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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (03) : 298 -304. doi: 10.3877/cma.j.issn.1673-5250.2021.03.010

论著

布地奈德联合重组人干扰素α-1b治疗急性婴幼儿毛细支气管炎的临床疗效
葛瑜, 李建木†(), 冯玲玲, 杨凡   
  • 收稿日期:2020-11-18 修回日期:2021-04-27 出版日期:2021-06-01
  • 通信作者: 李建木

Clinical efficacy of budesonide combined with recombinant human interferon α-1b in the treatment of acute infantile bronchiolitis

Yu Ge, Jianmu Li†(), Lingling Feng, Fan Yang   

  • Received:2020-11-18 Revised:2021-04-27 Published:2021-06-01
  • Corresponding author: Jianmu Li
  • Supported by:
    Scientific Research Project of Hubei Health and Family Planning Commission(WJ2017F127)
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引用本文：

葛瑜, 李建木, 冯玲玲, 杨凡. 布地奈德联合重组人干扰素α-1b治疗急性婴幼儿毛细支气管炎的临床疗效[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(03): 298-304.

Yu Ge, Jianmu Li, Lingling Feng, Fan Yang. Clinical efficacy of budesonide combined with recombinant human interferon α-1b in the treatment of acute infantile bronchiolitis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(03): 298-304.

目的

探讨布地奈德联合重组人干扰素(rhIFN)α-1b治疗急性婴幼儿毛细支气管炎(AIB)的临床疗效。

方法

选取2017年1月至2019年1月，长江大学附属仙桃市第一人民医院院收治的174例AIB患儿为研究对象。采用随机数字表法，将其分为观察组(n＝87)和对照组(n＝87)。对观察组患儿进行布地奈德雾化+rhIFNα-1b雾化吸入治疗，而对照组患儿仅进行布地奈德雾化吸入治疗。比较2组患儿一般临床资料，治疗总有效率，主要临床症状消失时间，治疗前、后患儿血清T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)，免疫球蛋白(IgG、IgA、IgM)，以及血清白细胞介素(IL)-4、-6和肿瘤坏死因子(TNF)-α水平变化情况。本研究遵循的程序符合纳入病例医院伦理委员会制定的伦理学标准，得到该委员会批准(审批文号：XTYYLW2021036)，并与所有患儿监护人签署临床研究知情同意书。

结果

①2组患儿性别、年龄、病程、母乳喂养率等一般临床资料比较，差异无统计学意义(P>0.05)。②观察组患儿治疗总有效率(83/87，95.4%)显著高于对照组(71/87，81.6%)，并且差异有统计学意义(χ2＝8.135、P＝0.004)。③观察组患者咳嗽、喘息、气促及肺部啰音消失时间，均短于对照组，并且差异均有统计学意义(P<0.05)。④2组患儿治疗后，对CD4+、CD8+、CD4+/CD8+水平分别进行组间比较，差异均有统计学意义(P<0.05)；而组内分别比较，则仅CD8+水平低于治疗前，其余CD4+、CD4+/CD8+水平均分别高于治疗前，并且差异亦均有统计学意义(P<0.05)。⑤治疗后，观察组患儿IgG、IgA、IgM水平均分别高于对照组，并且差异均有统计学意义(P<0.05)；而组内分别比较，则IgG、IgA和IgM水平亦均高于治疗前，并且差异亦均有统计学意义(P<0.05)。⑥治疗后，2组患儿血清IL-4、-8及TNF-α水平均低于对照组，并且差异均有统计学意义(P<0.05)；而组内分别比较，则血清IL-4、IL-8及TNF-α水平亦均低于治疗前，并且差异均有统计学意义(P<0.05)。

结论

布地奈德联合rhIFNα-1b治疗AIB临床效果显著，可改善患儿临床症状及机体免疫功能，降低炎性反应。

关键词: 布地奈德, 重组人干扰素α-1b, 婴幼儿毛细支气管炎，急性, 免疫功能, T淋巴细胞, 儿童
Objective

To explore clinical efficacy of budesonide combined with recombinant human interferon (rhIFN)α-1b in the treatment of acute infantile bronchiolitis (AIB).

Methods

From January 2017 to January 2019, a total of 174 AIB children admitted to Xiantao First People′s Hospital Affiliated to Yangtze University were selected into this study. By radom number table method, they were divided into observation group (n=87, aerosol inhalation therapy by rhIFNα-1b combined with budesonide) and control group (n=87, aerosol inhalation therapy only by budesonide). The general clinical data, total effective rate, disappearance time of main symptoms(cough, wheeze, pant), levels of T lymphocyte subsets (CD4+ , CD8+ , CD4+ /CD8+ ), immunoglobulins (Ig)G, IgA, IgM, serum interleukin (IL)-4, -6 and tumor necrosis factor (TNF)-α levels before and after treatment were compared between two groups. The procedures followed in this study conformed to the ethical standards formulated by the Ethics Committee of cases collection hospital, which has been approved by the Ethics Committee (Approval No.XTYYLW2021036), and informed consent was obtained form guardians of all children.

