运动康复对哮喘患儿嗜酸性粒细胞炎症表达的影响

doi:10.12372/jcp.2022.22e0129

摘要/Abstract

摘要：

目的探讨运动康复治疗对变应性哮喘患儿嗜酸性粒细胞（EOS）炎症的影响。方法选择2019年6月至2021年5月就诊的粉尘螨致敏支气管哮喘缓解期患儿作为研究对象。对照组予规范化吸入糖皮质激素（ICS）控制治疗,治疗组在此基础上坚持运动康复治疗。治疗后3个月、1年及高发季节分别检测血EOS计数、嗜酸细胞阳离子蛋白（ECP）、白介素-13（IL-13）及呼出气一氧化氮（FeNO）,并随访1年后哮喘病情控制情况。结果共101例患儿。治疗组51例,男31例、女20例,年龄（8.0±2.0）岁,病情为轻度持续32例,中度持续19例;对照组50例,男29例、女21例,年龄（8.5±2.7）岁,轻度持续28例,中度持续22例。随访3个月、1年以及高发季节治疗组患儿EOS、FeNO、ECP及IL-13均较对照组降低,差异有统计学意义（P<0.05）。治疗组年均ICS总剂量少于对照组,差异有统计学意义（P<0.05）。治疗组与对照组哮喘急性发作次数差异有统计学意义（P<0.05）,治疗组无急性发作的比例高于对照组。结论哮喘儿童在ICS规范化控制治疗的前提下,运动康复治疗对有效减低气道EOS炎症水平表达、减少ICS用量、减少哮喘急性发作具有积极意义。

关键词: 变应性哮喘, 运动康复, 嗜酸性粒细胞炎症, 儿童

Abstract:

Objective To explore the effect of aerobic exercise on eosinophil inflammation in children with allergic asthma. Methods A total of 101 children with dust mite-sensitized bronchial asthma in remission from June 2019 to May 2021 were enrolled. Among them, 50 cases in the control group followed the GINA regimen were given comprehensive treatment based on inhaled corticosteroids (ICS), and 51 cases in the treatment group practiced aerobic exercise on top of the GINA regimen. Blood eosinophil count (EOS), eosinophil cationic protein (ECP), interleukin-13 (IL-13) and fractional exhaled nitric oxide (FeNO) at 3 months, 1 year, and high-incidence seasons after treatment and asthma control after 1 year of follow-up in the two groups of children were evaluated. Results A total of 101 children with asthma in remission were included in the study. There were 51 cases in the treatment group, including 31 males and 20 females, aged (8.0±2.0) years, with mild persistent asthma in 32 cases and moderate persistent asthma in 19 cases. The control group consisted of 50 cases, 29 males and 21 females, aged (8.5±2.7) years, with 28 cases of mild persistent asthma and 22 cases of moderate persistent asthma. The EOS, FeNO, ECP and IL-13 in the treatment group were lower than those in the control group in 3 months, 1 year and high-incidence season, and the differences were statistically significant (P<0.05). The average annual total dose of ICS in the treatment group was less than that in the control group, and the difference was statistically significant (P<0.05). There was a statistically significant difference between the treatment group and the control group in the distribution of acute attacks of asthma (P<0.05), and the proportion of children with asthma in the treatment group was lower. Conclusions Under the premise of standardized control and treatment of ICS in children with asthma in remission, the aerobic exercise has positive function on effectively reducing the expression of airway eosinophilic inflammation, reducing the dosage of ICS, and reducing acute asthma attacks.

Key words: allergic asthma, aerobic exercise, eosinophil inflammation, child

谭永强, 刘海沛, 施燕蓉. 运动康复对哮喘患儿嗜酸性粒细胞炎症表达的影响[J]. 临床儿科杂志, 2022, 40(8): 586-590.

TAN Yongqiang, LIU Haipei, SHI Yanrong. Effect of aerobic exercise on eosinophil inflammation in children with allergic asthma[J]. Journal of Clinical Pediatrics, 2022, 40(8): 586-590.

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时点	组别	EOS计数×10⁹·L^-1	FeNO/ppb·L^-1	ECP/ng·mL^-1	IL-13/pg·mL^-1
研究开始	对照组	0.5(0.5~0.7)	20.5(16.0~26.0)	3.7±0.8	79.8±16.7
	治疗组	0.5(0.4~0.7)	21.0(16.0~25.0)	3.6±0.9	78.4±17.4
	统计量	Z=0.56	Z=0.27	t=0.44	t=0.40
	P	0.575	0.791	0.665	0.688
随访3个月	对照组	0.5(0.5~0.7)	20.5(15.0~25.0)	3.7±0.8	80.2±17.3
	治疗组	0.4(0.4~0.6)	15.0(12.0~21.0)	3.3±0.8	72.7±18.4
	统计量	Z=2.30	Z=2.94	t=2.45	t=2.10
	P	0.021	0.003	0.016	0.038
随访1年	对照组	0.6(0.4~0.7)	20.0(15.0~27.0)	3.6±0.8	77.5±16.5
	治疗组	0.4(0.3~0.6)	18.0(13.0~21.0)	3.2±0.8	70.6±13.7
	统计量	Z=2.47	Z=2.22	t=2.35	t=2.29
	P	0.013	0.027	0.021	0.024
高发季节	对照组	0.7(0.5~0.8)	25.5(19.0~37.5)	4.2±1.1	87.5±16.9
	治疗组	0.6(0.5~0.7)	21.0(18.0~23.0)	3.6±0.8	76.7±16.3
	统计量	Z=2.68	Z=2.98	t=2.92	t=3.26
	P	0.007	0.003	0.004	0.002

组别	例数	人年均ICS总用量/mg	急性发作/次			控制水平
组别	例数	人年均ICS总用量/mg	0	1、2	>2	完全控制	部分控制	未控制
对照组	50	30.4(18.3~36.5)	30(60.0)	17(34.0)	3(6.0)	40(80.0)	8(16.0)	2(4.0)
治疗组	51	18.3(12.1~25.2)	42(82.4)	9(17.6)	0(0)	45(88.2)	6(11.8)	0(0)
统计量		Z=3.40	-			-
P		0.001	0.019¹⁾			0.311¹⁾