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小剂量红霉素联合孟鲁司特钠...因子及C-ACT评分的影响_李青.pdf
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剂量 红霉素 联合 孟鲁司特钠 因子 ACT 评分 影响 李青
Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期小剂量红霉素联合孟鲁司特钠治疗儿童难治性哮喘对血清炎症因子及C-ACT评分的影响李青,梁宽,胡梦娇,赵静利,罗婷婷宝鸡市人民医院儿科,陕西宝鸡721000【摘要】目的探讨小剂量红霉素联合孟鲁司特钠治疗儿童难治性哮喘对血清炎症因子及儿童哮喘控制测试(C-ACT)评分的影响。方法选取2018年10月至2021年10月宝鸡市人民医院收治的80例难治性哮喘患儿纳入研究,采用随机数表法将患儿分为观察组和对照组,每组40例。所有患儿均给予布地奈德吸入剂,对照组患儿在此基础上添加孟鲁司特钠片口服治疗,观察组在对照组治疗的基础上联合小剂量红霉素(35 mg/kg)口服治疗,两组患儿均持续治疗4周。比较两组患儿哮喘相关症状缓解时间,治疗前后的肺功能第一秒用力呼气量(FEV1)、最大呼气流速峰值(PEF),用力呼气75%流速(FEF75)以及最大呼气中期流速(MMEF75/25)、血清炎症相关因子白细胞介素-8(IL-8)、白细胞介素-13(IL-13)以及肿瘤坏死因子-(TNF-)、T淋巴细胞亚群水平(CD3+、CD4+、CD8+、CD4+/CD8+)。治疗前后,采用C-ACT评分评估患儿哮喘控制情况。结果治疗后,观察组患儿的喘息、肺部湿啰音及咳嗽缓解时间分别为(6.241.32)d、(1.230.54)d、(5.490.54)d,明显短于对照组的(7.141.57)d、(1.590.47)d、(6.471.12)d,差异均有统计学意义(P0.05);治疗后,观察组患儿的FEV1、PEF、FEF75及MMEF75/25指数分别为(1.840.37)L、(4.120.29)L/s、(1.290.32)L/s、(2.060.24)L/s,明显高于对照组的(1.670.24)L、(3.970.19)L/s、(1.120.17)L/s、(1.920.17)L/s,差异均具有统计学意义(P0.05);治疗后,观察组患儿的IL-8、IL-13及TNF-水平分别为(74.1222.32)ng/L、(92.5712.36)g/L、(0.740.14)ng/mL,明显低于对照组的(88.5421.19)ng/L、(101.5611.25)g/L、(1.060.21)ng/mL,差异均有统计学意义(P0.05);治疗后,观察组患儿的CD3+、CD4+、CD4+/CD8+水平分别为(68.548.97)%、(36.795.14)%、1.740.34,明显高于对照组的(63.479.12)%、(33.574.98)%、1.390.28,CD8+水平为(21.123.27)%,明显低于对照组的(24.123.32)%,差异均有统计学意义(P0.05);治疗后,观察组患儿的C-ACT评分(22.120.97)分,明显高于对照组的(20.121.37)分,差异有统计学意义(P0.05)。结论小剂量红霉素联合孟鲁司特钠可有效降低难治性哮喘患儿的血清炎症因子,维持机体免疫平衡,提高肺功能,改善临床症状,以提高患儿哮喘控制程度。【关键词】儿童;难治性哮喘;小剂量红霉素;孟鲁司特钠;血清炎症因子;哮喘控制【中图分类号】R725.6【文献标识码】A【文章编号】10036350(2023)04052905Effects of low-dose erythromycin combined with montelukast sodium on serum inflammatory factors andC-ACT scores in children with refractory asthma.LI Qing,LIANG Kuan,HU Meng-jiao,ZHAO Jing-li,LUOTing-ting.Department of Pediatrics,Baoji Peoples Hospital,Baoji 721000,Shaanxi,CHINA【Abstract】ObjectiveTo explore the effects of low-dose erythromycin combined with montelukast sodium onserum inflammatory factors and scores of childhood asthma control test(C-ACT)in children with refractory asthma.MethodsA total of 80 children with refractory asthma admitted to Baoji Peoples Hospital between October 2018 andOctober 2021 were enrolled.According to random number table method,they were divided into an observation groupand a control group,with 40 patients in each group.Based on budesonide inhalation,patients in control group were treat-ed with montelukast sodium,while those in the observation group were treated with low-dose erythromycin(3-5 mg/kg)on basis of control group,continuously for 4 weeks.The remission time of asthma-related