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, Langfang People's Hospital, Langfang 065000, China

关键词：

　咳嗽变异性哮喘；气道炎症；过敏情况；布地奈德福莫特罗；疗程

Keywords：

Cough variant asthma; Airway inflammation; Allergy; Budesonide formoterol; Course of treatment

CLC：

R 562.25

DOI：

10.12114/j.issn.1008-5971.2021.00.270

Funds：

河北省廊坊市科技支撑计划项目（2019013095）

摘要：

背景　咳嗽变异性哮喘（CVA）是引起成年人慢性咳嗽的主要原因，布地奈德福莫特罗作为治疗此 病的重要药物，其最佳疗程目前尚无统一定论，如何在保证治疗安全性的同时尽可能使患者获益是当前临床研究热点 和难点。目的　探讨CVA患者疗效与布地奈德福莫特罗疗程的相关性。方法　选取廊坊市人民医院门诊2018年8月至 2020年3月收治的CVA患者200例，按照随机数字表法将所有患者分为A组56例、B组69例和C组75例。患者均予以常规 对症治疗及布地奈德福莫特罗粉吸入治疗，其中A组疗程为8周、B组疗程为16周、C组疗程为24周。比较三组患者治 疗前后肺通气功能指标〔用力肺活量（FVC）、第1秒用力呼气容积（FEVl ）、呼气流量峰值（PEF）〕、气道炎症指 标〔白介素（IL）-10、IL-5〕、过敏指标〔血嗜酸粒细胞计数（EOS）、血清免疫球蛋白E（IgE）水平〕及哮喘控制 测试（ACT）评分。指标间的相关性分析采用Spearman秩相关分析。结果　B、C组患者治疗后FVC、FEV1、PEF、痰 IL-10水平高于A组，痰IL-5水平、血EOS及血清IgE水平低于A组（P＜0.05）；C组患者治疗后FVC、FEV1、PEF、痰 IL-10水平高于B组，痰IL-5水平、血EOS及血清IgE水平低于B组（P＜0.05）。B、C组患者治疗后ACT评分高于A组， C组患者治疗后ACT评分高于B组（P＜0.05）。Spearman秩相关分析结果显示，CVA患者治疗后FVC（rs =0.265）、 FEV1（rs =0.326）、PEF（rs =0.417）、痰IL-10水平（rs =0.412）及ACT评分（rs =0.358）与布地奈德福莫特罗疗程呈正 相关（P＜0.001），痰IL-5水平（rs =-0.386）、血EOS（rs =-0.315）及血清IgE水平（rs =-0.391）与布地奈德福莫特罗 疗程呈负相关（P＜0.001）。结论　随着布地奈德福莫特罗疗程增加，CVA患者肺通气功能、过敏情况及哮喘控制效 果逐渐改善，气道炎症逐渐减轻，故本研究建议布地奈德福莫特罗疗程为24周。

Abstract：

Background Cough variant asthma (CVA) is the main cause of chronic cough in adults, budesonide formoterol is an important drug in the treatment of CVA. As for the optimal treatment course of budesonide formoterol in the treatment of CVA, there has not been a unified authoritative conclusion. How to ensure the safety of treatment and benefit patients as much as possible is a hot and difficult point in current clinical research. Objective To investigate the correlation of therapeutic effect of CVA patients with treatment course of budesonide formoterol. Methods A total of 200 cases of CVA patients admitted to the Outpatient Department of Langfang People's Hospital from August 2018 to March 2020 were selected, and they were divided into group A (n=56) , group B (n=69) and group C (n=75) according to random number table methods. Patients were received conventional symptomatic treatment and inhalation of budesonide formoterol powder, of which the course of treatment was 8 weeks in group A, 16 weeks in group B, and 24 weeks in group C. Pulmonary ventilation function indexes [forced vital capacity (FVC) , forced expiratory volume in the first second (FEV1) , peak expiratory flow (PEF) ] , airway inflammation indexes [interleukin (IL) -10, IL-5 ] , allergy indexes [blood eosinophil count (EOS) , serum immunoglobulin E (IgE) level] and asthma control test (ACT) scores before and after treatment were compared among the three groups. Spearman rank correlation analysis was used for correlation analysis. Results After treatment, FVC, FEV1, PEF, sputum level of IL-10 of group B and group C were higher than those of group A, sputum level of IL-5, blood EOS and serum IgE level were lower than those of group A (P < 0.05) ; FVC, FEV1, PEF, sputum level of IL-10 of group C were higher than those of group B, sputum level of IL-5, blood EOS and serum IgE level were lower than those of group B (P < 0.05) . After treatment, ACT score of group B and group C were higher than those of group A, ACT score of group C was higher than that of group B (P < 0.05) . Spearman rank correlation analysis results showed that, FVC (rs =0.265) , FEV1 (rs =0.326) , PEF (rs =0.417) , sputum level of IL-10 (rs =0.412) and ACT score (rs =0.358) after treatment was positively correlated with treatment course of budesonide formoterol in CVA patients, respectively (P < 0.001) , sputum level of IL-5 (rs =-0.386) , blood EOS (rs =-0.315) and serum IgE level (rs =-0.391) was negatively correlated with treatment course of budesonide formoterol in CVA patients, respectively (P < 0.001) . Conclusion With the increase of treatment course of budesonide formoterol, the pulmonary ventilation function, allergy and asthma control effect of CVA patients gradually improved, and the airway inflammation gradually decreased. Therefore, this study suggested that the treatment course of budesonide formoterol is 24 weeks.

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