目的 探讨应用储雾罐经口鼻吸入糖皮质激素联合口服孟鲁司特钠阻断气道变态反应性炎症向纵深发展,防止变应性鼻炎(AR)向咳嗽变异型哮喘(CVA)、支气管哮喘(BA)转化的效果.方法 232例AR患儿被随机分为对照组114例,观察组118例.对照组予口服氯雷他定片,体重＜30 kg,每次5 mg,每日1次,体重≥30 kg,每次10 mg,每日1次.观察组在对照组治疗基础上,吸入丙酸氟替卡松定量气雾剂,每次1揿(125μg),每日2次,症状控制后减为每日1次,采用带有活瓣的储雾罐辅助吸入,若患儿能够配合,嘱闭口呼吸1分钟.同时口服孟鲁司特钠,1～5岁用4 mg,6～ 14岁用5 mg,每天1次.两组疗程均为3个月.疗程结束后,每月至少随访1次,随访时间3年.若症状未愈或复发,继续以上治疗3个月.治疗后半年、1年、2年、3年比较两组AR未愈或复发以及CVA和BA发生率.若患儿诊断为BA则按有关治疗常规进行治疗.若符合CVA诊断标准,再将患儿随机分成两组,观察组按上述治疗方案继续半年治疗,对照组仅予祛痰、止咳、抗感染等治疗.症状未控制时每1～2周随访1次,症状控制后每月随访1次,随访时间3年.治疗后半年、1年、2年、3年比较两组CVA未愈或复发以及BA发生率.结果 治疗后半年、1年、2年、3年AR未愈或复发率在对照组和观察组分别为52％、60％、71％、80％和14.15％、16.38％、18.87％、25.47％,CVA发生率在对照组和观察组分别为40％、48％、57％、71％和15.09％、16.98％、20.75％、23.73％,BA发生率在对照组和观察组分别为30％、39％、47％、53％和11.32％、13.21％、16.04％、18.87％,对照组均明显高于观察组(P≤0.001);CVA未愈或复发率在对照组和观察组分别为45％、55％、62.5％、75％和17.5％、25％、30％、37.5％,转化为BA在对照组和观察组分别是35％、45％、60％、70％和10％、12.5％、15％、17.5％,对照组均明显高于观察组(P＜0.01).且随着随访时间延长,上述各项发生率对照组比观察组增加更为明显.结论通过应用储雾罐经口鼻吸入糖皮质激素联合口服孟鲁司特钠,可防止AR及CVA反复,且可防止AR向CVA和BA转化,阻断气道变态反应性炎症向纵深发展.
目的 探討應用儲霧罐經口鼻吸入糖皮質激素聯閤口服孟魯司特鈉阻斷氣道變態反應性炎癥嚮縱深髮展,防止變應性鼻炎(AR)嚮咳嗽變異型哮喘(CVA)、支氣管哮喘(BA)轉化的效果.方法 232例AR患兒被隨機分為對照組114例,觀察組118例.對照組予口服氯雷他定片,體重＜30 kg,每次5 mg,每日1次,體重≥30 kg,每次10 mg,每日1次.觀察組在對照組治療基礎上,吸入丙痠氟替卡鬆定量氣霧劑,每次1撳(125μg),每日2次,癥狀控製後減為每日1次,採用帶有活瓣的儲霧罐輔助吸入,若患兒能夠配閤,囑閉口呼吸1分鐘.同時口服孟魯司特鈉,1～5歲用4 mg,6～ 14歲用5 mg,每天1次.兩組療程均為3箇月.療程結束後,每月至少隨訪1次,隨訪時間3年.若癥狀未愈或複髮,繼續以上治療3箇月.治療後半年、1年、2年、3年比較兩組AR未愈或複髮以及CVA和BA髮生率.若患兒診斷為BA則按有關治療常規進行治療.若符閤CVA診斷標準,再將患兒隨機分成兩組,觀察組按上述治療方案繼續半年治療,對照組僅予祛痰、止咳、抗感染等治療.癥狀未控製時每1～2週隨訪1次,癥狀控製後每月隨訪1次,隨訪時間3年.治療後半年、1年、2年、3年比較兩組CVA未愈或複髮以及BA髮生率.結果 治療後半年、1年、2年、3年AR未愈或複髮率在對照組和觀察組分彆為52％、60％、71％、80％和14.15％、16.38％、18.87％、25.47％,CVA髮生率在對照組和觀察組分彆為40％、48％、57％、71％和15.09％、16.98％、20.75％、23.73％,BA髮生率在對照組和觀察組分彆為30％、39％、47％、53％和11.32％、13.21％、16.04％、18.87％,對照組均明顯高于觀察組(P≤0.001);CVA未愈或複髮率在對照組和觀察組分彆為45％、55％、62.5％、75％和17.5％、25％、30％、37.5％,轉化為BA在對照組和觀察組分彆是35％、45％、60％、70％和10％、12.5％、15％、17.5％,對照組均明顯高于觀察組(P＜0.01).且隨著隨訪時間延長,上述各項髮生率對照組比觀察組增加更為明顯.結論通過應用儲霧罐經口鼻吸入糖皮質激素聯閤口服孟魯司特鈉,可防止AR及CVA反複,且可防止AR嚮CVA和BA轉化,阻斷氣道變態反應性炎癥嚮縱深髮展.
