哮喘患者白三烯代谢水平与抗白三烯治疗反应的关系

Relationship between cysteinyl leukotriene metabolism and clinical response to antileukotriene treatment

目的探讨哮喘患者白三烯代谢水平与抗白三烯治疗临床反应的关系,为选择用药提供指导。方法对2003-12～2004-12武汉大学人民医院呼吸内科收治的91例急性期轻中度哮喘患者进行4周孟鲁司特治疗试验。观察用药前后症状积分、β2受体激动剂用量、末梢血嗜酸粒细胞(Eos)分类计数、血清IgE、肺功能、尿白三烯E4(uLTE4)的变化。Logistic回归分析检验临床参数与治疗反应的相关性。结果最终完成治疗试验78例,其中48例有明显临床改善(有效组);30例无明显改善(无效组)。有效组患者uLTE4质量浓度明显高于无效组(P<0.05),而Eos%、血清IgE、肺功能差异均无统计学意义(P>0.05)。uLTE4质量浓度≥1200pg/mL的患者达到有效临床反应的概率是uLTE4质量浓度<1200pg/mL患者的11.5倍(95%可信区间2.3～55.8)。结论uLTE4浓度与抗白三烯治疗临床反应密切相关,可以作为选择用药的标志物。

Objective To investigate the relationship between cysteinyl leukotriene and clinical response to antileukotriene treatment, and to help select a clinical pharmacolog/c scheme. Methods Seventy -eight cases with acute mild - moderate asthma were treated with montelukast in a four - week trial. Asthmatic symptom score, usage of β2 receptor agonist, percentage of eosinophil, serumal IgE concentration, spirometry and urinary leukotriene E4 （ uLTE4 ） were measured pre - and post - treatment. Logistic analysis was used to access the various clinical parameters correlated with the response to montelukast. Results There were 48 responders and 30 nonresponders. The uLTE4 level from the responders was higher than that of nonresponders （ P 〈 0. 05 ） . There was a significant correlation between the clinical response and uLTE4 level, but not demographic features, percentage of eosinophils, serumal IgE concentration, or spirometry （P 〉 0. 05 ） . Subjects with a uLTE4 level of ≥ 1 200 pg/mL werel 1.5 times more likely to respond to montelukast than those with 〈 1 200 pg/mL （95% confidence interval, 2.3 - 55.8） . Conclusion The uLTE4 level is closely correlated with antileukotriene treatment. Urinary LTE4 is a good biomarker for selecting a clinical pharmacologic scheme.