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目的:观察雷公藤甲素对糖皮质激素抵抗型(SR)支气管哮喘(哮喘)患者血清细胞因子水平、哮喘症状和肺功能的影响,探讨雷公藤甲素对SR哮喘有无治疗作用。方法:SR哮喘患者16例,随机分组为A及B两组,每组各8例。2组患者均予口服丙卡特罗50~100μg/d和茶碱400 mg/d,并急性发作时吸入沙丁胺醇200-800μg/d。A组患者同时联合应用雷公藤甲素每次33μg,口服,每日3次。疗程4周。疗程开始及结束时分别行血清干扰素(IFN)-γ、白细胞介素(IL)-4、IL-5水平测定,哮喘临床积分和肺功能检查。结果:治疗后,A组患者血清IFN-γ和肺功能指标用力肺活量(FVC%)、第1 s用力呼气容积(FEV1%)、最大呼气流量(PEF%)、50%肺活量时最大呼气流量(V50%)、25%肺活量时最大呼气流量(V25%)均显著增高,哮喘临床积分和血清IL-4、IL-5显著低于治疗前(P<0.01)和低于B组治疗后(P<0.05)。B组治疗后与治疗前比较,上述各项指标均无显著改变(P>0.05)。结论:雷公藤甲素与丙卡特罗和茶碱联合应用可能是治疗SR哮喘的有效方法。
Objective: To observe the effects of triptolide on serum cytokines, asthma symptoms and lung function in patients with glucocorticoid-resistant (SR) bronchial asthma (asthma), and to investigate whether triptolide has therapeutic effects on SR asthma. Methods: Sixteen SR patients with asthma were randomly divided into A and B groups, with 8 cases in each group. In both groups, oral procaterol 50 to 100 μg/d and theophylline 400 mg/d were given, and salbutamol 200-800 μg/d was inhaled during acute attacks. The patients in group A were also treated with 33 mg of triptolide at the same time, orally and 3 times a day. The course of treatment is 4 weeks. Serum levels of interferon (IFN)-γ, interleukin (IL)-4, and IL-5 levels, asthma clinical scores, and pulmonary function tests were measured at the beginning and end of treatment. Results: After treatment, the maximum call of serum IFN-γ and lung function index of forced vital capacity (FVC%), 1st forced expiratory volume (FEV1%), maximum expiratory flow (PEF%), 50% of lung capacity in group A patients Air flow (V50%) and maximum expiratory flow (V25%) at 25% of lung capacity were all significantly higher. Asthma clinical scores and serum IL-4 and IL-5 were significantly lower than before treatment (P<0.01) and were lower than group B. After treatment (P<0.05). Compared with before treatment in group B, there was no significant change in the above indicators (P>0.05). Conclusion: The combination of triptolide and procaterol and theophylline may be an effective method for the treatment of SR asthma.