阿奇霉素对哮喘二级预防的作用探讨

目的 通过检测炎性因子嗜酸细胞阳离子蛋白(eosinophile cationic protein,ECP)、白细胞介素-8(IL-8)、一氧化氮(No)的变化探讨阿奇霉素对哮喘高危儿气道炎症的影响及其对哮喘二级预防的作用.方法 选择初次喘息发作的具有特应性体质的毛细支气管炎患儿共223例,所有患儿应用常规治疗(β<,2>受体激动剂口服平喘,抗病毒治疗),症状控制(喘息基本消失)后随机分成四组:A组(57例)应用阿奇霉素口服(5mg/kg,每周2次,连用3个月),B组(54例)应用布地奈德混悬液氧喷(1/2支,每天2次,连用3个月),C组(57例)应用孟鲁斯特咀嚼片口服(4mg,每晚1次,连用3个月),D组(55例)空白对照,仅对症治疗.A、B、C三组均治疗3个月,分别在住院当日、用药干预前、干预后抽取静脉血,利用酶联免疫吸附测定试剂盒检测各组患儿血清中ECP、IL-8的浓度,硝酸酶还原法测NO,临床门诊及电话随访一年.结果 (1)ECP、IL-8、NO水平在A、B、C三组用药干预前与D组比较,以及A、B、C三组之间比较差异均无统计学意义,具有可比性;(2)A、B、C三组ECP、IL-8、NO水平用药后均下降,D组也有所下降,A、B、C三组与D组比较差异均有统计学意义(P均<0.01);A、B、C三组用药后ECP及NO下降水平,A组与B组比较差异无统计学意义(P>0.05),C组下降幅度较大,与A组比较差异有统计学意义(P<0.01);A、B、C三组用药后IL-8下降水平,A组幅度较大,与B、C组比较差异均有统计学意义(P均<0.01).(3)3个月内喘息再次发作人数及一年后哮喘发生情况,A、B、C三组较D组均有所减少,但与D组比较差异均无统计学意义(P>0.05),A组与B、C两组比较差异也无统计学意义(P>0.05).结论 (1)阿奇霉素对哮喘高危儿的炎性细胞因子ECP、IL-8、NO具有下调作用,对IL-8的下调作用尤为明显.(2)阿奇霉素对哮喘高危儿的ECP、NO的下调作用与布地奈德相似,但与孟鲁斯特比较有差异,对IL-8的下调作用比布地奈德及孟鲁斯特明显.(3)阿奇霉素对哮喘的二级预防具有一定的临床意义.

Exploration of azithromycin on secondary prevention of asthma

Objective To discuss the effect of azithromycin on the airway inflammation in children at high risk for asthma by detecting the serum concentration change of eosinophil cationic protein(ECP), intedeukin-8(IL-8) and nitrogen oxide(NO), and also to explore the effect of azithromycin on secondary prevention of asthma. Methods Two hundred and twenty three cases of primary asthmatic attack with atopy (eczema, family asthmatic history) were collected and divided into four groups(group A, B,C,D) after asthmatic symptoms relief, group A was taken orally with azithromycin(5mg/kg Biw), group B was inhaled budesonide(0.5mg Bid), group C was taken orally with singulair (4mg qN),and group D was only given with symptomatic treatment. The vein blood was sampled on the first day in hospital, before and after medication respectively when treatment of three months was completed. Serum concentration of ECP and IL-8 was obtained by ELISA methods, and NO was measured by nitric acid enzyme reduction method. Clinic service and telephone follow-up was taken for one year. Results After three monthes intervention, there was significant difference in the serum concentration of ECP, IL-8 and NO at group A, B, C compared with group D( P<0.01 ). There was no significant difference in decrease of ECP and NO between group A and B( P > 0.05), but decrease of ECP and NO in group C was significant difference compared with group A( P<0.01). The serum concentration of IL-8 in each group was obviously decreased especially in group A, and difference was obvious between group A and group B,C( P<0.01). There was no significant difference in the cases of asthma recurrence within three months and asthmatic recurrence within one year between group A and group B, group C and group D respectively. Conchlsions (1)The medication of azithromycin might result to decrease the serum concentration of ECP and NO, especially for IL-8 in children at high risk for asthma. (2)The effects of azithromycin on change of ECP and NO in children at high risk for asthma were similar to budesonide, but different with montelukast, while the inhabitant effects of IL-8 were different with inhaled steroid hormone and leukotriene receptor obviously. (3)There was some valid contribution of azithromycin actting on the secondary prevention of asthma in our investigation.