标题：小剂量红霉素联合孟鲁司特钠治疗儿童难治性哮喘对血清炎症因子及C-ACT评分的影响

      作者：李青，梁宽，胡梦娇，赵静利，罗婷婷    宝鸡市人民医院儿科，陕西 宝鸡 721000

      卷次： 2023年34卷4期

      【摘要】 目的 探讨小剂量红霉素联合孟鲁司特钠治疗儿童难治性哮喘对血清炎症因子及儿童哮喘控制测试(C-ACT)评分的影响。方法 选取2018年10月至2021年10月宝鸡市人民医院收治的80例难治性哮喘患儿纳入研究，采用随机数表法将患儿分为观察组和对照组，每组40例。所有患儿均给予布地奈德吸入剂，对照组患儿在此基础上添加孟鲁司特钠片口服治疗，观察组在对照组治疗的基础上联合小剂量红霉素(3~5 mg/kg)口服治疗，两组患儿均持续治疗4周。比较两组患儿哮喘相关症状缓解时间，治疗前后的肺功能[第一秒用力呼气量(FEV1)、最大呼气流速峰值(PEF)，用力呼气75%流速(FEF75)以及最大呼气中期流速(MMEF75/25)]、血清炎症相关因子[白细胞介素-8 (IL-8)、白细胞介素-13 (IL-13)以及肿瘤坏死因子-α (TNF-α)]、T淋巴细胞亚群水平(CD3+、CD4+、CD8+、CD4+/CD8+)。治疗前后，采用C-ACT评分评估患儿哮喘控制情况。结果 治疗后，观察组患儿的喘息、肺部湿啰音及咳嗽缓解时间分别为(6.24±1.32) d、(1.23±0.54) d、(5.49±0.54) d，明显短于对照组的(7.14±1.57) d、(1.59±0.47) d、(6.47±1.12) d，差异均有统计学意义(P<0.05)；治疗后，观察组患儿的FEV1、PEF、FEF75及MMEF75/25指数分别为(1.84±0.37) L、(4.12±0.29) L/s、(1.29±0.32) L/s、(2.06±0.24) L/s，明显高于对照组的(1.67±0.24) L、(3.97±0.19) L/s、(1.12±0.17) L/s、(1.92±0.17) L/s，差异均具有统计学意义(P<0.05)；治疗后，观察组患儿的 IL-8、IL-13及TNF-α水平分别为(74.12±22.32) ng/L、(92.57±12.36) ?g/L、(0.74±0.14) ng/mL，明显低于对照组的(88.54±21.19) ng/L、(101.56±11.25) ?g/L、(1.06±0.21) ng/mL，差异均有统计学意义(P<0.05)；治疗后，观察组患儿的CD3+、CD4+、CD4+/CD8+水平分别为(68.54±8.97)%、(36.79±5.14)%、1.74±0.34，明显高于对照组的(63.47±9.12)%、(33.57±4.98)%、1.39±0.28，CD8+水平为(21.12±3.27)%，明显低于对照组的(24.12±3.32)%，差异均有统计学意义(P<0.05)；治疗后，观察组患儿的C-ACT评分(22.12±0.97)分，明显高于对照组的(20.12±1.37)分，差异有统计学意义(P<0.05)。结论 小剂量红霉素联合孟鲁司特钠可有效降低难治性哮喘患儿的血清炎症因子，维持机体免疫平衡，提高肺功能，改善临床症状，以提高患儿哮喘控制程度。
      【关键词】 儿童；难治性哮喘；小剂量红霉素；孟鲁司特钠；血清炎症因子；哮喘控制
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2023）04—0529—05

Effects of low-dose erythromycin combined with montelukast sodium on serum inflammatory factors andC-ACT scores in children with refractory asthma.
LI Qing, LIANG Kuan, HU Meng-jiao, ZHAO Jing-li, LUOTing-ting. Department of Pediatrics, Baoji People's Hospital, Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of low-dose erythromycin combined with montelukast sodium onserum inflammatory factors and scores of childhood asthma control test (C-ACT) in children with refractory asthma.Methods A total of 80 children with refractory asthma admitted to Baoji People's Hospital between October 2018 andOctober 2021 were enrolled. According to random number table method, they were divided into an observation groupand a control group, with 40 patients in each group. Based on budesonide inhalation, patients in control group were treat-ed with montelukast sodium, while those in the observation group were treated with low-dose erythromycin (3-5 mg/kg)on basis of control group, continuously for 4 weeks. The remission time of asthma-related symptoms, levels of lung func-tion indexes [forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), forced expiratory flow after75% of vital capacity has been expelled (FEF75), maximal midexpiratory flow rate (MMEF75/25)], serum inflamma-tion-related factors [interleukin-8 (IL-8), interleukin-13 (IL-13), tumor necrosis factor-α (TNF-α)], and T lymphocytesubsets (CD3+, CD4+, CD8+, CD4+/CD8+) before and after treatment were compared between the two groups. Before andafter treatment, asthma control of patients was evaluated by C-ACT scores. Results The remission time of wheezing,lung rales, and cough in the observation group were (6.24±1.32) d, (1.23±0.54) d, and (5.49±0.54) d, significantly short-er than (7.14±1.57) d, (1.59±0.47) d, (6.47±1.12) d in the control group (P<0.05). After treatment, FEV1, PEF, FEF75,and MMEF75/25 in the observation group were (1.84±0.37) L, (4.12±0.29) L/s, (1.29±0.32) L/s, and (2.06±0.24) L/s,significantly higher than (1.67±0.24) L, (3.97±0.19) L/s, (1.12±0.17) L/s, (1.92±0.17) L/s in the control group (P<0.05).After treatment, levels of IL-8, IL-13, and TNF-α in the observation group were (74.12±22.32) ng/L, (92.57±12.36) ?g/L,and (0.74±0.14) ng/mL, significantly lower than (88.54±21.19) ng/L, (101.56±11.25) ?g/L, (1.06±0.21) ng/mL in thecontrol group (P<0.05). After treatment, levels of CD3+, CD4+, and CD4+/CD8+ in the observation group were (68.54±8.97)%, (36.79±5.14)%, and 1.74±0.34, significantly higher than (63.47±9.12)%, (33.57±4.98)%, 1.39±0.28 in the con-trol group (P<0.05). After treatment, CD8 + in the observation group was significantly lower than that in the controlgroup: (21.12±3.27)% vs (24.12±3.32)%, P<0.05; C-ACT score was significantly higher than that in the control group:(22.12±0.97) points vs (20.12±1.37) points, P<0.05. Conclusion Low-dose erythromycin combined with montelukastsodium can effectively reduce serum inflammatory factors in children with refractory asthma, maintain immune balance,improve lung function and clinical symptoms, so as to improve asthma control.
      【Key words】 Children; Refractory asthma; Low-dose erythromycin; Montelukast sodium; Serum inflammatoryfactor; Asthma control