本文選題：吸入性糖皮質(zhì)激素 + 氨茶堿　； 參考：《鄭州大學(xué)》2012年博士論文

【摘要】：1 目的 支氣管哮喘是氣道的慢性非特異性炎癥反應(yīng)。哮喘嚴(yán)重影響患者的生活、工作和學(xué)習(xí),影響兒童及青少年的生長發(fā)育。嚴(yán)重哮喘急性發(fā)作,若未得到及時(shí)有效的治療,可以致命。哮喘農(nóng)村患病率高于城市,僅0.3%的患者按全球哮喘防治方案正規(guī)治療[1],影響患者依從性不高的主要原因是經(jīng)濟(jì)困難。吸入性糖皮質(zhì)激素是控制哮喘首選藥物,其療效好,副作用小,得到臨床醫(yī)生的肯定[2],但因價(jià)格較貴,難以普及。確定哮喘長期治療方案,既要考慮藥物的療效及安全性,也要考慮患者的實(shí)際情況。貧困地區(qū)或低經(jīng)濟(jì)收入的患者,推薦使用ICS聯(lián)合口服茶堿長期控制哮喘[2]。本研究的目的在于明確ICS(吸入糖皮質(zhì)激素)聯(lián)合口服茶堿的療效及對(duì)呼吸道炎癥的抑制作用,以及ICS(吸入糖皮質(zhì)激素)聯(lián)合口服茶堿治療對(duì)體內(nèi)T淋巴細(xì)胞亞群的影響,治療過程中T淋巴細(xì)胞亞群與哮喘患者肺功能、氣道炎癥水平的相關(guān)性。本研究為哮喘的臨床治療提供參考,為廣大中低收入哮喘人群尋找價(jià)廉、易接受的治療方案。2 方法 2.1受試對(duì)象所有研究對(duì)象在實(shí)驗(yàn)前四周內(nèi)未用全身糖皮質(zhì)激素及其它抗過敏藥,二周內(nèi)未口服白三烯受體拮抗劑,一周內(nèi)未吸入長效β2一受體激動(dòng)劑口服β受體激動(dòng)劑。1)吸入激素聯(lián)合氨茶堿對(duì)中度持續(xù)哮喘患者的治療作用。依據(jù)GINA診斷標(biāo)準(zhǔn),選擇我院呼吸科門診2011年1月至2011年12月的中度哮喘患者25例,試驗(yàn)組患者每日吸入布地奈德(普米克都保,阿斯利康公司,批號(hào):NC1219),每次200μg,每天2次;口服氨茶堿片0.1g每天3次。吸入激素聯(lián)合口服氨茶堿或者長效β2受體激動(dòng)劑控制中度持續(xù)哮喘的療效觀察及治療前后體內(nèi)T淋巴亞群的變化。依據(jù)《支氣管哮喘防治指南》[2]哮喘診斷標(biāo)準(zhǔn),選擇鄭州大學(xué)人民醫(yī)院呼吸科門診2011年1月至2011年12月的未控制哮喘患者280例。采用隨機(jī)、開放、平行、對(duì)照的方法,將患者分為試驗(yàn)組(ICS+茶堿)和對(duì)照組(ICS+LABA)兩組,每組140例。試驗(yàn)組每日吸入布地奈德(普米克都保,阿斯利康公司,批號(hào):NC1219),每次200μg,每天2次;口服氨茶堿片(北京紫竹藥業(yè)有限公司,批號(hào):H11020445)0.1g,每天3次。對(duì)照組患者每日吸入布地奈德/福莫特羅(信必可都保,阿斯利康公司,批號(hào):ML967),每吸(160/4.5)μg,每天2吸。研究期間給予舒喘靈氣霧劑(上海信誼公司)用以必要時(shí)緩解癥狀�？偗煶虨�3月。3)吸入糖皮質(zhì)激素聯(lián)合茶堿對(duì)未控制吸煙哮喘患者的療效觀察篩選門診未控制支氣管哮喘患者80例,隨機(jī)分為試驗(yàn)組和對(duì)照組,試驗(yàn)組為吸煙患者,對(duì)照組為不吸煙患者。兩組均每日吸入布地奈德,每次200μg,每天2次,聯(lián)合口服氨茶堿片0.1g,每天3次。療程3個(gè)月。2.2藥物的選擇及使用方法試驗(yàn)藥物:普米克加茶堿組(普米克都保,阿斯利康公司,400ug/d分2次吸入,氨茶堿0.1,3次/日)。布地奈德/福莫特羅(信必可都保,阿斯利康公司,批號(hào):ML967),每吸(160/4.5)μg,每天2吸。研究期間給以舒喘靈氣霧劑(上海信誼公司)必要時(shí)用以緩解癥狀,療程為6周。2.3觀察指標(biāo)1.不同藥物治療后哮喘控制水平;2.不同藥物呼吸系統(tǒng)癥狀評(píng)分;3.不同藥物治療前后晨晚間峰流速((PEF);4.不同藥物治療前后FEV 1占預(yù)計(jì)值百分比(FEV}%);5.不同藥物治療前后誘導(dǎo)痰嗜酸粒細(xì)胞計(jì)數(shù);6.不同藥物治療前后外周靜脈血IL-4,Ig E;7.不同藥物治療前后外周血中Th1,Th2,Th17細(xì)胞的分布情況,以及血清中IL-4、IL-5、IL-17等細(xì)胞因子的水平。并分析其與以上臨床指標(biāo)的相關(guān)性。3 結(jié)果 3.1 ICS聯(lián)合氨茶堿可以降低哮喘患者體內(nèi)Th2、Th17細(xì)胞的比例,Th2、Th17細(xì)胞與哮喘患者肺功能、氣道炎癥水平有很好的相關(guān)性。3.2治療哮喘1月時(shí),ICS聯(lián)合氨茶堿在改善PEF、ACT評(píng)分方面,明顯不及ICS聯(lián)合長效β2受體激動(dòng)劑組(P均0.05),痰嗜酸粒細(xì)胞比例的改善優(yōu)于ICS聯(lián)合長效β2受體激動(dòng)劑組(P0.05),Fe NO無明顯區(qū)別(P0.05);治療3月時(shí),ICS聯(lián)合氨茶堿對(duì)痰嗜酸粒細(xì)胞比例的改善優(yōu)于ICS聯(lián)合長效β2受體激動(dòng)劑組(P0.05),對(duì)Fe NO、PEF、ACT評(píng)分的改善與對(duì)照組無明顯區(qū)別(P均0.05)。兩組均能降低哮喘患者體內(nèi)Th2、Th17細(xì)胞的比例,降低外周血上清中IL-4、IL-5、IL-17、Ig E的水平,組間沒有統(tǒng)計(jì)學(xué)差異。3.3吸煙患者用ICS聯(lián)合氨茶堿治療前、治療3月后的ACT評(píng)分、PEF、FEV1%預(yù)計(jì)值、IL-4、IL-5、Ig E值分別為:(12.2±3.3)和(18.3±2.9),(255.9±99.7)L·min-1和(290.3±105.2)L·min-1,(66.5±4.7)和(72.9±5.4),(14.5±3.2)pg·m L-1和(12.3±3.4)pg·m L-1,(27.2±6.4)pg·m L-1和(24.2±5.8)pg·m L-1,(82.7±16.8)IU·m L-1和(67.1±14.3)IU·m L-1,非吸煙者分別為:(13.0±3.4)和(19.1±2.6),(279.1±103.3)L·min-1和(321.3±110.4)L·min-1,(68.8±5.8)和(74.8±5.5),(13.4±2.9)pg·m L-1和(11.4±2.8)pg·m L-1,(26.5±6.9)pg·m L-1和(22.8±6.2)pg·m L-1,(78.8±18.2)IU·m L-1和(66.4±17.8)IU·m L-1,兩組組內(nèi)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。