三步序贯法对老年SDA患者诱导痰和BALF相关指标的影响

摘要

Objective To study the impacts of three-step sequential therapy on induced sputum and bronchoalveolar lavage fluid (BALF) related indicators in senile patients with elderly steroid-dependent asthma (SDA).Methods A total of 58 senile patients (≥65years old) with SDA were selected and randomly divided into a control group and a treatment group (n=29,respectively).The control group was treated with budesonide inhalation therapy and the treatment group with three-step sequential therapy until two weeks after the complete withdrawal of hormone.The lung function and changes in induced sputum and BALF related indicators between the two groups were compared.Results After the treatment,the forced vital capacity (FVC),the second-1 forced expiratory volume (FEV1),the percentage of the second-1 force expiratory volume in the expected value (FEV1pre) and the FEV1/FVC in the two groups increased significantly,and the increase in the treatment group was greater than that in the control group (P ＜ 0.05);the contents of induced sputum and the lymphocytes,neutrophils,eosinophils and eosinophils of BALF and interleukin-5 (IL-5) in the two groups decreased greatly,the content of macrophage increased dramatically,and the decrease or increase in the treatment group was greater than that in the control group (P ＜ 0.05).During the treatment,no adverse reactions occurred in the two groups.Conclusion Three step sequential therapy can significantly improve the lung function of senile patients with DSA,lower the degree of inflammatory reaction,has better effects than simple budesonide inhalation therapy,and has no significant adverse reactions.%目的 研究三步序贯法对老年激素依赖性哮喘(SDA)患者诱导痰和肺泡灌洗液(BALF)相关指标的影响.方法 58例老年(≥65岁)SDA患者随机分为两组,均给予逐渐撤减泼尼松用量方案治疗,其中29例给予布地奈德吸入治疗者归为对照组,29例采用三步贯序法治疗者归为治疗组,治疗截止于激素完全撤离后2w,比较两组肺功能以及诱导痰和BALF相关指标变化.结果 治疗后,两组用力肺活量(FVC)、第1 s用力吸气呼气量(FEV1)、第1 s用力呼气量占预计值(FEV1pre)和FEV1/FVC均显著上升,且治疗组上升幅度大于对照组(P＜0.05);两组诱导痰和BALF的淋巴细胞、中性粒细胞、嗜酸性粒细胞、嗜酸性细胞阳离子蛋白(ECP)和白介素-5(IL-5)含量均显著下降,巨噬细胞含量显著上升,且治疗组下降或上升幅度大于对照组(P＜0.05).治疗期间,两组均未见明显不良反应.结论 三步序贯法可明显改善老年DSA患者肺功能,减轻炎症反应程度,效果优于单纯的布地奈德吸入治疗,且无显著不良反应.