Abstract: Objective　To explore the clinical effect of inhaled salmeterol/fluticasone propionate combined with budesonide in the treatment of asthma, and analyze its influence on serum interleukin-21 (IL-21) and IL-18 levels. Methods　A total of 86 patients with bronchial asthma who were admitted to Haiyang People's Hospital from January 2020 to December 2021 were selected. They were randomly divided into an observation group (47 cases) and a control group (39 cases) by the coin flipping method. There were 22 males and 25 females in the observation group, aged (43.48±5.57) years; there were 25 males and 14 females in the control group, aged (44.39±6.01) years. All patients underwent conventional symptomatic treatment. On this basis, the patients in the control group were treated with inhaled salmeterol/fluticasone propionate, and the patients in the observation group were treated with inhaled salmeterol/fluticasone propionate combined with budesonide. The two groups were compared in terms of clinical effect, clinical symptom improvement time, and changes in pulmonary function and serum IL-21 and IL-18 levels. The recurrence of asthma within 3 months after treatment and adverse reactions during treatment were recorded. t test was used for the measurement data and χ² test was used for the count data. Results　The total effective rate of the observation group was 91.49% (43/47), which was higher than that of the control group [71.79% (28/39)] (P<0.05). After treatment, the clinical symptom improvement time in the observation group was shorter than that in the control group (P<0.05), the forced expiratory volume in 1 second (FEV₁), FEV₁/ forced vital capacity (FVC), and peak expiratory flow (PEF) levels were higher than those in the control group (all P<0.05), the serum IL-21 and IL-18 levels were lower than those in the control group (both P<0.05). The recurrence rate of asthma in the observation group was 6.38% (3/47), significantly lower than that in the control group [23.08% (9/39)] (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions　Inhaled salmeterol/fluticasone propionate combined with budesonide can significantly improve the clinical symptoms and lung function in asthmatic patients, with a low recurrence rate and good safety. The mechanism may be related to regulation of serum IL-21 and IL-18 levels.

Key words: Bronchial asthma, Inhaled salmeterol/fluticasone propionate, Budesonide, Interleukin-21, Interleukin-18, Clinical effect

摘要： 目的　探究沙美特罗替卡松吸入剂联合布地奈德治疗哮喘的临床疗效，分析对患者血清白细胞介素-21（IL-21）、IL-18水平的影响。方法　选取2020年1月至2021年12月于海阳市人民医院接受治疗的86例支气管哮喘患者，采用抛硬币法进行随机分组，分为观察组（47例）和对照组（39例）。观察组男22例，女25例，年龄（43.48±5.57）岁；对照组男25例，女14例，年龄（44.39±6.01）岁。所有患者均接受常规对症治疗，在此基础上对照组采用沙美特罗替卡松吸入剂治疗，观察组采用沙美特罗替卡松吸入剂联合布地奈德治疗。比较两组患者临床疗效、临床症状改善时间，治疗前后肺功能及血清IL-21、IL-18水平变化，记录患者治疗后3个月的哮喘复发情况及治疗期间不良反应发生情况。计量资料行t检验，计数资料行χ²检验。结果　观察组的治疗总有效率为91.49%（43/47），高于对照组的71.79%（28/39）（P<0.05）。治疗后，观察组的临床症状改善时间均短于对照组（均P<0.05），第1秒用力呼气量（FEV₁）、FEV₁/用力肺活量（FVC）和最大呼气流速（PEF）水平高于对照组（均P<0.05），血清IL-21、IL-18水平低于对照组（均P<0.05）。观察组的哮喘复发率为6.38%（3/47）明显低于对照组的23.08%（9/39）（P<0.05）；两组患者的不良反应发生率比较，差异无统计学意义（P>0.05）。结论　沙美特罗替卡松吸入剂联合布地奈德治疗可明显改善哮喘患者的临床症状，提高患者肺功能，且复发率低，临床疗效可靠，安全性较好，其机制可能与调节血清IL-21、IL-18水平有关。

关键词: 支气管哮喘, 沙美特罗替卡松吸入剂, 布地奈德, 白细胞介素-21, 白细胞介素-18, 临床疗效