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目的:观察加用口服泼尼松片治疗与单纯吸入糖皮质激素在婴幼儿哮喘急性发作期中的疗效。方法:6个月～3岁婴幼儿支气管哮喘患儿48例,随机分为常规治疗组(A组,n=24)与口服泼尼松组(B组,n=24),对照组为6个月～3岁的健康体检儿童(C组,n=20)。B组在常规GINA方案治疗的同时短期加服泼尼松片3～7天,1～2 mg.kg-1.d-1(总量不超过40 mg),分2～3次。治疗第3天,利用血细胞计数板检测3组患儿血嗜酸性粒细胞数,采用流式细胞计数法检测外周血T细胞亚群CD4/CD8,ELISA法检测血清IgE、IL-4水平。结果:哮喘患儿血清IgE、IL-4水平均明显提高。B组患儿疗效优于A组,其血嗜酸性粒细胞数及血清IgE、IL-4水平均低于A组(P<0.05),两组CD4/CD8比值差异无统计学意义(P>0.05)。结论:加服泼尼松片比单纯吸入糖皮质激素对婴幼儿哮喘急性发作期疗效好,其原因为弥补了婴幼儿吸入治疗依从性差的缺陷,发挥了糖皮质激素抗炎和抗过敏的作用。
OBJECTIVE: To observe the curative effect of oral administration of prednisone tablets and inhaled corticosteroids in infant acute asthma exacerbation. Methods: Forty-eight infants with bronchial asthma from 6 months to 3 years old were randomly divided into routine treatment group (group A, n = 24) and oral prednisone group B (n = 24) Months to 3 years old healthy children (C group, n = 20). Group B was treated with conventional GINA regimen while short-term oral prednisone tablets 3 to 7 days, 1 ~ 2 mg.kg-1.d-1 (total no more than 40 mg), divided into 2 or 3 times. On the third day after treatment, the number of blood eosinophils in the three groups was detected by hematocytometer. The levels of CD4 / CD8 in peripheral blood T lymphocytes were detected by flow cytometry. The serum levels of IgE and IL-4 were detected by ELISA. Results: Serum IgE and IL-4 levels in children with asthma were significantly increased. The efficacy of group B was better than that of group A, and the levels of blood eosinophil and serum IgE and IL-4 in group B were lower than those in group A (P <0.05). There was no significant difference in CD4 / CD8 ratio between the two groups (P> 0.05). CONCLUSIONS: The addition of prednisone tablets is more effective than inhaled corticosteroids in infants and young children with acute exacerbation of asthma. The reason for this is to make up for the poor compliance of infants and young children with inhalation therapy and to exert the anti-inflammatory and anti-allergic effects of glucocorticoids .