 05);治疗组FEV1/FVC与IL-6(r=-0. 72,P=0. 01)和TNF-α(r=-0. 67,P=0. 02)呈负相关,BODE指数与IL-6 (r=0. 59,P=0. 03)和TNF-α(r=0. 74,P=0. 01)呈正相关。结论:布地奈德及福莫特罗联合孟鲁司特钠治疗CVA疗效确切,血清IL-6和TNF-α水平的变化与肺功能的损伤程度有关。
Objective: To observe the effects of Budesonide and formoterol combined with montelukast sodium on serum IL-6 and TNF-α expression and lung function in patients with cough variant asthma. Methods: 196 patients with CVA were divided into two groups: control group and treatment group,and both groups were treated with routine CVA. The control group inhaled budesonide and formoterol,and the treatment group took montelukast sodium on the basis of the control group for 10 weeks. The therapeutic efficacy,serum IL-6,TNF-α expression,1 s final forced expiratory volume and forced vital capacity ratio( FEV1/FVC),peak expiratory flow variability( PEFR),PaCO2,PaO2 and BODE index were compared between the two groups,and the correlation between serum of IL-6 as well as TNF-α and the index of FEV1/FVC as well as BODE was analyzed in treatment group.Results: At the end of the course of treatment,the curative effect of the treatment group was better than that of the control group( P < 0. 05),and FEV1/FVC and PaO2 was significantly higher than that in control group( P < 0. 05). The index of PaCO2,PEFR and BODE,serum IL-6 and TNF-α levels were significantly lower than those in control group( P < 0. 05). There was a negative correlation between FEV1/FVC as well as IL-6( r =-0. 72,P = 0. 01) and TNF-α( r = 0. 74,P = 0. 01) in the treatment group,and There was a positive correlation between BODE index and IL-6( r = 0. 59,P =0. 03) and TNF-α( r = 0. 74,P = 0. 01). Conclusion: Budesonide and formoterol combined with montelukast sodium is effective in the treatment of CVA,and the changes of serum IL-6 and TNF-αlevels are related to the degree of lung function injury.

关键词(KeyWords)： 哮喘;肺功能;白细胞介素6;肿瘤坏死因子α;布地奈德;福莫特罗;孟鲁司特钠
asthma;lung function;interleukin 6;tumor necrosis factor α;budesonide;formoterol;montelukast sodium

Abstract:

Keywords:

基金项目(Foundation): 北京市科技计划课题“首都临床特色应用研究”(Z141107002514083)

作者(Author): 王惠欣
WANG Huixin

DOI: 10.19367/j.cnki.1000-2707.2019.02.025

参考文献(References)：

• [1]韩晓华,王丽娟,赵林颖,等.风咳方联合穴位贴敷对咳嗽变异性哮喘患者肺功能及临床症状的改善作用[J].检验医学与临床,2016,13(22):3203-3205.
• [2]HOSSAIN S S,ISLAM M S,RAHMAN M M,et al. Di-agnostic value of sputum eosinophil counts in patients withcough variant asthma[J]. Bangladesh Journal of Infec-tious Diseases,2017,2(2):37-41.
• [3] HOSSAIN S S,ISLAM M S,RAHMAN M M,et al.Clinical and demographic profiles of patients diagnosed ascough variant asthma attended at tertiary referral hospital[J]. Bangladesh Journal of Infectious Diseases,2017,2(1):30-33.
• [4]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2015)[J].中华结核和呼吸杂志,2016,39(5):323-354.
• [5]GAO J,PLEASANTS R A. Role of the fixed combinationof fluticasone and salmeterol in adult Chinese patients withasthma and COPD[J]. Int J Chron Obstruct Pulmon Dis,2015,18(10):775-789.
• [6]CLEMMER G L,WU A C,ROSNER B,et al. Measur-ing the corticosteroid responsiveness endophenotype inasthmatic patients[J]. J Allergy Clin Immunol,2015,136(2):274-281.
• [7]邱容,肖昌武,文富强.布地奈德福莫特罗联合苏黄止咳胶囊对咳嗽变异性哮喘的疗效观察[J].临床肺科杂志,2017,22(2):304-306.
• [8]YI F,HAN L,LIU B,et al. Comparison of clinical char-acteristics and responsiveness to bronchodilator betweencough variant asthma and eosinophilic bronchitis[J].Chest,2016,149(4):A550-A553.
• [9]LILLIENBERG L,ANDERSSON E,JANSON C,et al.Occupational exposure and new-onset asthma in a popula-tion-based study in Northern Europe(Rhine)[J]. AnnOccup Hyg,2013,57(4):482-492.
• [10]ZHOU X,HONG J,CHENG H,et al. Budesonide sus-pension nebulization treatment in Chinese pediatric pa-tients with cough variant asthma:a multi-center observa-tional study[J]. Journal of Asthma Official Journal of theAssociation for the Care of Asthma,2016,53(5):532-527.
• [11]HAMAMOTO Y,BENOIT A,MCGOVERN T K,et al.Montelukast reduces airway hypersensitiveness and neu-trophilic inflammation in a murine model of oxidativestress induced asthma[J]. Am J Respir Crit Care Med,2015,19(1):A1345.
• [12]皇甫春荣,李平.孟鲁司特钠治疗小儿咳嗽变异性哮喘的临床研究[J].中国临床药理学杂志,2013,29(12):908-910.
• [13]许芳.孟鲁司特钠联合信必可都保治疗儿童咳嗽变异性哮喘的临床疗效和安全性评价[J].中国现代医生,2014,52(7):68-70.
• [14]HOLME H,WINCKWORTH L C. Montelukast can re-duce the severity and extent of atopic dermatitis[J]. JPaediatr Child Health,2013,49(5):412-415.
• [15]PAPI A,NICOLINI G,BONER A L,et al. Short termefficacy of nebulized beclomethasone in mild-to-moderatewheezing episodes in pre-school children[J]. Ital J Pedi-atr,2011,37(1):39-45.
• [16]Kondo N. Long-term management of child asthma[J].Arerugi,2012,61(6):771-784.
• [17]MOITRA S,PURI R,PAUL D,et al. Global perspec-tives of emerging occupational and environmental lungdiseases[J]. Curr Opin Pulm Med,2015,21(2):114-120.
• [18]DE BACKER J,VOS W,VINCHUKAR S,et al. Theeffects of extrafine beclometasone/formoterol(BDP/F)on lung function,dyspnea,hyperinflation,and airwaygeometry in COPD patients:novel insight using functionalrespiratory imaging[J]. J Aerosol Med Pulm Drug Deliv,2015,28(2):88-99.
• [19]何相好,郭霞,何智勇,等.不同麻醉方式对腹部手术患者术后感染与免疫功能及血清IL-6和TNF-α水平的影响研究[J].中华医院感染学杂志,2017,27(5):1074-1077.
• [20]杜永亮,马雷,施萍. BODE指数在煤工尘肺临床评价中的应用价值[J].河南科技大学学报(医学版),2015,33(3):213-215.

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