吸煙和非吸煙患者用ICS聯(lián)合氨茶堿治療后均能降低哮喘患者體內(nèi)Th2、Th17細(xì)胞的比例,組間沒有統(tǒng)計(jì)學(xué)差異。3.4統(tǒng)計(jì)學(xué)分析采用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析。各項(xiàng)指標(biāo)的變化值以x±s表示,采用多組比較的ANOVA檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。4 結(jié)論 4.1 ICS聯(lián)合氨茶堿,可以降低哮喘患者體內(nèi)Th2、Th17細(xì)胞的比例,Th2、Th17細(xì)胞與哮喘患者肺功能、氣道炎癥水平有很好的相關(guān)性。4.2 ICS(吸入糖皮質(zhì)激素)聯(lián)合氨茶堿,在改善哮喘患者肺功能、控制氣道炎癥方面與ICS聯(lián)合長效β2受體激動(dòng)劑有相似的療效。4.3小劑量ICS(吸入糖皮質(zhì)激素)聯(lián)合小劑量氨茶堿,在改善吸煙哮喘患者癥狀、提高肺功能、控制氣道炎癥方面與不吸煙患者有相同的療效。
[Abstract]:1 bronchial asthma is a chronic nonspecific inflammatory response in the airway. Asthma seriously affects the life, work and learning of the patients. It affects the growth and development of children and adolescents. The acute attack of severe asthma can be fatal if it is not given timely and effective treatment. The prevalence of asthma in rural areas is higher than that in the city, and only 0.3% of the patients are based on global asthma prevention. The main reason for the regular treatment of [1] is economic difficulty. Inhaled glucocorticoid is the first drug to control asthma. It has good curative effect and small side effect. It is difficult to be popularized by the clinician, but it is difficult to popularize the long-term treatment for asthma. The purpose of the study was to identify the efficacy of the combination of ICS (inhaled glucocorticoids) combined with oral theophylline and the inhibitory effect on respiratory inflammation, as well as the combination of ICS (inhaled glucocorticoid) and oral theophylline treatment, in poor or low income patients. The purpose of the study is to use ICS combined with oral theophylline for long-term control of asthma [2].. The effect of therapy on the T lymphocyte subsets in the body, the correlation between the T lymphocyte subsets and the lung function and airway inflammation in the patients with asthma. This study provides a reference for the clinical treatment of asthma, and for the majority of the middle and low income asthma people to find the inexpensive and acceptable treatment program.2 method, all the subjects of the subjects are in the actual study. No systemic glucocorticoid and other antiallergic drugs were used in the four weeks before the test. No oral leukotriene receptor antagonist was taken within two weeks. The therapeutic effect of inhaled hormone combined with aminophylline on moderate persistent asthmatic patients was not inhaled during one week. The effect of inhaled hormone and aminophylline on moderate persistent asthmatic patients was not inhaled within one week. According to GINA diagnostic criteria, 2 Department of respiration outpatients in our hospital were selected. 