小剂量糖皮质激素布地奈德吸入在支气管哮喘治疗中的应用

目的探讨小剂量布地奈德粉吸入治疗支气管哮喘的临床疗效及作用机制。方法将我院收治的98例支气管哮喘患者按照分层随机分组法分为观察组和对照组。对照组给予口服全身糖皮质激素、β2受体激动剂及氨茶碱等常规治疗药物;观察组给予小剂量布地奈德粉雾剂吸入。观察两组患者肺功能改善情况、临床疗效及血浆皮质醇浓度。结果治疗后,观察组气道阻力(Raw)与气道传导率(Gaw)分别为154.6%±12.3%、85.1%±7.5%,气道高反应性(BHR)正常患者占50.8%(32/63);对照组Raw和Gaw分别为324.1%±27.6%、56.7%±6.1%,BHR正常患者占27.8%(10/36),两组比较差异有统计学意义(P<0.05)。观察组、对照组的临床总有效率分别为92.1%(58/63)、63.9%(23/36),两组比较差异有统计学意义(P<0.05)。观察组治疗前、后的血浆皮质醇浓度分别为(317.7±54.9)、(324.5±43.8)nmol/L,治疗前后比较差异无统计学意义(P>0.05);观察组治疗前经ACTH刺激后血浆皮质醇浓度为(371.2±37.5)nmol/L,治疗后经ACTH激发的血浆皮质醇浓度为(366.2±45.8)nmol/L,治疗前后比较差异无统计学意义(P>0.05)。结论小剂量布地奈德粉雾剂吸入治疗支气管哮喘疗效显著,长期使用不会引起HPAA功能抑制。

Clinical efficacy of small doses of nebulized budesonide in the treatment of bronchial asthma

Objective To explore the clinical onide in the treatment of bronchial asthma. Methods efficacy and the mechanism of small doses of nebulized budes- According to a stratified randomization method, 98 cases of bronchial asthma patients in our hospital were divided into observation group and control group. Patients in control group were given the conventional treatment, patients in observation group were given a small dose of budesonide inhalation. The improvement of lung function, clinical efficacy and plasma cortisol concentrations were observed. Results After treatment,the airway resistance was 154. 6% ± 12. 3% ,the airway conductance was 85. 1% ±7.5% ,the proportion of patients with normal BHR counted for 50. 8% （ 32/63 ） in observation group; the airway resistance was 324. 1% ± 27.6% , the airway conductance was 56. 7% ± 6. 1% , the proportion of patients with normal BHR counted for 27.8% （10/36） in control group. There were significant differences between the two groups（ P 〈 0. 05 ）. The total effective rates of observation group and control groups were 92. 1% （58/63）and 63.9% （23/36） , there was significant difference between the two groups（ P 〈 0. 05 ）. No significant difference was found in the plasma cortisol levels in observation group before and after treatment （317.7 ±54. 9） vs. （324. 5 ±43.8） ,P 〉0. 05]. Before and after ACTH excitation,no significant difference was found in the plasma cortisol levels in observation group （371.2 ± 37.5 ） nmol/L vs. （ 366.2 ± 45.8 ） nmol/L ; P 〉 0. 05 ]. Conclusion Long term small doses of inhaled budesonide can significantly improve the clinical efficacy of bronchial asthma, and it cannot suppress the HPAA axis function of the patients.