목적 탐토응용저무관경구비흡입당피질격소연합구복맹로사특납조단기도변태반응성염증향종심발전,방지변응성비염(AR)향해수변이형효천(CVA)、지기관효천(BA)전화적효과.방법 232례AR환인피수궤분위대조조114례,관찰조118례.대조조여구복록뢰타정편,체중＜30 kg,매차5 mg,매일1차,체중≥30 kg,매차10 mg,매일1차.관찰조재대조조치료기출상,흡입병산불체잡송정량기무제,매차1흠(125μg),매일2차,증상공제후감위매일1차,채용대유활판적저무관보조흡입,약환인능구배합,촉폐구호흡1분종.동시구복맹로사특납,1～5세용4 mg,6～ 14세용5 mg,매천1차.량조료정균위3개월.료정결속후,매월지소수방1차,수방시간3년.약증상미유혹복발,계속이상치료3개월.치료후반년、1년、2년、3년비교량조AR미유혹복발이급CVA화BA발생솔.약환인진단위BA칙안유관치료상규진행치료.약부합CVA진단표준,재장환인수궤분성량조,관찰조안상술치료방안계속반년치료,대조조부여거담、지해、항감염등치료.증상미공제시매1～2주수방1차,증상공제후매월수방1차,수방시간3년.치료후반년、1년、2년、3년비교량조CVA미유혹복발이급BA발생솔.결과 치료후반년、1년、2년、3년AR미유혹복발솔재대조조화관찰조분별위52％、60％、71％、80％화14.15％、16.38％、18.87％、25.47％,CVA발생솔재대조조화관찰조분별위40％、48％、57％、71％화15.09％、16.98％、20.75％、23.73％,BA발생솔재대조조화관찰조분별위30％、39％、47％、53％화11.32％、13.21％、16.04％、18.87％,대조조균명현고우관찰조(P≤0.001);CVA미유혹복발솔재대조조화관찰조분별위45％、55％、62.5％、75％화17.5％、25％、30％、37.5％,전화위BA재대조조화관찰조분별시35％、45％、60％、70％화10％、12.5％、15％、17.5％,대조조균명현고우관찰조(P＜0.01).차수착수방시간연장,상술각항발생솔대조조비관찰조증가경위명현.결론통과응용저무관경구비흡입당피질격소연합구복맹로사특납,가방지AR급CVA반복,차가방지AR향CVA화BA전화,조단기도변태반응성염증향종심발전.
Objective To investigate the effect on preventing exacerbation of airway allergy inflammation by inhaled corticosteroid with a spacer through nose and mouth combined with oral montelukast,in order to prevent transformation from allergic rhinitis (AR) to cough variant asthma (CVA) and bronchial asthma (BA).Methods 232 cases of AR were randomly divided into control group (114 cases) and observation group (118 cases).Control group was treated by oral loratadine (Wt ＜ 30 kg,5 mg once daily; Wt ≥ 30 kg,10mg once daily).Observation group was administered by inhaled fluticasone propionate with 125 μ g twice daily and oral montelukast (1-5 yrs,4 mg once daily; 6-14 yrs,5 mg once daily) on basis of control group.When patients' symptoms were controlled,dose of fluticasone propionate was reduced to once daily.Fluticasone was inhaled with a spacer,patients were required to close their mouth and to breathe for 1 minute through their nose if they were able to cooperate.Course of treatment was 3 months in both groups.After treatment,patients were followed up at least once a month for 3 years.If patients' symptoms weren' t controlled or didn' t recur,treatment above would be continued for another 3 months.The unhealed and recurrent rates of AR,incidence of CVA and BA were compared between two groups half a year,1 year,2 years and 3years after treatment.If patients were diagnosed with BA,they would be treated by routine therapy of BA.If patients corresponded to diagnostic criteria of CVA.they would be randomly divided into control group and observation group again.Observation group would continue to he treated by above-mentioned therapy for half a year,while control group was treated by antitussives,expectorants and antibiotics.Patients were followed up every 1-2 weeks when their symptoms weren't controlled,then they were followed up once a month when their symptoms were controlled.Follow-up lasted for 3 years.The unhealed and recurrent rates of CVA,incidence of BA were compared between two groups half a year,1 year,2 years and 3 years after treatment.Results Half a year,1 year,2 years and 3 years after treatment,the unhealed and recurrent rates of AR in control group and observation group were 52％,60％,71％,80％ and 14.15％,16.38％,18.87％,25.47％respectively (P ＜ 0.001),the incidences of CVA in control group and observation group were 40％,48％,57％,71％ and 15.09％,16.98％,20.75％,23.73％ respectively (P ＜ 0.001),the incidences of BA in control group and observation group were 30％,39％,47％,53％ and 11.32％,13.21％,16.04％,18.87％ respectively (P ≤ 0.001).In patients with CVA,the unhealed and recurrent rates in control group and observation group were 45％,55％,62.5％,75％ and 17.5％,25％,30％,37.5％ respectively (P ＜ 0.01),incidences of BA in control group and observation group were 35％,45％,60％,70％ and 10％,12.5％,15％,17.5％ respectively (P ＜ 0.01).As the time of follow-up extended,above-mentioned rates in control group had increased more obviously than those in observation group.Conclusions Repetitions of AR and CVA were prevented,and transformation from AR to CVA and BA was also prevented by inhaled corticosteroid combined with oral montelukast,which could stop airway allergy inflammation from worsening.
