甲泼尼龙与地塞米松对哮喘患儿辅助性T细胞影响的初步研究

目的比较甲泼尼龙（甲基强的松龙）与地塞米松对哮喘患儿的临床疗效及对辅助性T细胞的影响。方法将39例急性发作期中重度哮喘患儿随机分成两组：A组21例，给予甲泼尼龙每次1～2mg／kg静脉滴注，每12～24h一次；B组18例，给予地塞米松每次0.25～0．75mg／kg静脉滴注，每12～24h一次。监测治疗前呼吸功评分、治疗后哮鸣音消失的时间、〉5岁患儿治疗前及3d后最大呼气流速；采用放射免疫法测定治疗前及3d后血清中IL-2及IL-4水平。结果A组哮鸣音消失时间比B组明显缩短（P=0.042）；治疗72h后最大呼气流速A组明显高于B组（P=0.025）；治疗前及3d后地塞米松对血清中IL-2、IL-4及IL-2／IL-4值的影响均不大（P〉0.05），甲泼尼龙对血清中IL-2的影响也不大（P〉0．05）；A组患儿治疗后IL-4水平比治疗前明显降低（P=0．001），IL-2／IL-4值比治疗前明显升高（P=0.027）；治疗前患儿呼吸功分数与治疗前IL-2／IL-4值无相关性（P=0．613）。结论调节IL-2或IL-4水平可能并非是地塞米松发挥作用的主要途径；甲泼尼龙对血清IL-2的影响不大，但能有效地降低IL-4水平，从而提高IL-2／IL-4值，改善哮喘患儿Th1／Th2功能失衡。

Preliminary studies on effects of methylprednisolone and dexamethasone on Th cytokines in asthmatic children

Objective This study was carried out to compare chnical efficiency of methylprednisolone (MP) and dexamethasone (Dex) and their effects on Th cytokines in asthmatic children.Methods A total of 39 children with moderate and severe asthma at acute exacerbation were randomly divided into two groups, one (A) with MP 1 -2 mg/kg (n=21) and the other (B) with Dex 0.25 -0.75 mg/kg (n= 18),every 12 -24 h by intravenous drip.Scores of respiratory effort and peak expiratory flow rate prior to and three days after treatment in the asthmatic children aged over five years were evaluated,respectively,as well as the time of wheezing vanishing after treatment.Serum levels of interleukin-2 (IL-2) and IL-4 were determined by radioimmunoassay (RIA) prior to and three days after treatment,respectively.Results There was statistically significant difference in the time of wheezing vanishing between groups A and B (P = 0.042).Three days after treatment,PEER was significantly higher in group A than that in group B (P = 0.025).No statistically significant difference in serum IL-2 and IL-4,as well as ratio of IL-2/IL-4,was found in group B prior to and three days after treatment (P>0.05).Statistically significant difference in serum IL-2 was not observed in group B prior to and three day after treatment (P>0.05),and serum IL-4 decreased significantly (P=0.001) and ratio of serum IL-2/IL-4 (P=0.027) increased significantly three days after treatment than those prior to treatment.No significant correlation between respiratory-effort scores and ratio of serum IL-2/IL-4 prior to treatment was found (P=0.613).Conclusions Up-regulation of IL-2,or inhibition of release of IL-4,probably is not the main anti-inflammatory mechanism of dexamethasone.Methylprednisolone has little effect on serum IL-2,but can effectively reduce serum IL-4, thus increasing the ratio of serum IL-2/IL-4 and counterbalancing function of the Thl/Th2 cells.