GINA 联合阿法骨化醇对支气管哮喘患儿血清25-（OH）D3、IL-4、IL-12、IgE 的影响

摘要

Objective To investigate the effects GINA regimen combined alfacalcidol on serum 25-(OH) D3 ,IL-4,IL-12,IgE and its efficacy in treatment of children with asthma. Methods Patients in accord-ance with bronchial asthma diagnostic criteria visited pediatric outpatient department of our hospital from March 2012 to December 2013 were divided into a GINA treatment + vitamin D group (GINA + D group)and a GINA regimen group (GINA group)with using a random number table method,and the other healthy chil-dren selected for the same period were enrolled in the control group.The first two groups were given standard-ized treatment with GINA regimen,GINA + D group were added with oral alfacalcidol capsule.All children with asthma were traced,observed and followed up for one year.The treatment efficacy was evaluated and the serum 25-(OH)D3 ,IgE,IL-4,IL-12 levels were detected among three groups in different periods. Re-sults ①The difference was statistically significant (P <0.01)in asthma attack total control rate between GI-NA + D group and GINA group.②The serum IgE,IL-4 levels in GINA group and GINA + D group were significantly higher than the control group (all P <0.001),the serum IL-12 level in treatment group was sig-nificantly lower than the control group (P <0.001).③Three months after 25-(OH)D3 treatment,GINA +D group had lower serum IgE,IL-4 level,comparison of post-treatment IgE and IL-4 to pre-treatment in GINA + D group and those of post-treatment in GINA group yielded statistically significant differences (all P<0.001)and the 25-(OH)D3 ,IL-12 level was significantly increased at the same period (all P <0.001). Conclusion Low serum level occurred in children with asthma,25 -(OH)D3 played an important role as an immunomodulation,in immune response in asthma,airway hyper- responsiveness.and in treatment of chil-dren with asthma by GINA standardization regimen,while giving 25 - (OH)D3 adjuvant therapy will help greatly improve the condition of children and reduce recurrence and improve the quality of life for children with asthma.%目的：探讨 GINA 联合阿法骨化醇对哮喘儿童血清25羟维生素 D3[25-(OH)D3]与 IL-4、IL-12、IgE 的影响及其对儿童哮喘的治疗效果。方法选取2012年3月~2013年12月在我院儿科门诊就诊符合支气管哮喘诊断标准的患儿,采用随机数字表法分为 GINA 方案治疗+维生素 D 组(GINA+D 组)和 GINA 方案治疗组(GINA 组),另选取同期健康体检的儿童为对照组,前两组均按 GINA 方案规范化治疗,GINA+D 组另给予阿法骨化醇胶囊口服,对所有哮喘儿童追踪、观察、随访1年,评价疗效,并检测三组不同时期血清25-(OH)D3、IgE、IL-4、IL-12水平。结果①GINA+D 组哮喘发作总控制率与 GINA 组比较,差异有统计学意义(P <0.01)；②GINA 组及 GINA+D 组血清 IgE、IL-4浓度明显高于对照组,差异有统计学意义(P 均<0.001),而 IL -12低于对照组,差异有统计学意义(P <0.001)；③GINA+D 组予25-(OH)D3治疗3个月后与加 D 治疗前、GINA 组 GINA 治疗后比较,血清 IgE、IL-4浓度明显降低,差异有统计学意义(P 均<0.001),25-(OH)D3、IL-12明显增高,差异有统计学意义(P 均<0.001)。结论哮喘儿童血清存在低水平状态,25-(OH)D3作为一种免疫调节剂,在哮喘的免疫应答、气道高反应性等方面发挥重要作用,临床上在治疗哮喘儿童时按 GINA 方案规范化治疗外,同时给予25-(OH)D3辅助治疗,将有助于极大改善患儿病情,减少复发,提高哮喘儿童的生活质量。