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回顾性观察研究不同药物治疗方案对咳嗽变异性哮喘患儿的疗效。

Retrospective, observational study of different medication regimens and outcome in children with cough variant asthma.

机构信息

Department of Respiratory Diseases, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, Shandong, China.

Jinan Key Laboratory of Pediatric Respiratory diseases, Jinan Children's Hospital, Jinan, Shandong, China.

出版信息

Immun Inflamm Dis. 2024 Aug;12(8):e1357. doi: 10.1002/iid3.1357.

Abstract

OBJECTIVE

This retrospective longitudinal cohort study aimed to explore the best therapeutic regimen and treatment duration of cough variant asthma (CVA) in children.

METHODS

A total of 314 children with CVA were divided into receive inhaled corticosteroids (ICS) combined with long-acting beta2-agonist (LABA) group, ICS combined with leukotriene receptor antagonists (LTRA) group, ICS monotherapy group and LTRA monotherapy group. All clinical data were statistically analyzed. Logistic regression model was used to compare the advantages and disadvantages of different treatment schemes at each follow-up time point and the best treatment scheme. The Cox proportional hazard regression model based on inverse probability weighting was used to compare the effects of different medication regimens on adverse outcomes with asthma recurrence or progression as the end point.

RESULTS

(1) After comprehensive analysis, ICS + LABA group was the preferred control regimen for CVA within 8 weeks. After 8 weeks of diagnosis, the efficacy of ICS group or LTRA group was comparable to that of ICS + LABA group and ICS + LTRA group. (2) The ICS + LABA group showed a significant improvement in cough at an early stage, particularly at 4 weeks; the symptoms of ICS + LTRA and ICS groups were significantly improved at 36 weeks. The LTRA group alone showed significant improvement at 20 weeks.

CONCLUSION

ICS + LABA, ICS + LTRA, ICS alone and LTRA alone can effectively treat CVA. ICS + LABA could improve the symptoms most quickly within 8 weeks after CVA diagnosis, followed by ICS + LATR group. After 8 weeks, it can be reduced to ICS alone to control CVA for at least 36 weeks based on the remission of symptoms in children.

摘要

目的

本回顾性纵向队列研究旨在探讨儿童咳嗽变异性哮喘(CVA)的最佳治疗方案和治疗持续时间。

方法

将 314 例 CVA 患儿分为吸入糖皮质激素(ICS)联合长效β2-受体激动剂(LABA)组、ICS 联合白三烯受体拮抗剂(LTRA)组、ICS 单药组和 LTRA 单药组,对所有临床资料进行统计学分析。采用 Logistic 回归模型比较各随访时间点不同治疗方案的优缺点及最佳治疗方案。采用基于逆概率加权的 Cox 比例风险回归模型比较不同药物治疗方案对以哮喘复发或进展为终点的不良结局的影响。

结果

(1)综合分析后,ICS+LABA 组为 CVA 8 周内的首选对照方案。诊断后 8 周,ICS 组或 LTRA 组的疗效与 ICS+LABA 组和 ICS+LTRA 组相当。(2)ICS+LABA 组在早期咳嗽症状改善明显,尤其在 4 周时;ICS+LTRA 组和 ICS 组在 36 周时症状明显改善;LTRA 组单独治疗在 20 周时显示出显著改善。

结论

ICS+LABA、ICS+LTRA、ICS 单药和 LTRA 单药均可有效治疗 CVA。ICS+LABA 可在 CVA 诊断后 8 周内最快改善症状,其次是 ICS+LATR 组。8 周后,根据患儿症状缓解情况,可减少至 ICS 单药控制 CVA 至少 36 周。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39ea/11304893/efa1fbe00de0/IID3-12-e1357-g002.jpg

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