2 In 25 cases of moderate asthma from January to December 2011, patients in the test group inhaled budesonide daily (general Mick, AstraZeneca, batch number: NC1219), 200 mu g each time, 2 times a day, 3 times a day for oral Aminophylline Tablets 0.1g. Inhaled hormone combined oral aminophylline or long effect beta 2 receptor agonists to control the efficacy of moderate persistent asthma The changes of T lymphatic subgroup in the body before and after treatment were observed and 280 cases of uncontrolled asthma in the Department of respiration of the Department of respiration, Zhengzhou University from January 2011 to December 2011 were selected according to the diagnostic criteria of asthma prevention and control guidelines of the people's Hospital of Zhengzhou University. The patients were randomly, open, parallel, and controlled. The patients were divided into the experimental group (ICS+ theophylline) and the control group (I CS+LABA) two groups, each group of 140 cases. The test group inhaled budesonide daily (Mick Du Bao, AstraZeneca, batch number: NC1219), 200 mu g each time, 2 times a day; oral Aminophylline Tablets (Beijing zizuzhu Pharmaceutical Co., H11020445) 0.1g, 3 times a day. The control group inhaled budesonide / formoterol daily (sure, Ashley) "Kang company, batch number: ML967), each inhalation (160/4.5) mu g, 2 inhalation per day. During the study period, the sulbactin aerosol (Shanghai Xinyi company) was used to relieve symptoms when necessary. The total course was March.3) inhaled corticosteroids combined theophylline for uncontrolled smoking patients, 80 cases of uncontrolled bronchial asthma were selected and randomly divided into a trial. The two groups were inhaled budesonide daily, 200 g each time, 2 times a day, combined oral Aminophylline Tablets 0.1g, 3 times a day. The course of treatment for 3 months.2.2 drugs and the use of a test drug: Pulmicort and theophylline group (general Mick, AstraZeneca, 400ug/d, 2) Inhalation, aminophylline 0.1,3 times / day). Budionide / formoterol (sure, AstraZeneca, batch number: ML967), each inhalation (160/4.5) mu g, 2 inhalation per day. During the study period, the schuterol aerosol (Shanghai Xinyi) was given to relieve symptoms when necessary, and the treatment course was 6 weeks.2.3 observation index 1. different medication after treatment of asthma control level; 2. no The same drug respiratory system symptom score; 3. morning and evening peak flow rate (PEF) before and after treatment with different drugs; 4. FEV 1 before and after treatment of different drugs (FEV}%); 5. induced phlegm eosinophil count before and after treatment of different drugs; 6. IL-4, Ig E before and after treatment of different drugs; 7. Th1, Th2 in peripheral blood before and after treatment of different drugs. The distribution of Th17 cells, the level of IL-4, IL-5, IL-17 and other cytokines in the serum, and analyze the correlation with the above clinical indicators,.3 results 3.1 ICS combined with aminophylline can reduce the proportion of Th2, Th17 cells in the