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目的探讨在常规治疗基础上给予肝素雾化吸入治疗小儿喘息样支气管炎反复发作的疗效及免疫学机制。方法喘息性支气管炎患儿50例,随机分为观察组30例和对照组20例,对照组给予吸氧、抗感染等常规治疗,观察组在对照组基础上给予肝素100u/kg+生理盐水5mL雾化吸入,2次/d,共14d。记录2组喘息时间和肺部啰音时间;分别于治疗前及治疗14d后检测2组血清白细胞介素(interleukin,IL)-4、IL-8、正常T细胞表达分泌的活性调节蛋白(regulated upon activation normal T cell expressed and secreted,RANTES)、干扰素-γ(interferon-gamma,INF-γ)水平及CD4~+CD25~+CD127~-Treg细胞比率,并与18例体检健康者(阴性对照组)进行比较。结果观察组喘息时间[(4.5±1.1)d]及肺部啰音时间[(6.9±0.8)d]较对照组[(6.6±1.4)、(8.1±0.9)d]短(P<0.01);治疗前,观察组和对照组血清IL-4[(2.45±0.22)、(2.38±0.18)ng/L]、IL-8[(33.90±2.20)、(32.10±2.00)ng/L]、RANTES[(48.8±8.7)、(41.9±9.5)μg/L]水平均明显高于阴性对照组[IL-4(1.41±0.17)ng/L、IL-8(15.60±2.20)ng/L、RANTES(13.3±4.8)μg/L](P<0.01),INF-γ[(0.37±0.14)、(0.38±0.09)ng/L]及CD4~+CD25~+CD127~-Treg细胞比率[(6.4±0.9)%、(5.5±0.8)%]均低于阴性对照组[(1.44±0.20)ng/L、(7.9±1.2)%](P<0.01);观察组治疗后血清IL-4[(1.52±0.13)ng/L]、IL-8[(18.60±2.10)ng/L]及RANTES[(23.1±4.5)μg/L]水平均较对照组治疗后[(1.78±0.16)ng/L)、(22.90±1.20)ng/L、(28.0±6.1)μg/L]降低(P<0.05),观察组治疗后血清INF-γ[(1.46±0.16)ng/L)]及CD4~+CD25~+CD127~-Treg细胞比率[(7.2±0.9)%]均较对照组治疗后[(0.83±0.09)ng/L、(6.4±1.0)%]增高(P<0.05)。结论喘息样支气管炎反复发作患儿在常规治疗基础上给予肝素雾化吸入治疗,可下调血清IL-4、IL-8、RANTES水平,上调INF-γ和CD4~+CD25~+CD127~-Treg细胞比率,缩短喘息时间及肺部啰音时间。
Objective To investigate the curative effect and immunological mechanism of repeated inhalation of heparin on children with asthmatic bronchitis on the basis of routine treatment. Methods Fifty children with asthmatic bronchitis were randomly divided into observation group (n = 30) and control group (n = 20). The control group was given conventional therapy such as oxygen and anti-infection. The observation group was given heparin 100u / kg + Inhalation inhalation, 2 times / d, a total of 14d. The wheezing time and the pulmonary rales time were recorded in two groups. Before treatment and after 14 days of treatment, the levels of interleukin (IL) -4, IL-8, and normal T cells secreted by the two groups were measured and regulated The results showed that the expression of RANTES, IFN-γ, and CD4 ~ + CD25 ~ + CD127 ~ -Treg in normal controls were significantly higher than those in healthy controls (negative control Group) for comparison. Results Compared with the control group [(6.6 ± 1.4), (8.1 ± 0.9) d], the wheezing time [(4.5 ± 1.1) d] and the pulmonary rales time [(6.9 ± 0.8) d] (2.45 ± 0.22), (2.38 ± 0.18) ng / L], IL-8 [(33.90 ± 2.20), (32.10 ± 2.00) ng / L] in the observation group and the control group before treatment, The levels of RANTES [(48.8 ± 8.7) and (41.9 ± 9.5) μg / L] were significantly higher than those in the negative control group [IL-4 (1.41 ± 0.17) ng / (0.37 ± 0.14), (0.38 ± 0.09) ng / L], and the ratio of CD4 ~ + CD25 ~ + CD127 ~ -Tregs were significantly higher in RANTES (13.3 ± 4.8) μg / L and 6.4 ± 0.9% and 5.5 ± 0.8%, respectively) were lower than those in the negative control group (1.44 ± 0.20 ng / L, 7.9 ± 1.2%, P <0.01) [(1.52 ± 0.13) ng / L], IL-8 [(18.60 ± 2.10) ng / L] and RANTES (23.1 ± 4.5) μg / L were significantly higher than those in the control group [(1.78 ± 0.16) ng (22.90 ± 1.20) ng / L, (28.0 ± 6.1) μg / L] (P <0.05), and the levels of INF-γ in serum of the observation group (1.46 ± 0.16) ng / L and CD4 (P <0.05). Compared with the control group, the percentage of ~ + CD25 ~ + CD127 ~ -Treg cells in the control group was significantly higher than that in the control group [(0.83 ± 0.09) ng / L and (6.4 ± 1.0)%], respectively. Conclusions Children with recurrent asthmatic bronchitis recurrent heparin inhalation therapy on the basis of routine treatment may decrease the levels of serum IL-4, IL-8 and RANTES, up-regulate the levels of INF-γ and CD4 ~ + CD25 ~ + CD127 ~ -Treg Cell ratio, shortened breathing time and lung rales time.