支气管哮喘合并变应性鼻炎上、下气道共治的临床观察

目的 观察沙美特罗替卡松粉吸入剂联合布地奈德鼻喷雾剂治疗支气管哮喘合并变应性鼻炎的疗效,验证上、下气道共治有利于哮喘合并变应性鼻炎临床症状控制.方法 选取轻、中度持续支气管哮喘合并常年变应性鼻炎患者62例,随机分为两组,A组应用沙美特罗替卡松粉吸入剂联合布地奈德鼻喷雾剂,B组应用沙美特罗替卡松粉吸入剂.比较两组治疗前后与30例健康志愿者(C组)1秒钟用力呼气容积占预计值百分比(FEV1%)、血清嗜酸性粒细胞阳离子蛋白(ECP)、外周血嗜酸性粒细胞占白细胞百分比(外周血EOS%)、诱导痰嗜酸性粒细胞占有核细胞百分比(痰EOS%)及鼻炎症状评分、哮喘控制问卷(ACQ).结果 治疗前A组与B组FEV1%、血清ECP、外周血EOS%、痰EOS%、鼻炎症状评分、ACQ评分差异均无统计学意义(P>0.05).治疗后A组、B组与C组比较,FEV1%分别为(84.6±5.6)%、(83.8±5.1)%、(94.2±2.1)%,A组与B组差异无统计学意义(P>0.05),A组、B组均低于C组(P<0.01);血清ECP分别为(7.4±2.7)μg/L、(9.7±3.1)/μg/L、(3.9±1.7)/μg/L,B组>A组>C组(P<0.05或<0.01);外周血EOS%分别为(7.4±2.5)%、(7.8±3.1)%、(2.5±1.2)%,A组与B组差异无统计学意义(P>0.05),A组、B组均高于C组(P<0.01);痰EOS%分别为(6.7±4.9)%、(5.6±5.4)%、(1.6±0.7)%,A组与B组差异无统计学意义(P>0.05),A组、B组均高于C组(P<0.01).A组治疗后鼻炎症状和ACQ评分均低于B组,分别为(1.3±1.1)分vs(4.2±1.3)分(P<0.01),(3.5±2.3)分vs(4.7±2.1)分(P<0.05).结论 沙美特罗替卡松粉吸入剂联合布地奈德鼻喷雾剂较单纯使用沙美特罗替卡松粉吸入剂能更全面地控制嗜酸性粒细胞介导的上、下气道炎症,进而可以更好地控制支气管哮喘合并变应性鼻炎患者的临床症状.

Clinical observation in patients with asthma and rhinitis by use both upper and lower airway treatment

Objective To observe the therapeutic effect of salmeterol and fluticasone propionate inhalation powder in combination with budesonide nasal spray in patients with bronchial asthma and allergy rhinitis.Proof for the treatment of upper airway combined with lower airway is more advantageous to control asthma and rhinitis.Methods Sixty-two outpatients with mild to moderate persistent asthma and perennial rhinitis from Department of Respiration in North China Coal Medical College were randomly divided into two groups,group A inhaled salmeterol and fluticasone propionate inhalation powder in combination with budesonide nasal spray,group B only inhaled salmeterol and fluticasone propionate inhalation powder.Thirty healthy volunteers served as control （group C）.Forced expiratory volume in 1 second（FEV1）,serum eosinophile cationic protein（ECP）,peripheral blood eosinophils percentage （EOS%）,induced sputum EOS%,rhinitis symptoms score and asthma control questionnaire （ACQ）score were measured before and after 4 weeks＇ treatment in group A,group B and group C.Results Before treatment,FEV1%,serum ECP,peripheral blood EOS%,induced sputum EOS%,rhinitis symptoms score,ACQ score in group A and group B were not statistically significant（P〉0.05）.After treatment,FEV1% in group A,group B and group C were （84.5±5.5）%,（83.8±5.1）%,（94.2±2.1）%,the difference between group A and group B was not statistically significant（P〉0.05）,either group A or group B was lower than group C（P〈0.01）.Serum ECP in group A,group B,group C were （7.4±2.7） μg/L,（9.7±3.1） μg/L,（3.9±1.7） μg/L,group B was higher than group A（P〈0.05）,group A was higher than group C（P〈0.01）.Peripheral blood EOS% in group A,group B,group C were （7.4±2.5）%,（7.8±3.1）%,（2.5±1.2）%.Induced sputum EOS% in group A,group B,group C were （6.7±4.9）%,（5.6±5.4）%,（1.6±0.7）%,the difference of peripheral blood EOS% and induced sputum EOS% between group A and group B were not statistically significant（P〉0.05）,either group A or group B was higher than group C（P〈0.01）.Rhinitis symptoms score in group A and group B were （1.3±1.1） scores,（4.2±1.3） scores;ACQ score in group A and group B were（3.5±2.3） scores,（4.7±2.1） scores,rhinitis symptoms score and ACQ score in group A were lower than group B（P〈0.05）.Conclusion Salmeterol and fluticasone propionate inhalation powder in combination with budesonide nasal spray can roundly control the eosinophil-mediated inflammation in upper and lower airway,and can better control the clinical symptoms of allergy rhinitis and asthma.