目的 探讨血锌缺乏对咳嗽变异性哮喘(CVA)患儿肺功能、气道炎症和临床疗效的影响,为指导临床CVA治疗及预后评估提供参考。方法 选取2016年2月-2018年2月本院收治的60例血锌缺乏的CVA患儿为研究对象(血锌缺乏组),同期选择年龄相仿的血锌正常的CVA患儿60例实施对照研究(血锌正常组)。两组入院后均接受常规治疗,疗程均为8周;记录两组治疗前后肺功能、诱导痰嗜酸性粒细胞(EOS)、白介素-4(IL-4)、白介素-10(IL-10)水平变化。治疗结束后评定两组治疗的临床疗效,并记录治疗后随访1年时的复发情况。结果 两组治疗后用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV1%)、呼气峰流速(PEF)和最大呼气中段流速(MMEF)较治疗前均有显著升高(P＜0.05),血锌缺乏组治疗后的以上肺功能指标均低于血锌正常组治疗后(P＜0.05)。两组治疗后诱导痰中EOS、IL-4、IL-10水平较治疗前均有显著改善(P＜0.05),血锌缺乏组治疗后的以上指标改善情况均差于血锌正常组治疗后(P＜0.05);治疗8周后血锌缺乏组临床疗效分级情况显著低于血锌正常组治疗后(Z=2.197,P=0.028)。血锌缺乏组随访1年时复发率高于血锌正常组(χ²=3.962,P=0.046)。多元Logistic回归方程显示血锌缺乏是CVA患儿病情控制不佳的危险因素。结论 血锌缺乏不利于CVA患儿肺功能和气道慢性炎症的改善,且与复发密切相关,可能是患儿病情控制不良的危险因素之一,因此应当定期监测患儿此类微量元素,可适时酌情补充含锌制剂,以改善患儿预后。

Objective To discuss the effects of zinc deficiency on pulmonary function,airway inflammation and clinical efficacy in children with cough variant asthma(CVA),so as to provide evidence for clinical assessment and treatment of CVA. Methods A total of 60 CVA children with zinc deficiency admitted to Yulin First Hospital from February 2016 to February 2018 were selected as participants(zinc deficiency group),meanwhile 60 CVA children with similar age and normal zinc level were selected for control study(normal zinc group) during the same period. Both group received conventional treatment of 8 weeks course. Lung function,induced sputum EOS,IL-4 and IL-10 levels were recorded before and after treatment. Clinical efficacy and recurrence of one year follow-up after treatment were recorded. Results FVC,FEV1%,PEF and MMEF after treatment significantly increased in both groups(P<0.05). EOS,IL-4 and IL-10 levels in induced sputum after treatment were significantly improved in both groups(P<0.05),and the improvement of the above indicators after treatment in deficient zinc group was worse than normal zinc group(P<0.05). Clinical efficacy grade of zinc deficiency group was significantly lower than normal zinc group(Z=2.197,P=0.028). Recurrence rate of zinc deficiency group was higher than that of normal zinc group(χ²=3.962,P=0.046). Multiple Logistic regression analysis showed that serum zinc deficiency was risk factor of poor control. Conclusions Serum zinc deficiency is not conducive to improvement of lung function and airway inflammation,and is closely related to recurrence. It may be risk factor for poor control of the disease. Therefore trace elements should be regularly monitored,and zinc supplementation should be given timely and appropriately so as to improve prognosis.