【摘要】 目的　在观察低剂量吸入糖皮质激素的基础上联合应用H1阻滞剂对变应性哮喘的防治作用。方法　采用多中心、随机、双盲、安慰剂对照方法 ,将 67例轻、中度变应性哮喘伴变应性鼻炎患者分为氯雷他定组 (3 4例 )和对照组 (3 3例 ) ,进行 3～ 6个月的治疗 ,观察吸入二丙酸倍氯米松每天40 0 μg ,14天后减至每天 2 0 0 μg ,并联合应用氯雷他定 10mg或安慰剂 (每天 2次 )。记录患者的哮喘症状评分、鼻炎发作天数、感冒次数、按需吸入 β2 激动剂的次数和测定气道反应性与血清中上皮细胞粘附分子 1(ICAM 1)和血管内皮粘附分子 1(VCAM 1)的变化。结果　对照组治疗前、后每周哮喘症状计分为 (4 6± 0 9)分、(3 1± 0 9)分 ,氯雷他定组为 (4 8± 1 2 )分、(2 4± 0 9)分 ,两组比较差异有显著性 (P <0 0 1) ;对照组鼻炎患者每周发作天数治疗前、后分别为 (4 0± 1 0 )天、(3 5± 1 2 )天、(4 0±1 2 )天、(1 9± 0 9)天 ,两组比较差异有显著性 (P <0 0 0 1) ;对照组患者每月感冒样症状的发生次数为 (1 1± 0 4)次 ,氯雷他定组为 (0 8± 0 5 )次、两组比较差异有显著性 (P <0 0 0 1) ;按需吸入 β2 激动剂的平均次数减少 (P <0 0 0 1) ;治疗后气道反应性改善更明显 (P <0 0 5 ) ;而血清中ICAM 1、VCA更多还原

【Abstract】 Objective To evaluate the therapeutic effects of H 1 blocker in combination with low dose inhaled corticosteroid on allergic asthma Methods A multi center, double blind, randomized, placebo control study was conducted in 67 patients with mild to moderate allergic asthma Patients were randomized to receive either Loratadine 10 mg or placebo twice a day on the basis of inhaled beclomethasone dipropionate (400 μg/d for 14 days, then reduced to 200 μg/d) for 5 3±1 3 months Symptom scores of asthma, frequencies of episode of rhinitis and common cold and doses of inhaled Salbutamol as rescue drug were recorded Bronchial hyperresponsiveness (PD 20 FEV 1 in response to Histamine) and serum ICAM 1 and VCAM 1 were measured before and after the treatment Results Aftor treatment, there was much better improvement in symptom score (2 4±0 9 vs 3 1±0 9, P <0 01), symptomatic days due to rhinitis (4 0±1 2 d/week vs 1 9±0 9 d/week, P <0 001), episode of common cold symptom (0 8±0 5 time vs 1 1±0 4 time, P <0 001), average doses of inhaled β 2 agonist as rescue medication(2 6±0 9 puff/week vs 3 7±0 8 puff/week, P <0 001) and bronchial responsiveness ( P <0 05) in Loratadine group as compared with the control group However, there was no significant change in serum ICAM 1 and VCAM 1 levels after treatment in both groups( P >0 05) Conclusions On the basis of low dose inhaled corticosteroid, orally administered Loratadine significantly improves the therapeutic efficacy of asthma in patients with allergic asthma and rhinitis更多还原