长期吸入布地奈德对哮喘幼儿骨代谢及骨密度的影响

发布时间：2018-01-18 11:00

  本文关键词：长期吸入布地奈德对哮喘幼儿骨代谢及骨密度的影响　出处：《承德医学院》2016年硕士论文　论文类型：学位论文

  更多相关文章： 哮喘 吸入糖皮质激素 布地奈德 骨代谢 血钙 血磷 血碱性磷酸酶 骨密度

【摘要】：支气管哮喘(下文简称哮喘)是儿童时期常见的呼吸道慢性疾病之一,近二十余年来多次调查显示儿童哮喘患病率呈逐年上升趋势。哮喘的发病机制十分复杂,目前认为哮喘的本质是气道慢性炎症反应。这种气道慢性炎症增加了气道痉挛---气道高反应---暴露于刺激物之中的恶性循环。其中气道高反应是哮喘的基本特征之一,它是指气道对多种多样的刺激因素,如过敏原、物理因素、化学因素、运动等出现高度敏感的状态,可以在一定的程度上表示出气道慢性炎症的严重情况。哮喘的临床表现特点是间歇性发作,表现为反复发作的喘息、咳嗽、胸闷、呼吸急促等,通常易出现在夜间及剧烈运动期间,这些症状与广泛多变的可逆性气流阻塞有密切关系,可以经过有效治疗或者自行缓解。但若哮喘不经有效治疗,易出现反复发作并进行性加重,严重时会出现哮喘危重状态,表现为呼吸困难,大汗淋漓,烦躁不安,甚至会出现端坐呼吸,意识障碍及呼吸循环衰竭,进而危及到患儿的生命安全。因此,哮喘反复发作,严重影响了患儿的身心健康发展。目前,随着哮喘研究进展及炎症学说的确定,糖皮质激素(GC)已被作为治疗哮喘的第一线药物。全身应用GC已经产生了明显的全身不良反应,而吸入性糖皮质激素(ICS)因其疗效好、直接作用于气道黏膜,全身副作用少而得到广泛推广。但是同时,ICS的疗程长,吸入种类、频次及剂量不同,在儿科医生及患儿家属中广泛存在着安全性的争议。布地奈德(BUD)是最常用的一种ICS,它能有效的消除气道炎症从而降低气道高反应性,进而达到治疗哮喘的目的。长期吸入BUD是否会对哮喘患儿的骨代谢和骨密度产生影响,是儿科医生及患儿家属关注的焦点。本研究通过观察60例哮喘幼儿持续吸入BUD对其骨代谢指标和骨密度的影响,了解长期应用ICS治疗哮喘的安全性。目的:通过检测哮喘幼儿持续吸入布地奈德后骨代谢生化指标---血钙(Ca)、血磷(P)、血碱性磷酸酶(ALP)以及骨密度(BMD)的变化情况,探究长期吸入bud对哮喘患儿骨代谢及骨密度指标的影响,了解是否有可能引起骨量丢失,进而指导哮喘患儿应用雾化吸入gc来预防和治疗哮喘发作。方法:收集2014年1月至2015年10月,于我院门诊及住院部诊治的支气管哮喘幼儿60例。所选患儿均规律吸入bud(1mg/d)≥3个月。调查所选患儿在用药期间能够影响骨代谢和骨密度的三个常见因素---饮食因素、体育活动、日照时间,以了解这些因素的均衡分布情况。于用药前、用药1个月、用药3个月三个时间窗,对所选患儿分别进行血ca、血p、血alp及bmd的测定。所有数据应用excel录入,使用spss19.0统计软件进行分析,首先进行一般资料的频数分布描述,然后进行各指标均数差别的检验(χ2检验或方差分析)。结果:1患儿一般情况分析:所选患儿平均年龄为2.17±0.62岁,其中1周岁至2周岁之间占45%(27),2周岁到3周岁之间占55%(33);男、女各占56.7%(34)和43.3%(26)。分析所选患儿在治疗过程中影响骨代谢指标和骨密度的三种因素。饮食因素:合理膳食且无偏食为较好,占80%-85%(48-50),三个时间段比较差异无统计学意义。体育活动:活动时间大于2h为较好,占86%-89%(52-53),三个时间段比较差异无统计学意义。日照时间:大于2h为较好,占86%-89%(52-53),三个时间段比较差异无统计学意义。2患儿的骨代谢指标在三个时间点的变化情况:所选患儿于用药前、用药1个月、用药3个月这三个时间点的血ca、血p、血alp的测定结果如下:血ca(mmol/l)分别为2.26±0.16,2.28±0.15,2.27±0.13(p=0.64);血p(mmol/l)分别为1.78±0.18,1.80±0.19,1.82±0.16(p=0.52);血alp(u/l)分别为116.80±20.42,115.15±17.07,115.53±17.04(p=0.87)。各指标均数间比较均为p0.05,差异无统计学意义。3患儿的骨密度在三个时间点的变化情况:所选患儿于用药前、用药1个月、用药3个月这三个时间点的bmd(z值)分别为0.45±0.28,0.51±0.30,0.50±0.27(p=0.55),三个均数之间比较为p0.05,差异无统计学意义。结论:1所选哮喘患儿在吸入布地奈德期间的饮食因素、体育活动及日照时间是均衡的。2所选哮喘患儿三个时间点的骨代谢指标及骨密度无明显改变,表明长期吸入布地奈德不会对哮喘患儿的骨质发育产生影响。
[Abstract]:Bronchial asthma (hereinafter referred to as asthma) is one of the most common childhood chronic respiratory disease in recent twenty years, many surveys show that the prevalence of childhood asthma increased year by year. The pathogenesis of asthma is very complicated, now that the nature of asthma is a chronic airway inflammation. This chronic airway inflammation increases airway spasm, airway high vicious spiral the reaction - exposure to irritants. Among which the airway hyperresponsiveness is one of the basic features of asthma, it refers to a variety of airway stimuli, such as allergen, physical factors, chemical factors, such as movement appeared highly sensitive state, can show serious chronic airway inflammation in a certain extent. The clinical features of asthma is characterized by repeated episodes of intermittent episodes of wheezing, coughing, chest tightness, shortness of breath, usually at night and prone to violent movement During the start period, there is a close relationship between