摘要
目的观察卡介菌多糖核酸联合孟鲁司特治疗支气管哮喘的临床疗效及对患者肺功能和血清炎性因子的影响。方法选取2019年1月至2020年12月就诊于湖州市第一人民医院符合纳入标准的支气管哮喘患者80例,采用随机对照研究方法,以随机数字表法分为对照组和联合组各40例,对照组予以常规对症治疗同时口服孟鲁司特,联合组在对照组基础上予以卡介菌多糖核酸肌内注射。观察并比较两组患者治疗前后血清炎性因子水平和肺功能变化,并对两组患者的临床疗效和不良反应进行比较。结果对照组、联合组的总有效率分别为80.00%(32/40)、95.00%(38/40),联合组的总有效率显著高于对照组,差异有统计学意义(χ^(2)=4.11,P=0.043)。治疗前两组患者的呼气峰流速(PEF)、第1秒用力呼气容积(FEV1)、最大自主通气量(MVV)、用力肺活量(FVC)、气道阻力(Raw)和FEV1/FVC肺功能指标水平差异均无统计学意义(均P>0.05)。治疗后,联合组患者PEF、FEV1、FEV1/FVC、MVV以及FVC等肺功能指标较治疗前明显提高,联合组Raw较治疗前明显下降,差异均有统计学意义(t=-4.81、-5.09、-7.39、-4.12、-7.14、5.17,均P<0.001),且疗效优于对照组。治疗前两组患者的圣乔治呼吸问卷(SGRQ))和哮喘控制测试表(CAT)评分差异均无统计学意义(均P>0.05)。治疗后,联合组患者的SGRQ评分较对照组显著下降,而CAT评分显著上升,差异均有统计学意义(t=9.19、-3,44,均P<0.001)。治疗前两组患者血清白细胞介素4(IL-4)、IL-5及γ-干扰素(INF-γ)等炎性因子水平差异均无统计学意义(均P>0.05)。治疗后,联合组患者的外周血上述炎性因子水平相较于对照组显著下降,差异均有统计学意义(t=6.95、4.72、-11.24,均P<0.001)。两组治疗期间均未发生药物相关不良反应。结论卡介菌多糖核酸联合孟鲁司特治疗支气管哮喘不仅能够显著提高临床疗效,改善患者生活质量,还可改善肺功能,降低患者血清炎性因子水平,且安全性好。
Objective To investigate the clinical efficacy of Bacille Calmette-Guerin polysaccharide nucleic acid combined with montelukast in the treatment of bronchial asthma and its effect on lung function and serum inflammatory factor level.Methods Eighty patients with bronchial asthma who met inclusion criteria and received treatment in The First People's Hospital of Huzhou from January 2019 to December 2020 were included in this study.They were randomly assigned to undergo either routine systematic treatment and oral montelukast(control group,n=40)or routine systematic treatment,oral montelukast,and intramuscular injection of Bacille Calmette-Guerin polysaccharide nucleic acid in combination(combined group,n=40).The changes in serum inflammatory factors and pulmonary function after treatment relative to before treatment,clinical efficacy and adverse reactions were compared between the two groups.Results Total response rate in the control and combined groups was 80.00%(32/40)and 95.00%(38/40)respectively.Total response rate in the combined group was significantly higher than that in the control group(χ^(2)=4.11,P=0.043).There were no significant differences in peak expiratory flow rate,forced expiratory volume in 1 second,maximum voluntary ventilation,forced vital capacity,airway resistance and forced expiratory volume in 1 second/forced vital capacity between the two groups before treatment(all P>0.05).In the combined group,peak expiratory flow rate,forced expiratory volume in 1 second,forced expiratory volume in 1 second/forced vital capacity,maximum voluntary ventilation and forced vital capacity were significantly increased,and airway resistance was significantly decreased after treatment compared with before treatment(t=-4.81,-5.09,-7.39,-4.12,-7.14,5.17,all P<0.001).After treatment,clinical efficacy in the combined group was superior to that in the control group.Before treatment,there were no significant differences in the St George's Respiratory Questionnaire score and Asthma Control Test score between the two groups(both P>0.05).After treatment,St George's Respiratory Questionnaire score in the combined group was significantly decreased,while Asthma Control Test score was significantly increased compared with before treatment(t=9.19,-3.44,both P<0.001).Before treatment,there were no significant differences in serum interleukin-4,interleukin-5,and interferon-γlevels between the two groups(all P>0.05).After treatment,serum levels of interleukin-4,interleukin-5,and interferon-γin the combined group were significantly lower than those in the control group(t=6.95,4.72,-11.24,all P<0.001).No drugs-related adverse reactions were found in each group during the treatment period.Conclusion Bacille Calmette-Guerin polysaccharide nucleic acid combined with montelukast is highly effective on bronchial asthma.The combined therapy can improve quality of life and lung function,decrease serum inflammatory factor levels,and is safe.
作者
杨文涛
陈慧芬
谢艳萍
Yang Wentao;Chen Huifen;Xie Yanping(Department of Respiratory and Critical Care Medicine,The First People's Hospital of Huzhou,Huzhou 313000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2022年第11期1676-1681,共6页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省湖州市科学技术局公益性应用研究项目(2017GYB43)。
关键词
哮喘
支气管
呼吸功能试验
炎症趋化因子类
疗效比较研究
卡介苗
生活质量
Asthma
Bronchi
Respiratory function tests
Chemokines
Comparative effectiveness research
BCG vaccine
Quality of life
