布地奈德聯合螺內酯對支氣管肺發育不良早產兒血液中IL-1β、TNF-α變化的影響

葉旭強　戴怡蘅　劉衛東?曾立軍　麥麗珊　張李霞

【摘要】 目的：探討布地奈德聯合螺內酯對支氣管肺發育不良（BPD）早產兒血液中IL-1β、TNF-α變化的影響。方法：選取2012年11月-2017年11月在本院出生的早產兒92例，患兒均有BPD癥狀。按照隨機數字表法將其分為對照組與研究組，各46例。對照組給予螺內酯治療，研究組應用布地奈德聯合螺內酯治療。對比兩組炎性因子水平（IL-1β、TNF-α、IL-8）、臨床指標、體重、血氣分析指標、并發癥。結果：治療后，研究組IL-1β、TNF-α、IL-8水平均低于對照組（P<0.05）;治療后，研究組心率、呼吸頻率、經皮血氧飽和度、體重、血氣分析指標均優于對照組（P<0.05）;研究組并發癥發生率為8.7%，低于對照組的32.6%，差異有統計學意義（字2=8.026，P<0.05）。結論：應用布地奈德聯合螺內酯治療早產兒BPD，可以顯著改善患兒血液中IL-1β、TNF-α、IL-8等炎性因子水平，調節血氣指標，安全有效，值得推廣。

【關鍵詞】 布地奈德; 螺內酯; 支氣管肺發育不良; 早產兒; IL-1β; TNF-α

Effect of Budesonide Combined with Spironolactone on Changes of IL-1β and TNF-α in Blood of Premature Infants with Bronchopulmonary Dysplasia/YE Xuqiang，DAI Yiheng，LIU Weidong，et al.//Medical Innovation of China，2019，16（19）：0-057

【Abstract】 Objective：To investigate the effect of Budesonide combined with Spironolactone on the changes of IL-1β and TNF-α in blood of premature infants with bronchopulmonary dysplasia（BPD）.Method：92 cases of premature infants born in our hospital from November 2012 to November 2017 were selected，all of them had BPD symptoms.According to the random number table method，they were divided into control group and study group，46 cases in each group.The control group was treated with Spironolactone，while study group was treated with Budesonide combined with Spironolactone.The levels of inflammatory factors（IL-1β，TNF-α，IL-8），clinical indicators，body weight，blood gas analysis indicators and complications were compared between two groups.Result：After treatment，the levels of IL-1β，TNF-α，IL-8 in study group were lower than those of control group（P<0.05）.After treatment，the indexes of heart rate，respiratory rate，percutaneous oxygen saturation，body weight and blood gas analysis in study group were better than those of control group（P<0.05）.The incidence of complications was 8.7% in study group，which was lower than 32.6% of control group（字2=8.026，P<0.05）.Conclusion：The application of Budesonide combined with Spironolactone in treatment of BPD in premature infants can significantly improve the levels of IL-1β，TNF-α，IL-8 and other inflammatory factors in the blood of the infants，regulate blood gas indicators，which is safe and effective，and is worthy of promotion.

【Key words】 Budesonide; Spironolactone; Bronchopulmonary dysplasia; Premature infants; IL-1β; TNF-αFirst-authors address：Foshan Maternal and Child Health Hospital，Foshan 528000，China

doi：10.3969/j.issn.1674-4985.2019.19.014

支氣管肺發育不良（BPD）常見于早產兒，臨床特征表現為對氧氣的長時間依賴，屬慢性呼吸系統的常見病，嚴重呼吸窘迫綜合征為其原發疾病，影響患兒機體發育[1]。隨著現代醫療技術水的提高，早產兒的存活率也有所提升，因此隨之出現的BPD、神經系統發育異常等早產兒病變也出現了較高的發生率。由于早產，患兒機體肺未完全發育，肺泡數量少，伴隨機體不斷發育，肺泡數量也持續增多，由于感染、機械通氣、炎性反應等諸多不利因素的作用，患兒極易出現肺泡停滯發育的狀況，影響患兒身體發育[2]。當前階段，針對早產兒BPD的防治，尚無系統規范化治療方案，主要措施有氧療、支氣管擴張劑、抗生素、肺泡表面活性劑、一氧化氮、糖皮質激素、維生素A、利尿劑等治療[3]，其中糖皮質激素的預防及治療作用被證實是有效的，布地奈德為吸入性糖皮質激素，療效類似于其他類糖皮質激素，具有防治BPD的功效[4]。本研究對BPD早產兒進行布地奈德聯合螺內酯治療，將布地奈德聯合螺內酯治療對血液中IL-1β、TNF-α變化的影響以及相關不良反應發生狀況進行探討，現報道如下。