哮喘联盟

   摘要
   背景:高剂量的吸入性皮质激素（ICS）在哮喘加重儿童中的抗炎作用是未知的。我们的目的是研究单一高剂量ICS与口服强的松治疗的对比， 比较其在一项为期6天的高剂量ICS或口服强的松（P）治疗后，对哮喘急性加重儿童的呼出气冷凝液(EBC)中Cys-LTs 浓度和 8-异前列腺素水平的影响。
   方法:将94名患有中到重度哮喘加重的儿童以哮喘评分、呼气流量峰值(PEF)，第一秒用力呼气量(FEV1) ，呼出 Cys-LT 和 8-异前列腺素作为指标以评估其治疗前后的状况。收集52名患者经吸入性丙酸氟替卡松(FP) (4000μg)或P治疗前和治疗4小时后，以及为期6天的FP-1000μg/天 或 P 治疗之后的EBC。Cys-LTs 和8-异前列腺素浓度的确定采用特定的免疫试剂盒。
   结果:单一高剂量 FP (n=59)和 p (n=35)治疗均使哮喘评分 (p<0.0001)，PEF (p<0.0001), 和 FEV1 (p<0.0001)显著改善。初次治疗后(p=0.001)和6天的FP组 (p<0.0001)治疗阶段末期的 EBC中Cys-LT 浓度均显著降低。 8-异前列腺素浓度只有在为期6天的FP组FP-1000μg/天(p=0.023)的治疗后才会降低。哮喘加重的儿童中，呼出Cys-LTs 在P治疗4小时后 (p=0.012)和6天P治疗(p=0.018)后会显著降低。
   结论:高剂量 ICS 治疗可能会在治疗哮喘加重的儿童中有效。这种效果在4小时后就开始了。对 Cys-LTs生成的抑制作用促进了早期效果。对 Cys-LTs 和氧化的抑制作用促进了之后观察到的作用。

 

（苏欣 审校）
AllergolImmunopathol(Madr). 2015Aug26.pii:S0301-0546(15)00102-0.doi:10.1016/j.aller.2015.05.006. [Epub ahead of print]
 

The efficacy of single-high dose inhaled corticosteroid versus oral prednisone treatment on exhaled leukotriene and 8-isoprostane levels in mild to moderate asthmatic children with asthma exacerbation.
 

Keskin O1, Uluca U2, Keskin M2, Gogebakan B3, Kucukosmanoglu E4, Ozkars MY4, Kul S5, Bayram H3, Coskun Y2.
 

Abstract
BACKGROUND:The anti-inflammatory effect of high-dose inhaled corticosteroids (ICS) in children with asthma exacerbation is unknown. We aimed to investigate the efficacy of single-high dose ICS versus oral prednisone treatment followed by a course of six day high-dose ICS or oral prednisone (P) treatment on the concentrations of Cys-LTs and 8-isoprostane levels in the exhaled breath condensate (EBC) of children with asthma exacerbation.
METHODS:Ninety-four children with moderate-severe asthma exacerbation were evaluated with asthma scores, peak expiratory flow rate (PEF), forced expiratory volume in first second (FEV1) and exhaled Cys-LT and 8-isoprostane levels before and after treatment. EBC was collected from 52 patients before and four hours after treatment with inhaled fluticasone propionate (FP) (4000μg) or P and after six days of treatment with FP-1000μg/day or P. Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit.
RESULTS:Both single high-dose FP (n=59) and p (n=35) treatment resulted in a significant improvement in asthma score (p<0.0001), PEF (p<0.0001), and FEV1 (p<0.0001). Cys-LT concentration in the EBC decreased significantly both after the initial treatment (p=0.001), and at the end of the six-day period in the FP group (p<0.0001). 8-Isoprostane concentration was lower only after six days of treatment with FP-1000μg/day in the FP group (p=0.023). There was a significant decrease in exhaled Cys-LTs after four hours (p=0.012) and six days of P treatment (p=0.018) in children with asthma exacerbation.
CONCLUSIONS:High-dose ICS treatment may be useful in the treatment of children with asthma exacerbation. The effects start as early as after four hours. The suppression of Cys-LTs production contributes to the early effects. Suppression of both Cys-LTs and oxidants may favourably contribute to the effects observed later.
 

AllergolImmunopathol(Madr). 2015Aug26.pii:S0301-0546(15)00102-0.doi:10.1016/j.aller.2015.05.006. [Epub ahead of print]