these symptoms and a wide variety of reversible airflow obstruction can be relieved or after effective treatment. But if asthma without effective treatment, prone to recurrent and progressive, there will be serious severe asthma, showed dyspnea, sweating, irritability, and even there orthopnea, disturbance of consciousness and respiratory failure, and endanger the children's safety. Therefore, repeated attacks of asthma, serious impact on children's physical and mental health development. At present, with the research progress and the inflammation theory of asthma, Glucocorticoid (GC) has been used as first-line drugs for the treatment of asthma in the body. The application of GC has produced obvious systemic adverse reactions, and inhaled corticosteroids (ICS) because of its good curative effect, directly on the airway mucosa, with fewer side effects and spread. But at the same time, I The CS long course of treatment, inhalation of different types, frequency and dose in the family and children, pediatricians exists widely in the security dispute. Budesonide (BUD) is one of the most commonly used ICS, which can effectively eliminate airway inflammation and reduce airway hyperresponsiveness, which can cure asthma. The long-term inhalation of BUD children with asthma will affect bone metabolism and bone density, is the focus of the family and children's pediatrician. In this study, through the observation of 60 cases of asthmatic children inhaled the effect of BUD on bone metabolism and bone mineral density, should understand the long-term safety of ICS for the treatment of asthma. Objective: to detect the budesonide inhalation asthma children after the biochemical indexes of bone metabolism, serum calcium (Ca), phosphorus (P), serum alkaline phosphatase (ALP) and bone mineral density (BMD) changes, to explore the long-term inhalation of bud on bone metabolism in children with asthma and bone density index To find out whether there is influence, may cause the loss of bone mass, and then guide the application of atomization inhalation on children with asthma GC for the prevention and treatment of asthma. Methods: from January 2014 to October 2015, in our hospital outpatient and inpatient diagnosis and treatment of bronchial asthma in children 60 cases. The selected patients were regular inhalation of bud (1mg/d) is more than 3 months of investigation. The children can choose three common factors, dietary factors, bone metabolism and bone density in use during sports activities, sunshine time, in order to understand the equilibrium distribution of these factors. In the 1 months before the medication, medication, medication for 3 months the three time window, the selected patients were blood Ca, blood p, serum ALP and BMD. All the data input by Excel, were analyzed using spss19.0 statistical software, describes the frequency distribution of the first general inspection data, then each index mean difference (x ~ 2 test or analysis of variance). 鏋，

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