symptoms,levels of lung func-tion indexes forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),forced expiratory flow after75%of vital capacity has been expelled(FEF75),maximal midexpiratory flow rate(MMEF75/25),serum inflamma-tion-related factors interleukin-8(IL-8),interleukin-13(IL-13),tumor necrosis factor-(TNF-),and T lymphocytesubsets(CD3+,CD4+,CD8+,CD4+/CD8+)before and after treatment were compared between the two groups.Before andafter treatment,asthma control of patients was evaluated by C-ACT scores.ResultsThe remission time of wheezing,lung rales,and cough in the observation group were(6.241.32)d,(1.230.54)d,and(5.490.54)d,significantly short-er than(7.141.57)d,(1.590.47)d,(6.471.12)d in the control group(P0.05).After treatment,FEV1,PEF,FEF75,and MMEF75/25 in the observation group were(1.840.37)L,(4.120.29)L/s,(1.290.32)L/s,and(2.060.24)L/s,significantly higher than(1.670.24)L,(3.970.19)L/s,(1.120.17)L/s,(1.920.17)L/s in the control group(P0.05),具有可比性。本研究经医院伦理委员会审核通过,患儿家属知情并已签署知情同意书。1.2治疗方法两组患儿均给予布地奈德吸入粉雾剂(注册证号 H20140421,芬兰Orion CorporationOrion Pharma,Espoo Plant,200 g200吸)治疗,200400 g/次,2次/d。对照组患儿在此基础上添加孟鲁司特钠片口服治疗,即给予孟鲁司特钠咀嚼片(注册证号 H20181210/国药准字J20130054,英国Merck Sharp&Dohme Ltd,5 mg5片)5 mg/次,1次/d,睡前服用。观察组患儿在对照组治疗的基础上联合小剂量红霉素口服治疗,即给予红霉素肠溶片(国药准字H44021101,特一药业集团股份有限公司,0.125 g100片)35 mg/(kg次),3次/d。所有患儿均持续治疗4周。1.3观察指标与评价(检测)方法(1)临床症状缓解时间:比较两组患儿的喘息、肺部湿啰音以及咳嗽缓解的时间,缓解时间越短,说明患儿恢复的越快。(2)肺功能:分别于治疗前后,检测患儿的肺功能相关指标,即第一秒用力呼气量(FEV1)、最大呼气流速峰值(PEF),用力呼气75%流速(FEF75)以及最大呼气中期流速(MMEF75/25)。(3)T淋巴细胞亚群及血清炎症相关因子:分别于治疗前后,抽取患儿清晨空腹静脉血6 mL,平分为2份,一份用于检测血清炎症相关因子白细胞介素-8(IL-8)、白细胞介素-13(IL-13)以及肿瘤坏死因子-(TNF-),一份用于检测T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)。IL-8、IL-13、TNF-均采用酶联免疫吸附法检测(试剂盒:均采自江西艾博因生物科技有限公司),T淋巴细胞亚群检测采用流式细胞仪检测(仪器:美国贝克曼DxFLEX)。均由我院检验科资深检验师按照说明书及仪器说明进行操作。(4)哮喘控制情况:采用儿童哮喘控制测试(C-ACT)评分8评估患儿治疗前后哮喘控制情况,C-ACT 中主要包括呼吸急促,急救药物的使用,哮喘对生活和工作的影响,夜间觉醒情况,患儿对哮喘控制的标化等5各方面,共7个问题,前4个问题由儿童自行回答(每项评分03分),后3项由家长回答(每项评分05分),总分27分,分数越高,说明患儿哮喘控制越好。1.4统计学方法应用SPSS21.0统计学软件进行数据分析。计量资料满足正态分布且方差齐,以均数标准差(x-s)表示,组间差异比较采用两样本独立tand(0.740.14)ng/mL,significantly lower than(88.5421.19)ng/L,(101.5611.25)g/L,(1.060.21)ng/mL in thecontrol group(P0.05).After treatment,levels of CD3+,CD4+,and CD4+/CD8+in the observation group were(68.548.97)%,(36.795.14)%,and 1.740.34,significantly higher than(63.479.12)%,(33.574.98)%,1.390.28 in the con-trol group(P0.05).After treatment,CD8+in the observation group was significantly lower than that in the controlgroup:(21.123.27)%vs(24.123.32)%,P0.05;C-ACT score was significantly higher than that in the control group:(22

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