目的 探讨糖皮质激素对激素敏感性与激素非敏感性支气管哮喘患者血清中炎症因子的影响.方法 选取重度及以上急性发作期支气管哮喘患者39例,在常规解痉、平喘治疗的基础上予以激素80 m g/d治疗,静脉给药,达到激素减量标准时予以激素减量40 m g/d,按激素减量是否成功分为激素敏感组(A组)33例和激素非敏感组(B组)6例,分别采集患者入院后激素治疗前及激素减量时的静脉血5 mL,检测血清中炎症因子粒细胞集落刺激因子(GM-CSF)、白细胞介素-8(IL-8)水平,获得入院时及激素减量后24 h动脉血2 mL,用于检测氧分压(PO2)、二氧化碳分压(PCO2).结果 激素治疗前两组患者血清中炎症因子(GM-CSF、IL-8)、PaO2、PaCO2水平差异均无统计学意义(P>0.05),激素治疗后两组患者炎症因子及PaCO2水平较治疗前均有所下降、PaO2有所上升,治疗前后A组各项指标比较差异均有统计学意义(P<0.05),而B组各项指标比较差异均无统计学意义(P>0.05),治疗后A、B两组各项指标比较差异均有统计学意义(P<0.05).结论激素敏感性与非敏感性支气管哮喘急性发作期予以糖皮质激素治疗后症状缓解时体内炎症因子存在差异,这可能是导致激素非敏感性患者激素减量后症状再次加重的原因.%Objective To investigate the effects of glucocorticoid on serum inflammatory factors in patients with Hormone-sensitive bronchial asthma and hormone-insensitive bronchial asthma .Methods A total of 39 cases of bronchial asthma with severe and acute attack were selected ,on the basis of routine antispasmodic and antiasthmatic treatment ,hormone intravenous therapy was provided with 80 mg/d ,and 40 mg/d of hormone reduction was given when the hormone reduction standard was reached .The patients were divided into hor-mone sensitive group with 33 cases (group A) and hormone insensitive group with 6 cases (group B) accord-ing to whether the hormone reduction was achieved .5 mL of venous blood was obtained before hormone treat-ment and during the hormone reduction ,respectively .The serum levels of inflammatory cytokines granulocyte colony stimulating factor (GM-CSF) and interleukin-8 (IL-8) in serum were detected ,and 2 mL of arterial blood were obtained at admission and 24 h after hormone reduction ,which was used to detect PO2 and PCO2 . Results There were no significant difference between the serum levels of GM-CSF ,IL-8 ,PaO2 and PaCO2 in the two groups before hormone therapy (P>0 .05) .After hormone treatment ,the levels of inflammatory fac-tors and PaCO2 in the two groups decreased while PaO2 level increased ,the differences in the indexes of group A before and after treatment were statistically significant (P<0 .05) ,there was no significant difference in the indexes of group B (P>0 .05) ,and the difference between group A and B after treatment was statistically sig-nificant (P<0 .05) .Conclusion There is a difference in the inflammation factors after the treatment of glu-cocorticoid when the acute attack of hormone sensitive and hormone insensitive bronchial asthma .This may be the cause of the aggravation of the symptoms after hormone reduction in the hormone insensitive patients .
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