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目的通过检测炎性因子嗜酸性粒细胞阳离子蛋白(ECP)、IL-8、一氧化氮(NO)的变化,探讨阿奇霉素对呼吸道合胞病毒(RSV)毛细支气管炎患儿呼吸道炎性反应的影响。方法选择初次喘息发作的具有特应性体质的RSV毛细支气管炎患儿共185例。所有患儿应用常规治疗,症状控制后随机分成4组:阿奇霉素口服组(A组)、布地奈德混悬液气喷组(B组)、孟鲁斯特口服组(C组)、空白对照组(D组)。A组、B组、C组患儿均治疗3个月。各组患儿分别在住院当天、干预前、干预后抽取空腹静脉血2 mL,采用ELISA试剂盒检测其血清ECP、IL-8水平,硝酸酶还原法检测其NO水平,临床门诊及电话随访1 a。采用SPSS 15.0软件进行统计分析。结果A组与B组、C组与D组3个月内喘息再次发作人数及1 a后哮喘发生人数比较均无统计学差异。干预3个月后,A组、B组、C组ECP、IL-8、NO下降程度与D组比较均有统计学差异;A组ECP及NO下降程度与B组比较无统计学差异;C组ECP及NO下降水平较大,与A组比较有统计学差异(Pa<0.01);A组IL-8下降水平较大,与B组、C组比较均有统计学差异(Pa<0.01)。结论阿奇霉素对毛细支气管炎患儿炎性细胞因子ECP、IL-8、NO具有下调作用,对IL-8的下调作用尤为明显;阿奇霉素对毛细支气管炎患儿的呼吸道炎性反应具有一定抑制作用。
Objective To investigate the effects of azithromycin on respiratory inflammatory response in children with respiratory syncytial virus (RSV) bronchiolitis by detecting the changes of inflammatory cytokines such as eosinophil cationic protein (ECP), IL-8 and nitric oxide (NO) . Methods A total of 185 infants with RSV bronchiolitis who had atopic wheezing who had first wheezing episodes were selected. All children were treated with conventional therapy. After symptom control, they were randomly divided into 4 groups: azithromycin oral group (group A), budesonide suspension gas spray group (group B), montelukast oral group (group C), blank control Group (Group D). A group, B group, C group of children were treated for 3 months. Each group of children were on the day of hospitalization, intervention before and after the intervention fasting venous blood 2 mL, using ELISA kit to detect serum ECP, IL-8 levels, nitric oxide reduction method to detect the level of NO, clinics and telephone follow-up 1 a. SPSS 15.0 software for statistical analysis. Results There was no significant difference in the numbers of patients who had wheezing reemerges within 3 months and the number of asthma after 1 year in groups A and B, C and D respectively. After intervention for 3 months, the decrease of ECP, IL-8 and NO in group A, group B and group C were statistically different from that in group D; The decrease of ECP and NO in group A was not statistically different from that in group B; C The levels of ECP and NO decreased significantly in group A (P <0.01). The level of IL-8 in group A was significantly lower than that in group B (P <0.01) . Conclusions Azithromycin can down-regulate inflammatory cytokines ECP, IL-8 and NO in children with bronchiolitis, especially down-regulate IL-8. Azithromycin can inhibit airway inflammation in children with bronchiolitis.