作者：刘威威，苏玉峰，王欢，李敏，吴旭兰，陈晓香

单位：

065000 河北省廊坊市人民医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine, the People's Hospital of Langfang, Langfang 065000, China

关键词：

咳嗽变异性哮喘；布地奈德福莫特罗；疗程；治疗结果；辅助性T 细胞因子

Keywords：

Cough variant asthma; Budesonide and formoterol; Course of treatment; Treatment outcome; Th cytokines

CLC：

R 562.2

DOI：

10.12114/j.issn.1008-5971.2021.00.131

Funds：

河北省廊坊市科技支撑计划项目（2019013095）——不同疗程布地奈德福莫特罗吸入治疗咳嗽变异性哮喘的临床研究

摘要：

　背景　目前，布地奈德福莫特罗已广泛用于治疗咳嗽变异性哮喘，但选择兼顾有效性和安全性的治疗 疗程是临床研究的热点和难点。目的　比较不同疗程布地奈德福莫特罗对咳嗽变异性哮喘患者疗效及辅助性T（Th） 细胞因子的影响。方法　选取2018 年8 月—2020 年3 月廊坊市人民医院收治的198 例咳嗽变异性哮喘患者作为研究 对象，采用随机数字表法分为A 组、B 组和C 组，每组66 例。三组患者均予以布地奈德福莫特罗吸入治疗，其中A 组患者疗程为8 周、B 组患者为16 周、C 组患者为24 周。比较三组患者治疗前及治疗结束后1 d 咳嗽症状评分、莱 斯特咳嗽问卷（LCQ）评分、肺功能指标〔包括最大呼气流量占预计值的百分比（PEF%）、第1 秒用力呼气容积占预 计值的百分比（FEV1%）及用力肺活量占预计值的百分比（FVC%）〕、气道激发试验结果〔第1 秒用力呼气容积较 基础对照值下降大于20% 的最低累积剂量（PD20-FEV1）〕、诱导痰炎性递质〔包括诱导痰白介素（IL）-5、IL-10 及嗜酸粒细胞百分比（EOS%）〕、血清Th 细胞因子〔包括IL-2、肿瘤坏死因子α（TNF-α）、IL-10、IL-2/IL-10 及TNF-α/IL-10〕；比较三组患者治疗期间不良反应发生率；随访24 周，记录三组患者典型支气管哮喘转化率、气 道高反应转阴率及复发率。结果　三组患者治疗前后日间咳嗽症状评分、夜间咳嗽症状评分及LCQ 评分比较，差异 无统计学意义（P ＞ 0.05）；治疗后三组患者日间咳嗽症状评分、夜间咳嗽症状评分分别低于本组治疗前，LCQ 评分 分别高于本组治疗前（P ＜ 0.05）。B 组和C 组患者治疗后PEF%、FEV1%、FVC% 及PD20-FEV1 高于A 组，C 组患 者治疗后PEF%、FEV1%、FVC% 及PD20-FEV1 高于B 组（P ＜ 0.05）。B 组和C 组患者治疗后诱导痰IL-5 水平、 EOS% 低于A 组，C 组患者治疗后诱导痰IL-5 水平、EOS% 低于B 组（P ＜ 0.05）；B 组和C 组患者治疗后诱导痰 IL-10 水平高于A 组，C 组患者治疗后诱导痰IL-10 水平高于B 组（P ＜ 0.05）。B 组和C 组患者治疗后血清IL-2、 TNF-α 水平及IL-2/IL-10、TNF-α/IL-10 低于A 组，血清IL-10 水平高于A 组（P ＜ 0.05）；C 组患者治疗后血清 IL-2、TNF-α 水平及IL-2/IL-10、TNF-α/IL-10 低于B 组，血清IL-10 水平高于B 组（P ＜ 0.05）。C 组患者气道 高反应转阴率高于A 组，复发率低于A 组（P ＜ 0.05）。结论　与8 周和16 周布地奈德福莫特罗吸入治疗疗程相比， 24 周治疗疗程能更有效地减轻咳嗽变异性哮喘患者咳嗽症状、气道炎症，纠正Th 细胞因子失衡，进而获得更好的临 床获益，且未增加不良反应发生率。

Abstract：

　Background　At present, budesonide and formoterol have been widely used in the treatment of cough variant asthma, but it is a hot and difficult point in clinical research to choose a treatment course that takes both effectiveness and safety into consideration. Objective　To compare the impact of different courses of budesonide and formoterol on curative effect and helper T（Th） cytokines in patients with cough variant asthma. Methods　A total of 198 patients with cough variant asthma who were admitted in the People's Hospital of Langfang from August 2018 to March 2020 were selected as the research objects, and they were randomly divided into groups A, B and C, with 66 cases in each group. All patients were treated with budesonide and formoterol inhalation, the treatment course of group A was 8 weeks, group B was 16 weeks, while group C was 24 weeks. The cough symptom score, Leicester Cough Questionnaire (LCQ) score, pulmonary function indexes [including percentage of maximum expiratory flow to predicted value (PEF%) , percentage of forced expiratory volume in forced expiratory volume in one second (FEV1%) , and percentage of forced vital capacity to predicted value (FVC%) ] , the results of airway provocation test [FEV1 decreased by more than 20% of the minimum cumulative dose (PD20-FEV1) ] , induced sputum inflammatory mediators [including induced sputum interleukin (IL) -5, IL-10 and eosinophil percentage (EOS%) ] , serum Th cytokines [including IL- 2, tumor necrosis factor alpha (TNF-α) , IL-10, IL-2/IL-10 and TNF-α/IL-10] were compared among the three groups before treatment and 1 day after treatment. The incidence of adverse reactions during the treatment of the three groups was recorded; all patients were followed up for 24 weeks, and the conversion rate of typical bronchial asthma, negative conversion rate of airway hyperresponsiveness and recurrence rate were recorded. Results　There was no significant difference in daytime cough symptom score, nighttime cough symptom score and LCQ score among the three groups before and after treatment (P > 0.05) ; after treatment, the daytime cough symptom score and night cough symptom score of the three groups were lower than those before treatment, and the LCQ score of the three groups was higher than that before treatment, respectively (P

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