目的 观察按哮喘预测指数（asthma predictive index, API）分组治疗在5 岁以下喘息儿童中的应用价值。方法 239 例5 岁以下喘息患儿，API 阳性组126 例，API 阴性组113 例，分别随机分为糖皮质激素吸入治疗组（ICS 治疗组）及孟鲁司特钠治疗组（LTRA 治疗组）。治疗开始4 周内2 组所用药物种类和剂量相同，在疾病稳定期（第4 周后）ICS 治疗组仅使用布地奈德混悬液雾化吸入治疗，LTRA 治疗组仅使用孟鲁司特钠口服治疗，评估记录各组患儿不同时间点哮喘症状评分。结果 API 阳性组及阴性组在治疗后的前4 周，ICS和LTRA 2 种方法均有效，哮喘症状评分与治疗前比较差异有统计学意义，但2 个治疗组间比较差异无统计学意义；在治疗24 周时，2 种治疗方法仍有效，但API 阳性组中LTRA 治疗组较ICS 治疗组更有效；在API 阴性组中，LTRA 治疗组与ICS 治疗组疗效比较差异无统计学意义。结论 5 岁以下的儿童喘息，在疾病稳定期，可根据不同的API 分组，选择不同治疗方案，以达到更有效地控制喘息的目的。
Abstract
Objective To study the application value of asthma predictive index (API)-based group therapy in wheezing children under 5 years of age. Methods A total of 239 wheezing children under 5 years of age were divided into API-positive (n=126) and API-negative groups (n=113). Each group was randomly assigned to inhaled corticosteroids (ICS) subgroup and montelukast sodium (leukotriene receptor antagonist, LTRA) subgroup. The ICS and LTRA subgroups received the same drug therapy at the same dosage within the first four weeks of treatment. In the stable period of disease, the ICS subgroup only received aerosol inhalation of budesonide suspension, while the LTRA group was orally given montelukast sodium only. Asthma symptom scores were assessed and recorded at different time points. Results In the first four weeks of treatment, ICS and LTRA were effective both in the API-positive and API-negative groups; the two groups showed significant improvements in asthma symptom scores, and the asthma symptom score showed no significant difference between the ICS and LTRA subgroups of each group. After 24 weeks of treatment, the two therapies were still effective; in the API-positive group, the LTRA subgroup had a better treatment outcome than the ICS subgroup, but there was no significant difference in treatment outcome between the LTRA and ICS subgroups of the API-negative group. Conclusions For wheezing children under 5 years of age, therapeutic strategies can be chosen based on API in the stable period of disease, so as to better control wheezing.
关键词
喘息 /
哮喘预测指数 /
哮喘症状评分 /
儿童
Key words
Wheezing /
Asthma predictive index /
Asthma symptom score /
Child
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基金
上海市科学技术委员会科研计划项目医学重大课题（10DZ1951000）；上海市卫生适宜技术医学重大课题（2010Y140）
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