摘要
目的探讨丙卡特罗联合甘氨酸茶碱钠治疗支气管哮喘(bronchial asthma,BA)急性发作的疗效及对机体免疫微环境的影响。方法采用前瞻性随机对照研究方法,纳入2021年3月至2024年3月解放军南部战区海军第二医院收治的100例BA急性发作患者,通过随机数字表法将患者分为对照组与观察组,每组50例。对照组采用甘氨酸茶碱钠治疗,观察组采用丙卡特罗联合甘氨酸茶碱钠治疗,两组均连续治疗2周。比较两组患者临床症状缓解时间、肺功能指标、呼出气一氧化氮、血清炎症因子、免疫功能及不良反应发生率。结果治疗后,观察组患者喘息、胸闷、咳嗽症状的缓解时间[(3.12±1.34)、(3.45±1.41)、(3.87±1.16)d]短于对照组[(5.39±1.64)、(4.66±1.28)、(5.11±1.49)d](t=7.579、4.493、4.643,均P<0.001)。治疗后,两组患者第1秒用力呼气容积、用力肺活量、第1秒用力呼气容积与用力肺活量的比值与最大呼气流速较治疗前升高,且观察组[(3.46±0.92)L、(4.19±1.14)L、(82.39±9.97)%、(4.99±1.36)L/s]高于对照组[(2.68±0.85)L、(3.51±0.96)L、(76.44±9.56)%、(4.05±1.12)L/s](t=-4.403、-3.226、-3.046,-3.773,均P<0.05)。治疗后,两组呼出气一氧化氮水平较治疗前降低,且观察组[(30.56±4.91)ppb]低于对照组[(38.79±5.36)ppb](t=8.006,P<0.001)。治疗后,观察组白细胞介素6和肿瘤坏死因子α水平[(63.84±5.86)、(65.99±7.04)pg/mL]低于对照组[(74.12±6.39)、(87.52±8.75)pg/mL](t=8.384、13.556,均P<0.001),白细胞介素10水平[(73.81±6.97)pg/mL]高于对照组[(56.41±5.18)pg/mL](t=-14.168,P<0.001)。治疗后,观察组CD3+、CD4+与CD4+/CD8+值[(60.25±6.24)%、(40.88±3.54)%、(1.75±0.32)]高于对照组[(50.83±6.05)%、(33.54±2.96)%、(1.21±0.21)](t=-7.664、-11.248、-9.976,均P<0.001);观察组CD8+[(23.35±2.25)%]低于对照组[(27.61±2.87)%](t=8.260,P<0.001)。观察组不良反应发生率(3/50,6.00%)低于对照组(7/50,14.00%),差异无统计学意义(χ^(2)=1.778,P=0.182)。结论丙卡特罗联合甘氨酸茶碱钠能够有效治疗BA急性发作,缓解BA症状、改善肺功能、抑制气道炎症、调节免疫微环境。
Objective To investigate the efficacy of procaterol combined with theophylline sodium glycinate in treatment of acute exacerbations of bronchial asthma(BA)and observe its impact on the host immune microenvironment.Methods A total of 100 patients with acute exacerbations of BA who were treated in The Second Naval Hospital of Southern Theater Command of PLA between March 2021 and March 2024 were enrolled in the study and randomly divided into the control group and the observation group,with 50 cases in each group.The control group was treated with theophylline sodium glycinate and the observation group was given procaterol combined with theophylline sodium glycinate.Both groups were treated for 2 consecutive weeks.The time of remission of clinical symptoms,pulmonary function indexes,fractional exhaled nitric oxide(FeNO),serum inflammatory cytokines,immune function indexes and incidence rates of adverse reactions were compared between the two groups.Results The time of remission of wheezing,chest tightness and cough of the observation group was(3.12±1.34),(3.45±1.41)and(3.87±1.16)d after treatment,shorter than(5.39±1.64),(4.66±1.28)and(5.11±1.49)d of the control group(t=7.579,4.493,4.643,all P<0.001).The forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),FEV1/FVC ratio and peak expiratory flow(PEF)of the two groups were greater after treatment than those before treatment,and the above indexes of the observation group were(3.46±0.92)L,(4.19±1.14)L,(82.39±9.97)%and(4.99±1.36)L/s,respectively,higher than(2.68±0.85)L,(3.51±0.96)L,(76.44±9.56)%and(4.05±1.12)L/s of the control group(t=-4.403,-3.226,-3.046,-3.773,all P<0.05).The FeNO levels of the two groups were lower after treatment than those before treatment;the FeNO level of the observation group was(30.56±4.91)ppb,lower than(38.79±5.36)ppb of the control group(t=8.006,P<0.001).The levels of interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-α)of the observation group were(63.84±5.86)and(65.99±7.04)pg/mL,respectively,lower than(74.12±6.39)and(87.52±8.75)pg/mL of the control group(t=8.384,13.556,both P<0.001),and the IL-10 level of the observation group was(73.81±6.97)pg/mL,higher than(56.41±5.18)pg/mL of the control group(t=-14.168,P<0.001).The percentages of CD3+T cells and CD4+T cells as well as the CD4+/CD8+ratio of the observation group were(60.25±6.24)%,(40.88±3.54)%and(1.75±0.32)after treatment,higher than(50.83±6.05)%,(33.54±2.96)%and(1.21±0.21)of the control group(t=-7.664,-11.248,-9.976,all P<0.001),and the percentage of CD8+T cells of the observation group was(23.35±2.25)%,lower than(27.61±2.87)%of the control group(t=8.260,P<0.001).The incidence of adverse reactions was 6.00%(3/50)in the observation group,lower than 14.00%(7/50)in the control group,and there was no statistically significant difference(χ^(2)=1.778,P=0.182).Conclusion The combination of procaterol and theophylline sodium glycinate demonstrates significant efficacy in the treatment of the patients with acute exacerbations of BA,effectively alleviating the symptoms,improving the pulmonary function,inhibiting the airway inflammation and modulating the immune microenvironment.
作者
陈刚
赵松韵
朱珍珍
CHEN Gang;ZHAO Songyun;ZHU Zhenzhen(Department of Respiratory Medicine,The Second Naval Hospital of Southern Theater Command of PLA,Sanya 572000,China)
出处
《中国药物应用与监测》
2026年第3期396-400,共5页
Chinese Journal of Drug Application and Monitoring
基金
2024年海南省自然科学基金青年基金项目(824QN408)。
关键词
支气管哮喘
丙卡特罗
甘氨酸茶碱钠
急性发作
免疫功能
bronchial asthma
procaterol
theophylline sodium glycinate
acute exacerbation
immune function
