利巴韦林联合布地奈德雾化吸入治疗小儿毛细支气管炎的临床疗效及其对血清白介素4、干扰素γ水平的影响研究

摘要

目的：探究利巴韦林联合布地奈德雾化吸入治疗小儿毛细支气管炎的临床疗效及其对血清白介素4（IL-4）、干扰素γ（IFN-γ）水平的影响。方法选取2012年3月—2015年3月延安大学附属医院儿科收治的毛细支气管炎患儿69例，按照治疗方法分为对照组34例和观察组35例。两组患儿入院后均给予吸氧、控制喘憋与抗病原体等常规治疗，对照组患儿在常规治疗基础上给予利巴韦林注射液雾化吸入治疗；观察组患儿在常规治疗基础上给予利巴韦林注射液联合布地奈德混悬液雾化吸入治疗。比较两组患儿临床疗效、临床症状缓解/消失时间、心率恢复正常时间及住院时间，治疗前后 T 淋巴细胞亚群（CD +3细胞分数、CD +4细胞分数、CD +8细胞分数、CD +4/ CD +8细胞比值）和血清 IL-4、IFN-γ水平。结果观察组患儿临床疗效优于对照组（ u =1.772，P <0.05）。观察组患儿气促缓解时间、哮鸣音消失时间、湿啰音消失时间、咳嗽消失时间、心率恢复正常时间及住院时间均短于对照组（P <0.05）。两组患儿治疗前 CD +3细胞分数、CD +4细胞分数、CD +8细胞分数及 CD +4/ CD +8细胞比值比较，差异无统计学意义（P >0.05）；观察组患儿治疗后 CD +3细胞分数、CD +4细胞分数、CD +4/ CD +8细胞比值高于对照组，CD +8细胞分数低于对照组（P <0.05）。两组患儿治疗前血清 IL-4、IFN-γ水平比较，差异无统计学意义（P >0.05）；观察组患儿治疗后血清 IL-4水平低于对照组，血清 IFN-γ水平高于对照组（P <0.05）。结论利巴韦林联合布地奈德雾化吸入治疗小儿毛细支气管炎的临床疗效确切，可有效调节血清 IFN-γ、IL-4水平，改善免疫功能。%Objective To explore the clinical effect of atomization inhalation of ribavirin combined with budesonide in treating children with bronchiolitis and the impact on serum levels of IL-4 and IFN-γ. Methods From March 2012 to March 2015,a total of 69 children with bronchiolitis were selected in the Department of pediatrics,the Affiliated Hospital of Yan′an University,and they were divided into control group( n = 34) and observation group( n = 35) according to therapeutic methods. Children of both groups received conventional treatment after admission,including oxygen inhalation,asthma control, anti - pathogen treatment and so on,children of control group received extra atomization inhalation of ribavirin injection based on conventional treatment,while children of observation group received atomization inhalation of ribavirin combined with budesonide based on conventional treatment. Clinical effect,remission/ disappearence time of clinical symptoms,recovery time of heart rate, CD +3 cell percentage,CD +4 cell percentage,CD +8 cell percentage,CD +4 / CD +8 cell ratio,serum levels of IL-4 and IFN-γ before and after treatment were compared between the two groups. Results The clinical effect of observation group was statistically significantly better than that of control group( u = 1. 772,P < 0. 05). Remission time of anhelation,disappearence time of wheezing,disappearence time of moist rale,disappearence time of cough,recovery time of heart rate and hospital stays of observation group were statistically significantly shorter than those of control group( P < 0. 05). No statistically significant differences of CD +3 cell percentage,CD +4 cell percentage,CD +8 cell percentage or CD +4 / CD +8 cell ratio was found between the two groups before treatment(P > 0. 05);after treatment,CD +3 cell percentage,CD +4 cell percentage and CD +4 / CD +8 cell ratio of observation group were statistically significantly higher than those of control group,while CD +8 cell percentage of observation group was statistically significantly lower than that of control group(P < 0. 05). No statistically significant differences of serum level of IL-4 or IFN-γ was found between the two groups before treatment( P > 0. 05);after treatment,serum IL-4 level of observation group was statistically significantly lower than that of control group,while serum IFN-γ level of observation group was statistically significantly higher than that of control group(P < 0. 05). Conclusion Atomization inhalation of ribavirin combined with budesonide has certain clinical effect in treating children with bronchiolitis,can effectively adjust the serum levels of IL-4 and IFN-γ,improve the immunologic function.