patients with asthma, Th2, Th17 cells have a good correlation with the lung function of the asthmatic patients and the level of airway inflammation. In January, ICS combined with aminophylline was less than ICS combined with long effect beta 2 receptor agonist (P 0.05) in improving PEF and ACT score. The improvement of phlegm eosinophil ratio was better than ICS combined with long-acting beta 2 receptor agonist group (P0.05), Fe NO had no significant difference (P0.05); ICS combined with aminophylline was used to modify phlegm eosinophil ratio in March. Better than ICS combined with long effect beta 2 receptor agonist group (P0.05), the improvement of Fe NO, PEF, ACT score was not significantly different from the control group (P 0.05). The two groups could reduce the proportion of Th2 and Th17 cells in the patients with asthma, and reduce the level of IL-4, IL-5, IL-17, and IL-17, and there was no statistical difference between the groups. Before the treatment, the ACT scores after March, PEF, FEV1% predicted values, IL-4, IL-5 and Ig E values were respectively (12.2 + 3.3) and (18.3 + 2.9), (255.9 + 99.7) L min-1 and (290.3 + 105.2) L. Min-1, (66.5 + 4.7) and (72.9 + 5.4). .1 + 14.3) IU. M L-1, non smokers were (13 + 3.4) and (19.1 + 2.6), (279.1 + 103.3) L / min-1 and (321.3 + 110.4) L. Min-1, (68.8 + 5.8) and (74.8 + 5.5). There was statistical significance (P0.05), there was no statistical difference between groups (P0.05). Smoking and non smoking patients with ICS combined with aminophylline could reduce the proportion of Th2 and Th17 cells in the patients with asthma. There was no statistical difference between groups and.3.4 statistical analysis was analyzed by SPSS16.0 meter software. The change values of each index were x +. S indicated that using multiple comparison ANOVA tests, P0.05 was statistically significant.4 conclusion 4.1 ICS combined aminophylline, which could reduce the proportion of Th2, Th17 cells in asthmatic patients, Th2, Th17 cells and lung function in asthmatic patients, and a good correlation between the airway inflammation level and the.4.2 ICS (inhaled corticosteroids) combined with aminophylline, in improving asthma. Pulmonary function and control of airway inflammation in asthmatic patients are similar to ICS combined with long effect beta 2 receptor agonists..4.3 small dose of ICS (inhaled corticosteroids) combined with small dose aminophylline has the same effect in improving the symptoms of asthma, improving lung function, and controlling airway inflammation.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2012
【分類號(hào)】：R562.25

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相關(guān)期刊論文 前2條

1 鐘南山;;我國支氣管哮喘防治研究重點(diǎn)及努力方向[J];中華結(jié)核和呼吸雜志;2005年12期

2 ;Sputum interleukin-17 is increased and associated with airway neutrophilia in patients with severe asthma[J];Chinese Medical Journal;2005年11期

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本文編號(hào)：1886012