CAJ | 학술논문

目的比较甲泼尼龙(甲基强的松龙)与地塞米松对哮喘息儿的临床疗效及对辅助性T细胞的影响.方法将39例急性发作期中重度哮喘患儿随机分成两组:A组21例,给予甲泼尼龙每次1～2 mg/kg静脉滴注,每12～24 h一次;B组18例,给予地塞米松每次0.25～0.75 ms/kg静脉滴注,每12～24 h一次.监测治疗前呼吸功评分、治疗后哮鸣音消失的时间、>5岁患儿治疗前及3 d后最大呼气流速;采用放射免疫法测定治疗前及3 d后血清中IL-2及IL-4水平.结果 A组哮鸣音消失时间比B组明显缩短(P=0.042);治疗72 h后最大呼气流速A组明显高于B组(P=0.025);治疗前及3 d后地塞米松对血清中IL-2、IL-4及IL-2/IL-4值的影响均不大(P>0.05),甲泼尼龙对血清中IL-2的影响也不大(P>0.05);A组患儿治疗后IL-4水平比治疗前明显降低(P=0.001),IL-2/IL-4值比治疗前明显升高(P=0.027);治疗前患儿呼吸功分数与治疗前IL-2/IL-4值无相关性(P=0.613).结论调节IL-2或IL-4水平可能并非是地塞米松发挥作用的主要途径;甲泼尼龙对血清IL-2的影响不大,但能有效地降低IL-4水平,从而提高IL-2/IL-4值,改善哮喘患儿Th1/Th2功能失衡.
목적 비교갑발니룡(갑기강적송룡)여지새미송대효천식인적림상료효급대보조성T세포적영향.방법 장39례급성발작기중중도효천환인수궤분성량조:A조21례,급여갑발니룡매차1～2 mg/kg정맥적주,매12～24 h일차;B조18례,급여지새미송매차0.25～0.75 ms/kg정맥적주,매12～24 h일차.감측치료전호흡공평분、치료후효명음소실적시간、>5세환인치료전급3 d후최대호기류속;채용방사면역법측정치료전급3 d후혈청중IL-2급IL-4수평.결과 A조효명음소실시간비B조명현축단(P=0.042);치료72 h후최대호기류속A조명현고우B조(P=0.025);치료전급3 d후지새미송대혈청중IL-2、IL-4급IL-2/IL-4치적영향균불대(P>0.05),갑발니룡대혈청중IL-2적영향야불대(P>0.05);A조환인치료후IL-4수평비치료전명현강저(P=0.001),IL-2/IL-4치비치료전명현승고(P=0.027);치료전환인호흡공분수여치료전IL-2/IL-4치무상관성(P=0.613).결론 조절IL-2혹IL-4수평가능병비시지새미송발휘작용적주요도경;갑발니룡대혈청IL-2적영향불대,단능유효지강저IL-4수평,종이제고IL-2/IL-4치,개선효천환인Th1/Th2공능실형.
Objective This study was carried out to compare chnical efficiency of methylprednisolone (MP) and dexamethasone (Dex) and their effects on Th cytokines in asthmatic children.Methods A total of 39 children with moderate and severe asthma at acute exacerbation were randomly divided into two groups, one (A) with MP 1 -2 mg/kg (n=21) and the other (B) with Dex 0.25 -0.75 mg/kg (n= 18),every 12 -24 h by intravenous drip.Scores of respiratory effort and peak expiratory flow rate prior to and three days after treatment in the asthmatic children aged over five years were evaluated,respectively,as well as the time of wheezing vanishing after treatment.Serum levels of interleukin-2 (IL-2) and IL-4 were determined by radioimmunoassay (RIA) prior to and three days after treatment,respectively.Results There was statistically significant difference in the time of wheezing vanishing between groups A and B (P = 0.042).Three days after treatment,PEER was significantly higher in group A than that in group B (P = 0.025).No statistically significant difference in serum IL-2 and IL-4,as well as ratio of IL-2/IL-4,was found in group B prior to and three days after treatment (P>0.05).Statistically significant difference in serum IL-2 was not observed in group B prior to and three day after treatment (P>0.05),and serum IL-4 decreased significantly (P=0.001) and ratio of serum IL-2/IL-4 (P=0.027) increased significantly three days after treatment than those prior to treatment.No significant correlation between respiratory-effort scores and ratio of serum IL-2/IL-4 prior to treatment was found (P=0.613).Conclusions Up-regulation of IL-2,or inhibition of release of IL-4,probably is not the main anti-inflammatory mechanism of dexamethasone.Methylprednisolone has little effect on serum IL-2,but can effectively reduce serum IL-4, thus increasing the ratio of serum IL-2/IL-4 and counterbalancing function of the Thl/Th2 cells.