Results

①There were no significant differences between two groups in general clinical data such as gender constituent ratio, age, course of diseases and breast feeding rate (P>0.05). ②The total curative effective rate in observation group (95.4%, 83/87) was significantly higher than that in control group (81.6%, 71/87), and the difference was statistically significant (χ2=8.135, P=0.004). ③The disappearance time and rale of cough, wheeze, pant in observation group were shorter or lower than those in control group, and the difference between two groups were statistically significant (P<0.05). ④After treatment, levels of serum CD4+ , CD8+ and CD4+ /CD8+ between two groups, the differences were statistically significant (P<0.05). However, after treatment , only levels of serum CD8+ in observation group and control group were lower than those before treatment, respectively, and the other levels of CD4+ and CD4+ /CD8+ were higher than those before treatment, respectively, and the differences were also statistically significant (P<0.05). ⑤After treatment, levels of serum IgG, IgA and IgM in observation group were higher than those in control group, respectively, and the differences were statistically significant (P<0.05). However, comparison within groups, levels of serum IgG, IgA and IgM in observation group and control group after treatment were higher than those before treatment, respectively, and the differences were also statistically significant (P<0.05). ⑥After treatment, levels of serum IL-4, -8 and TNF-α in two groups were lower than those in control group, respectively, and the differences between two groups were statistically significant (P<0.05). However, comparison within groups, levels of serum IL-4, IL-8 and TNF-α in observation group and control group after treatment were lower than those before treatment, respectively, and the differences were statistically significant (P<0.05).

Conclusions

Aerosol inhalation therapy by budesonide combined with rhIFNα-1b has a significant clinical effect in treatment of AIB, which can improve children′s clinical symptoms and immune function, and reduce inflammatory response.

Key words: Budesonide, Interferon alfa-1b, Acute infantile bronchiolitis, Immunity, T-lymphocytes, Child
表1 2组AIB小儿毛细支气管炎患儿一般临床资料比较
组别 例数 性别[例数(%)] 年龄(月，±s) 病程(d，±s) 母乳喂养[例数(%)]
男 女
观察组 87 48(55.2) 39(44.8) 12.2±2.5 6.1±1.1 65(74.7)
对照组 87 50(57.5) 37(42.5) 12.2±3.3 6.0±1.1 67(77.0)
检验值   χ2＝0.093 t＝0.156 t＝0.298 χ2＝0.126  
P值   0.764 0.876 0.766 0.723  
表2 2组AIB患儿治疗有效率比较[例数(%)]
组别 例数 显效 有效 无效 总有效率
观察组 87 53(60.9) 30(34.5) 4(4.6) 83(95.4)
对照组 87 44(50.6) 27(31.0) 16(18.4) 71(81.6)
χ2值   - - - 8.135
P值   - - - 0.004
表3 2组AIB患儿临床症状消失时间比较(d，±s)
组别 例数 咳嗽 喘息 气促 啰音
观察组 87 6.0±1.1 4.1±1.2 4.3±1.3 4.1±1.1
对照组 87 8.0±2.2 6.2±1.5 6.4±1.5 5.7±1.3
t值   7.534 9.918 10.040 8.940
P值   <0.001 <0.001 <0.001 <0.001
表4 2组AIB患儿治疗前、后外周血T淋巴细胞亚群水平比较(%，±s)
组别 例数 CD4+ CD8+ CD4+/CD8+
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
观察组 87 39.4±4.2 48.4±5.0 12.973 <0.001 35.9±3.4 25.7±3.1 20.764 <0.001 1.1±0.2 1.7±0.2 18.587 <0.001
对照组 87 39.1±4.4 41.4±5.3 3.038 0.003 35.7±3.2 31.1±2.3 10.921 <0.001 1.1±0.2 1.3±0.2 6.097 <0.001
t值   0.351 9.091     0.501 12.986     0.321 12.493    
P值   0.726 <0.001     0.618 <0.001 0.749 <0.001    
表5 2组AIB患儿治疗前、后血清IgG、IgA、IgM水平比较(g/L，±s)
组别 例数 IgG IgA IgM
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
观察组 87 7.9±0.9 12.0±1.5 21.374 <0.001 1.03±0.18 1.35±0.22 10.501 <0.001 1.04±0.12 1.73±0.17 30.929 <0.001
对照组 87 7.9±0.9 9.3±1.2 8.771 <0.001 1.01±0.14 1.17±0.12 8.094 <0.001 1.07±0.14 1.29±0.22 7.869 <0.001
t值   0.221 12.733     0.818 6.701     1.518 14.761    
P值   0.826 <0.001     0.415 <0.001     0.131 <0.001    
表6 2组AIB患儿治疗前、后血清IL-4、-8及TNF-α水平比较(pg/mL，±s)
组别 例数 IL-4 IL-8 TNF-α
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
观察组 87 52.3±9.8 32.3±8.4 14.431 <0.001 62.0±13.3 28.9±9.7 18.744 <0.001 191.2±31.4 127.9±10.8 17.757 <0.001
对照组 87 52.2±9.9 40.3±8.1 8.616 <0.001 61.3±12.2 41.6±9.3 11.984 <0.001 188.5±29.6 155.8±21.4 8.356 <0.001
t值   0.106 6.391     0.341 8.796     0.581 10.852    
P值   0.915 <0.001     0.733 <0.001     0.562 <0.001    
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