H1阻滞剂鼻喷剂联用吸入激素对哮喘患者诱导痰嗜酸细胞及炎症因子的影响

目的观察H，阻滞剂鼻喷剂联用吸入激素对哮喘合并变应性鼻炎患者诱导痰中嗜酸细胞（E）及炎症因子的影响。方法61例中、重度哮喘伴变应性鼻炎患者在经口吸入沙美特罗／氟替卡松粉吸入剂的基础上随机给予下列治疗：氮革斯汀鼻喷剂（A组22例）、布地奈德鼻喷剂（B组20例）及氮革斯汀联合布地奈德鼻喷剂（C组19例）治疗，疗程3个月。观察其哮喘症状评分和测定诱导痰E％及诱导痰上清液中ECP、ICAM-1、IL-13的变化。结果治疗后三组的哮喘症状评分、诱导痰E％和ECP、ICAM－1浓度均较治疗前改善（P〈0．05）。治疗后A组哮喘症状评分、诱导痰E％和ECP、ICAM－1浓度与B组比较，差异无统计学意义（P〉0．05），C组治疗后哮喘症状评分和诱导痰ECP浓度与A组比较差异有统计学意义（P〈0．05）。而诱导痰IL－13浓度治疗前后比较，差异无统计学意义（P〉0．05）。结论在吸入激素的基础上联合应用H。阻滞剂鼻喷剂可有效治疗变应性哮喘、抑制气道E及ECP、ICAM－1。

Effect of H1 blocker nazal spray and inhaled corticosteroids on eosinophils and inflammatory cytokines level in induced sputum in allergic asthma

Objective To evaluate the therapeutic effects and inflammatory mediator levels in induced sputum of H1 blocker nazal spray in combination with inhaled corticosteroid on allergic asthma.Methods Sixty-one patients with moderate to severe allergic asthma were received either azelastine nazal spray(group A) or beclomethasone nazal spray(group B) or combination with azelastine nazal spray and beclomethasone nazal spray(group C) on the basis of inhaled samelterol/fluticasone for 3 months.Symptom scores of asthma and eosinophils in induced sputum were recorded,eosinophilic cationic protein(ECP),ICAM-1and interleukin 13(IL-13) in induced sputum supernatants were measured before and after the treatment.Results After treatment,there was significant improvement in symptom score,eosinophils in induced sputum and induced sputum ECP,ICAM-1 level in all three groups as compared with before the treatment(P < 0.05);there was no significant difference in symptom score,induced sputum eosinophils and induced sputum ECP,ICAM-1 level between group A and group B(P > 0.05);there was much better improvement in symptom score and induced sputum ECP in group C as compared with group A(P < 0.05).However,there was no significant change in induced sputum IL-13 levels after treatment in all groups(P > 0.05).Conclusion On the basis of inhaled corticosteroid,azelastine nazal spray significantly improves asthma symptom and reduces induced sputum ECP,ICAM-1 level and eosinophils in patients with asthma and allergic rhinitis.