支气管哮喘合并变应性鼻炎共治的临床观察

发布时间：2018-05-23 10:59

本文选题：支气管哮喘 + 变应性鼻炎　；参考：《华北煤炭医学院》2010年硕士论文

【摘要】：目的观察比较吸入ICS+LABA联合鼻喷IC与单纯吸入ICS+LABA治疗支气管哮喘合并变应性鼻炎的疗效,验证上、下气道共治更有利于哮喘合并变应性鼻炎患者临床症状的控制。方法选取就诊于华北煤炭医学院附属医院呼吸科门诊轻、中度持续支气管哮喘合并常年变应性鼻炎患者62例,随机分为两组,A组采取口吸沙美特罗替卡松粉吸入剂(商品名:舒利迭,Seretide,由葛兰素史克公司生产),每天早晚各吸1次,每吸50μg /250μg,同时鼻喷布地奈德鼻喷剂(商品名:雷诺考特,Rhinocort,由阿斯利康公司生产),每天早晚每侧鼻孔各喷1揿,每揿64μg。B组单纯经口吸入沙美特罗替卡松粉吸入剂(药品同A组),每天早晚各吸1次,每吸50μg /250μg。治疗4周后比较两组患者治疗前后肺功能、血清TIgE、血清ECP、外周血EOS%、诱导痰EOS%、鼻分泌物涂片EOS强度以及ACQ问卷评分、鼻炎症状评分的变化。另外选取华北煤炭医学院附属医院无急慢性呼吸道疾病及过敏性疾病健康体检人员30名作为健康对照组(C组)。治疗4周后比较A、B、C三组间肺功能、血清TIgE、血清ECP、外周血EOS%、诱导痰EOS%有无差异;比较A、B两组间鼻分泌物涂片EOS强度、ACQ问卷评分、鼻炎症状评分有无差异。结果经过4周治疗,A、B两组患者肺功能(FEV1%、FEV1/FVC%、PEF%)均有不同程度提高,血清TIgE、血清ECP、诱导痰EOS%、鼻炎症状评分、ACQ问卷评分均有明显下降,组内比较,治疗前后差异有统计学意义(P值均0.05)。A组患者治疗后鼻分泌物涂片EOS强度明显下降,与治疗前比较差异有统计学意义(P值0.05);B组患者治疗后鼻分泌物涂片EOS强度无明显下降,与治疗前比较差异无统计学意义(P值0.05)。A组、B组患者治疗后外周血EOS%均无明显下降,与治疗前比较差异均无统计学意义(P值0.05)。治疗后A、B、C三组间肺功能(FEV1%、FEV1/FVC%、PEF%)比较,差异有统计学意义(P值0.05),进一步两两比较,A组与B组,差异无统计学意义(P值0.05),C组与A组、B组任意一组比较,差异均有明显统计学意义(P值均0.05)。治疗后A、B、C三组间血清TIgE、血清ECP比较,差异均有统计学意义(P值均0.05),进一步两两比较,A组、B组、C组任意两组比较,差异均有显著统计学意义(P值均0.05)。治疗后A、B、C三组间外周血EOS%及诱导痰EOS%比较,差异均存在统计学意义(P值均0.05),进一步两两比较,A组与B组,差异均无统计学意义(P值均0.05)。C组与A组、B组任意一组比较,差异均有显著统计学意义(P值均0.05)。治疗后A、B两组鼻炎症状评分、ACQ量表评分以及鼻分泌物涂片EOS强度均存在显著统计学差异(P值均0.05)。结论1、口吸ICS+LABA联合鼻喷IC较单纯口吸ICS+LABA更能全面抑制上、下气道嗜酸性粒细胞介导的炎症反应;2、口吸ICS+LABA联合鼻喷IC与单纯口吸ICS+LABA均可降低哮喘合并变应性鼻炎患者血清中TIgE与ECP水平,而口吸ICS+LABA联合鼻喷IC较单独应用口吸ICS+LABA效果更加显著;3、口吸ICS+LABA联合鼻喷IC与单纯口吸ICS+LABA均可改善轻、中度持续哮喘合并变应性鼻炎患者肺功能,并且口吸ICS+LABA联合鼻喷IC与单纯口吸ICS+LABA在改善轻、中度持续哮喘合并变应性鼻炎患者肺功能方面无明显差别;4、口吸ICS+LABA联合鼻喷IC与单纯口吸ICS+LABA均可改善哮喘合并变应性鼻炎患者鼻炎症状与哮喘症状,而联合用药的改善效果更显著;5、短期中低剂量口吸ICS+LABA与ICS+LABA联合鼻喷IC均不能降低支气管哮喘合并变应性鼻炎患者外周血EOS%。
[Abstract]:Objective To compare the efficacy of inhaled ICS + LABA combined with nasal spray IC and simple inhalation of ICS + LABA in the treatment of allergic rhinitis complicated with bronchial asthma .

Methods Sixty - two patients with mild and moderate persistent bronchial asthma and perennial allergic rhinitis were randomly divided into two groups .

Results After 4 weeks treatment , the lung function ( FEV1 % , FEV1 / FVC % , PEF % ) in group A and group B were significantly improved , and the scores of serum TIX , serum ECP , induced sputum EOS % , rhinitis symptom score and ACQ were significantly decreased ( P < 0.05 ) . There was no significant difference between the two groups ( P < 0.05 ) . There was no significant difference between group A and group B ( P < 0.05 ) . There was significant difference between group C and group A and group B ( P < 0.05 ) .

Conclusion 1 , ICS + LABA combined with nasal spray IC and simple oral administration of ICS + LABA can improve the pulmonary function of patients with asthma complicated allergic rhinitis , and the combination of oral and suction ICS + LABA combined with nasal spray IC and simple oral administration of ICS + LABA can improve the pulmonary function of patients with mild and moderate persistent asthma and allergic rhinitis .
【学位授予单位】：华北煤炭医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R562.25;R765.21

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