小儿咳嗽变异型哮喘不同疗法与预后

目的:探讨小儿咳嗽变异型哮喘(CVA)的疗法与预后。方法:CVA患儿79倒随机分成A组(吸入糖皮质激素组).B组(口服氨茶碱和扑尔敏组)、C组(口服沙丁胺醇和酮替芬组)、D组(对照组)。A组予丙酸倍氯米松定量气雾剂吸入,每次100μg,每日2次。B组给予氨茶碱片每次4-5mg/kg,每日3次;扑尔敏每天0.35mg/kg,分3-4次。C组给予沙丁胺醇,每次0.1m/kg,每日2-3次,咳嗽消失后2周停药,酮替芬<3岁每次0.5mg,≥3岁每次1mg,每日均为2次。D组给予止咳、祛痰、抗感染等治疗。各组疗程均为6个月。随访时间半年至4年7个月。结果:用药2周有效率A、B、C组间无显著性差异(P>0.05),但均明显优于D组(P<0.01)。CVA复发率A组(20%)低于B组(45%),但两者在统计学上无显著性差异(P>0.05),可能与样本小有关,A组与C组及D组有显著性差异(P<0.05).B组与C组无显著性差异(P>0.05)。CVA转化为哮喘发生率A组低于B组及C组(P<0.05),明显低于D组(P<0.01)。B组与C组无显著性差异(P>0.05)。药物副作用发生率A、B、C组间无显著性差异(P>0.05)。结论:吸入糖皮质激素、口服氨茶碱和扑尔敏、口服沙丁胺醇和酮替芬对控制CVA对咳嗽症状均有较好疗效,但对预防CVA复发、CVA转化为哮喘,吸入糖皮质激素疗效优于氨茶碱和扑尔敏、沙丁胺醇和酮替芬。

Different Treatments and Prognoses of Cough Variant Asthma in Children

Objective:To investigate different teratments and their prognoses in Cough Variant Asthma(CVA) in children. Methods:Seventy-nine CVA children were randomly assigned into Group A(group of inhaled corticosteriods).Group B(group of oral phyllioe and chlorpheniramine),Group C(group of oral salbutamol and ketotifen),and Group D(control group).Group A received inhaled beclometasone dipropionate extrafine aerosol,100μg per time,twice a day.Group B received aminophylline tablets,4-5mg/kg per time,3 times daily;and chlorpheniramine 0.35mg/kg per day,3 or 4 times a day.Group C received salbutamol 0.1mg/kg a time.2 or 3 times daily,until 2 weeks after cough disappeared;and also ketotifen twice a day.0.5mg per time in children under 3 years old,and 1mg a time in children more than or equal to 3 years old.Group D received treatments to relive cough,eliminate phlegm and anti-infection. All patients received 6 months’ treatment and also follow-up viaried from 6 months to 4 years and 7 months.Results:No significant differences were observed in effecitve rates after 2 weeks of treatment among groups A,B and C(P>0.05).but they all significantly lower than that in Group D(P<0.01).CVA relapse rate in Group A(20%) was lower than Group B(45%).but there was no statisticaly significance in their difference(P>0.05).which was probably due to the small sample.CVA relapse rate in Group A was significantly different from that in Group C or Group D(P<0.05);and the rates of CVA relapse in Groups B and C were not significantly different(P>0.05). The occurrence rale of asthma developed from CVA in Group A was lower than that in Group B or Group C(P<0.05).and siginificantly lower than that in Group D(P<0.01).No significant difference was found between the occurrence rates of asthma in Groups B and C (P>0.05).There were no significant differences of side effect occurrence rates among groups A.B and C(P>0.05).Conclusion:All the three therapies,namely inhaled corticosteroids,oral aminophylline and chlorpheniramine and oral salbutamol and ketotifen,are effective in control CVA and relieving cough.As for the prevention of CVA relapse and asthma developed from CVA.however,inhaled corticosteroids is more effective than aminophylline and chlorpheniramine,and salbutamol and ketotifen.