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目的观察H1受体拮抗剂氮卓斯汀鼻喷剂联合吸入激素对哮喘合并变应性鼻炎的疗效,探讨其作用机制。方法 61例中、重度哮喘伴变应性鼻炎患者在规律经口吸入沙美特罗/氟替卡松粉吸入剂(50μg/250μg),2次/d,每次1吸的基础上随机给予下列治疗:A组(22例)氮卓斯汀鼻喷剂2次/d,每次两鼻孔各1喷;B组(20例)布地奈德鼻喷剂2次/d,每次两鼻孔各1喷;C组(19例)氮卓斯汀鼻喷剂2次/d,每次两鼻孔各1喷,联合布地奈德鼻喷剂2次d,每次两鼻孔各1喷。疗程均为3个月。观察3组患者的哮喘症状评分并测定诱导痰嗜酸粒细胞占有核细胞的百分比及诱导痰上清液中嗜酸粒细胞阳离子蛋白(ECP)、细胞间黏附分子-1(ICAM-1)、白介素13(IL-13)的水平变化。结果治疗后A组哮喘症状评分、诱导痰嗜酸粒细胞占有核细胞的百分比及诱导痰上清液中ECP、ICAM-1的水平与B组比较,差异均无统计学意义(P>0.05),C组治疗后哮喘症状评分及诱导痰上清液中ECP水平与A组比较,差异均有统计学意义(P<0.05)。结论在吸入激素的基础上联合应用H1受体拮抗剂鼻喷剂可抑制气道嗜酸粒细胞及ECP、ICAM-1水平,有效治疗哮喘合并变应性鼻炎,且不良反应较轻。对于顾忌鼻用激素的副作用而又认为联用两种鼻喷剂麻烦的患者可选择H1受体拮抗剂氮卓斯汀鼻喷剂联合吸入激素治疗。
Objective To observe the curative effect of H1 receptor antagonist Azelastine nasal spray combined with inhaled hormones on asthma with allergic rhinitis and to explore its mechanism. Methods Sixty-one patients with severe asthma and allergic rhinitis were randomly assigned salmeterol / fluticasone powder inhalation (50μg / 250μg) twice a day for 1 week. The following treatments were randomly assigned: A The patients in group B (n = 20) received budesonide nasal spray twice a day for 2 times a day, In group C (n = 19), Nazedostatin nasal spray was given twice a day for two times each, and budesonide nasal spray was given twice a day for two sprays. Treatment are 3 months. The asthma symptom scores of the three groups were observed and the percentage of eosinophils possessing nuclear cells and the levels of eosinophil cationic protein (ECP), intercellular adhesion molecule-1 (ICAM-1) Interleukin-13 (IL-13) levels change. Results After treatment, the score of asthma symptom, the percentage of eosinophils in induced sputum and the levels of ECP and ICAM-1 in induced sputum supernatant in group A were not significantly different from those in group B (P> 0.05) The score of asthma symptom and the level of ECP in induced sputum supernatant in group C were significantly different from those in group A (P <0.05). Conclusions The combination of inhaled hormones and H1 receptor antagonist nasal spray can inhibit airway eosinophils and ECP, ICAM-1 levels, effective treatment of asthma with allergic rhinitis, and mild adverse reactions. For fear of side effects of nasal hormones and that the combination of two nasal spray trouble patients can choose H1 receptor antagonist azelastine nasal spray combined with inhaled hormone therapy.