匹多莫德联合丙酸氟替卡松吸入治疗儿童哮喘的临床效果及对血清白细胞介素16和T淋巴细胞亚群水平的影响

摘要

目的 探讨匹多莫德联合丙酸氟替卡松吸入治疗儿童哮喘的临床效果及对血清白细胞介素16(IL-16)和T淋巴细胞亚群水平的影响.方法 选择2015年1-12月武汉市普仁医院儿科收治的80例哮喘息儿,根据随机数字表法将患儿分为观察组和对照组,每组40例.对照组采用丙酸氟替卡松吸入气雾剂治疗;观察组在对照组基础上联用匹多莫德口服液治疗.2组均持续治疗60d.治疗前及治疗60d后检测血清IL-16和T淋巴细胞亚群CD3+、CD4+、CD8+水平及CD4+/CD8+比值.疗程结束后均进行为期12个月的随访,记录上、下呼吸道感染次数、哮喘发作次数,采用儿童哮喘控制测试(C-ACT)进行评分以评价哮喘控制情况.结果 2组治疗前血清IL-16、CD3+、CD4+、CD8+、CD4+/CD8+比值差异无统计学意义(P＞0.05).治疗后,观察组血清IL-16水平明显低于治疗前及对照组[(539±96)ng/L比(723±136)、(654±107) ng/L],CD3+、CD4+、CD4+/CD8+明显高于治疗前及对照组[(64±3)％比(58±3)％、(58±4)％,(33.3±2.2)％比(28.7±2.5)％、(29.2±2.4)％,(1.29±0.26)比(1.15 ±0.24)、(1.18±0.25)],差异均有统计学意义(均P＜0.05).观察组上、下呼吸道感染次数、哮喘发作次数明显少于对照组[(2.2±0.6)次比(2.9±0.8)次、(1.3±0.4)次比(1.7±0.6)次、(2.9±0.8)次比(3.4±0.9)次],差异均有统计学意义(均P ＜0.05).随访结束时2组C-ACT评分均较治疗前明显提高,且观察组C-ACT评分明显高于对照组[(22.9±3.1)分比(20.1±3.3)分],差异均有统计学意义(均P＜0.05).结论 匹多莫德联合丙酸氟替卡松吸入治疗可降低哮喘患儿血清IL-16水平,改善机体免疫力,进而提高临床疗效及哮喘控制水平,减少复发.%Objective To investigate the effect of pidotimod combined with fluticasone propionate inhalation on serum interleukin-16 (IL-16) and T lymphocyte subsets in children with asthma.Methods Eighty children with asthma admitted from January to December 2015 in Puren Hospital of Wuhan were randomly divided into observation group and control group,with 40 cases in each group.The control group was treated with fluticasone propionate inhalation;the observation group was treated with pidotimod oral liquid combined with fluticasone propionate inhalation.Levels of serum IL-16,T lymphocyte subsets CD3+,CD4+,CD8+ and CD4+/CD8+ were detected before and after 60 days of treatment.Incidences of respiratory tract infection and asthma were recorded during 12 months of follow-up after treatment;asthma control was assessed by the Childhood Asthma Control Test (C-ACT).Results Levels of serum IL-16,CD3+,CD4+,CD8+ and CD4+/CD8+ had no significant differences between groups before treatment(P ＞ 0.05).After treatment,the level of serum IL-16 in observation group was significantly lower than that before treatment and that in control group[(539 ±96) ng/L vs (723 ± 136),(654 ± 107) ng/L];CD3+,CD4+ and CD4+/CD8+ in observation group were significantly higher than those before treatment and those in control group[(64 ±3)％ vs (58 ±3)％,(58 ±4)％;(33.3 ±2.2)％ vs (28.7 ±2.5)％,(29.2 ±2.4)％;(1.29 ±0.26) vs (1.15 ±0.24),(1.18 ±0.25)] (P ＜0.05).Incidences of upper respiratory tract infection,lower respiratory tract infection and asthma in observation group were significantly lower than those in control group [(2.2 ± 0.6) times vs (2.9 ± 0.8) times,(1.3 ± 0.4) times vs (1.7 ± 0.6) times,(2.9 ±0.8) times vs (3.4 ± 0.9) times] (P ＜ 0.05).The C-ACT score at the end of 12-month follow-up was significantly higher than that before treatment and there was a significant difference between observation group and control group [(22.9 ± 3.1) points vs (20.1 ± 3.3) points] (P ＜ 0.05).Conclusion Pidotimod combined with fluticasone propionate inhalation treating children with asthma can decrease serum IL-16 level,enhance immune function,improve asthma control and reduce the recurrence of asthma.