婴幼儿哮喘急性发作期加服糖皮质激素的疗效研究

目的:观察加用口服泼尼松片治疗与单纯吸入糖皮质激素在婴幼儿哮喘急性发作期中的疗效。方法:6个月～3岁婴幼儿支气管哮喘患儿48例,随机分为常规治疗组(A组,n=24)与口服泼尼松组(B组,n=24),对照组为6个月～3岁的健康体检儿童(C组,n=20)。B组在常规GINA方案治疗的同时短期加服泼尼松片3～7天,1～2 mg.kg-1.d-1(总量不超过40 mg),分2～3次。治疗第3天,利用血细胞计数板检测3组患儿血嗜酸性粒细胞数,采用流式细胞计数法检测外周血T细胞亚群CD4/CD8,ELISA法检测血清IgE、IL-4水平。结果:哮喘患儿血清IgE、IL-4水平均明显提高。B组患儿疗效优于A组,其血嗜酸性粒细胞数及血清IgE、IL-4水平均低于A组(P<0.05),两组CD4/CD8比值差异无统计学意义(P>0.05)。结论:加服泼尼松片比单纯吸入糖皮质激素对婴幼儿哮喘急性发作期疗效好,其原因为弥补了婴幼儿吸入治疗依从性差的缺陷,发挥了糖皮质激素抗炎和抗过敏的作用。

Study on the curative effect of additional glucocorticoid for infants with asthma at acute attack period

Objective:To observe the curative effects of additional oral administration of prednison pills and simple inhalation of glucocorticoid in treatment of infants with asthma at acute attack period. Methods:48 infants with bronchial asthma aged 6 months～3 years were selected and divided into conventional treatment group(group A,24 infants) and prednison group(group B,24 infants);20 infants aged 6 months～3 years receiving physical examination were selected as control group(group C).The infants in group B were treated with oral administration of prednison pills for 3～7 days at the same time of conventional GINA therapy,1～2 mg·kg-1·d-1(the total content was no more than 40 mg),twice or three times a day.On the third day after treatment,blood cell counting plate was used to detect the numbers of eosinophilic granulocytes in the three groups,flow cytometry was used to detect the ratio of CD4/CD8 in T cell subset in peripheral blood,and ELISA was used to detect the serum levels of IgE and IL-4. Results:The serum levels of IgE and IL-4 in infants with asthma increased significantly.The clinical curative effect in group B was superior to that in group A;the number of eosinophilic granulocytes,serum levels of IgE and IL-4 in group B were significantly lower than those in group A(P<0.05),there was no significant difference in the ratio of CD4/CD8 between the two groups(P>0.05). Conclusion:For the infants with asthma at acute attack period,the curative effect of additional oral administration of prednison pills is superior to that of simple inhalation of glucocorticoid,because it can remedy the disadvantage of poor compliance in the course of inhalation therapy and play the anti-inflammatory action and anti-allergic effect of glucocorticoid.