| 摘要: |
| [摘要]目的：探讨粉尘螨滴剂联合丙酸氟替卡松吸入气雾剂（辅舒酮）治疗小儿哮喘急性发作合并过敏性鼻炎的疗效及其对血清金属蛋白酶组织抑制因子-1（TIMP-1），痰液中的Toll样受体2（TLR2）、神经生长因子（NGF）的影响。方法：选取2018年3月至2020年11月我院收治的哮喘急性发作合并过敏性鼻炎患儿123例，按随机数表法分为观察组61例和对照组62例，对照组在常规治疗基础上给予舌下含服粉尘螨滴剂，观察组在常规治疗基础上给予舌下含服粉尘螨滴剂及丙酸氟替卡松吸入气雾剂吸入治疗，于治疗前及治疗12周对过敏性鼻炎及哮喘严重程度进行评分。采用免疫比浊法检测治疗前和治疗12周后免疫球蛋白M（IgM）、免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、血清C-反应蛋白（CRP）水平；采用流式细胞仪检测CD3+、CD4+、CD8+，计算CD4+/CD8+；采用酶联免疫吸附试验（ELISA）法检测血清白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）、TIMP-1、TLR2、NGF水平；肺功能仪检测第一秒用力呼气容积（FEV1）、呼气峰流速（PEF）、用力呼气25%流速（PEF25）、用力呼气50%流速（PEF50）、用力呼气75%流速（PEF75）。观察两组患儿治疗期间不良反应发生情况。结果：治疗12周后，观察组过敏性鼻炎及哮喘严重程度评分均低于对照组（P<0.05）。治疗12周后，观察组IgM、IgG、IgA、CD3+、CD4+及CD4+/CD8+水平均高于对照组（P<0.05），CD8+水平低于对照组（P<0.05）。治疗12周后，观察组CRP、IL-8、TNF-α水平均低于对照组（P<0.05），FEV1、PEF、PEF25、PEF50、PEF75水平均高于对照组（P<0.05）。观察组治疗12周后血清TIMP-1水平低于对照组（P<0.05），痰液中TLR2水平高于对照组，NGF水平低于对照组（P<0.05）。两组不良反应发生率比较差异无统计学意义（c2=1.03，P>0.05）。结论：粉尘螨滴剂联合丙酸氟替卡松吸入气雾剂较单一应用粉尘螨滴剂治疗可有效提升小儿哮喘急性发作合并过敏性鼻炎的疗效，提高患儿免疫功能，抑制炎症反应，改善肺功能，降低TIMP-1、NGF水平，抑制气道重塑，提高TLR2水平，调节炎性及神经源性因子，且不会增加不良反应发生率，安全性较高。 |
| 关键词: 粉尘螨滴剂 丙酸氟替卡松吸入气雾剂 儿童 哮喘 过敏性鼻炎 金属蛋白酶组织抑制因子-1 神经生长因子 Toll样受体2 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2022.05.011 |
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| 基金项目: |
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| Dermatophagoides Farinae Drops Combined with Fluticasone Propionate Inhalation Aerosol in the Treatment of Acute Attack of Asthma Complicated with Allergic Rhinitis in Children |
| Chen Jia, Gu Xing, Zhou Min |
| (Chengdu Integrated TCM & Western Medicine Hospital, Chengdu 610000, China) |
| Abstract: |
| [Abstract] Objective: To evaluate the efficacy of dermatophagoides farinae drops combined with fluticasone propionate inhalation aerosol in the treatment of acute attack of asthma complicated with allergic rhinitis in children and its effects on serum tissue inhibitor of metalloproteinase-1 (TIMP-1), nerve growth factor (NGF) and Toll like receptor 2 (TLR2) in sputum. Methods: Totally 123 children with acute attack of asthma complicated with allergic rhinitis admitted into our hospital from Mar. 2018 to Nov. 2020 were extracted to be divided into 61 cases in the observation group and 62 cases in the control group via the random number table. The control group was given dermatophagoides farinae drops on the basis of conventional treatment, while the observation group received dermatophagoides farinae drops combined with fluticasone propionate inhalation aerosol on the basis of conventional treatment. The severity of allergic rhinitis and asthma were scored before treatment and after treatment of 12 weeks. Immunoturbidimetry was used to detect immunoglobulin M (IgM), immunoglobulin G (IgG), immunoglobulin A (IGA) and serum C-reactive protein (CRP) before treatment and after treatment of 12 weeks. Flow cytometry was used to detect CD3+, CD4+, CD8+, and calculate CD4+/CD8+. Serum levels of interleukin-8 (IL-8), tumor necrosis factor (TNF)-α, TIMP-1, TLR2 and NGF were detected by enzyme linked immunosorbent assay (ELISA). The forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEF), 25% forced expiratory flow rate (PEF25), 50% forced expiratory flow rate (PEF50) and 75% forced expiratory flow rate (PEF75) were measured by pulmonary function analyzer. And the incidence of adverse drug reactions of two groups was observed. Results: After treatment of 12 weeks, the severity score of allergic rhinitis and asthma in the observation group were lower than those in the control group (P<0.05). After treatment of 12 weeks, the levels of IgM, IgG, IgA, CD3+, CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group (P<0.05), the levels of CD8+ were lower than those in the control group (P<0.05). After treatment of 12 weeks, the levels of CRP, IL-8 and TNF-α in the observation group were lower than those in control group (P<0.05), and the levels of FEV1, PEF, PEF25, PEF50 and PEF75 were higher than those in the control group (P<0.05). After 12 weeks of treatment, the serum levels of TIMP-1 in the observation group were lower than those in the control group (P<0.05), the sputum levels of TLR2 were higher than those in the control group, and the levels of NGF were lower than those in the control group (P<0.05). There was no significant difference in the incidence of adverse drug reactions between two groups (c2=1.03, P>0.05). Conclusion: Dermatophagoides farinae drops combined with fluticasone propionate inhalation aerosol can effectively improve the clinical efficacy of children with acute attack of asthma complicated with allergic rhinitis, improve the immune function, inhibit the inflammatory reaction, improve the lung function, decrease the levels of TIMP-1 and NGF, inhibit the airway remodeling, increase the levels of TLR2, regulate the inflammatory and neurogenic factors, with lower incidence of adverse drug reactions and higher safety. |
| Key words: dermatophagoides farinae drops fluticasone propionate inhalation aerosol children asthma allergic rhinitis tissue inhibitor of metalloproteinase-1 nerve growth factor Toll like receptor 2 |
