孟鲁司特治疗哮喘患者白三烯代谢水平的变化

Clinical Response of Leukotriene to Montelukast Treatment in Patients with Asthma

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。方法对2004年6月-2007年6月我院呼吸内科收治的62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51例,其中32例有明显临床改善(有效组);19例无明显改善(无效组)。有效组患者治疗前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10.8倍(95%可信区间2.5～53.8)。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 leukotriene and clinical re- sponse to antileukotriene treatment in patients with asthma. Methods Total 51 cases with acute mild -moderate asthma were treated with Montelukast in a fourweek trial. Asthmatic symptom score, us- age of {32 receptor agonist, percentage of eosinophil, serum IgE concentration, pulmonary function and u- rinary leukotriene E4 （uLTE4） level 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 32 responders and 19 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, serum IgE concentration, or pulmonary function（ P 〉0. 05）. Subjects with a uLTE4 level of ≥ 1 200pg/ml were 10. 8 times more likely to respond to Montelukast than those with 〈 1 200pg/ml （95% confidence interval, 2.5 53.8）. Conclusion The uLTE4 level is closely correlated with antileukotriene treatment. Urinary LTE4 is a good biomarker for selecting a clinical pharmacologic scheme.