氯雷他定对儿童支气管哮喘并变应性鼻炎的防治作用及其机制的研究

Effects of Loratadine and Inhale Corticosteroids on Asthmatic Children with Allergic Rhinitis

目的探讨小剂量吸入激素的基础上联合应用氯雷他定对儿童支气管哮喘并变应性鼻炎的防治作用及其机制。方法将62例支气管哮喘并变应性鼻炎患儿分为氯雷他定组(32例)和对照组(30例),在丙酸氟替卡松气雾剂治疗基础上分别加用氯雷他定和安慰剂治疗3个月。记录患儿的哮喘症状评分、变应性鼻炎发作时间、感冒样症状发作次数、喘鸣发作次数、β2-受体激动剂的用量,并测定血清可溶性细胞间黏附分子(sICAM-1)浓度。结果两组患儿治疗后的哮喘症状、变应性鼻炎发作时间、哮喘发作次数、感冒样症状发作次数、β2-受体激动剂用量间差异均有统计学意义(P<0.05);治疗前两组患儿的血清sICAM-1浓度间差异无统计学意义(P>0.05),而治疗后血清sICAMI-1浓度间差异有统计学意义(P<0.05)。结论在小剂量吸入激素的基础上联合应用氯雷他定能显著改善支气管哮喘并变应性鼻炎患儿的症状,降低血清sICAM-1浓度可能是其机制之一。

Objective To evaluate the therapeutic effects of Loratadine in combination with low dose inhaled cortieo- steroid on allergic asthma. Methods 67 children with mild to moderate allergic asthma were randomized to receive either Lorata- dine or placebo on the basis of inhaled Fluticasone propionate for 3 months. Symptom scores of asthma, frequencies of episode of rhinitis ~ common cold~ frequencies of episode of wheeze and doses of inhaled Ventolin as rescue drug were recorded. Serum sI- CAM - 1 were measured before and after treatment. Results After treatment, there was much better improvement in symptom score, frequencies of episode of rhinitis, common cold, frequencies of episode of wheeze, doses of inhaled Ventolin in Lorata- dine group as compared with the control group （P 〈 0. 05 ）. There was no change in serum sICAmI - 1 levels before treatment （P 〉 0. 05 ） However, there was a significant change in serum sICAM - 1 levels after treatment in Loratadine group （P 〈 0. 05 ）. Conclusion On the basis of inhale corticosteroids, orally administered Loratadine significantly improves the therapeutic efficacy of asthma in children with allergic asthma and rhinitis. One of the mechanisms of Loratadine is to reduce the expression of sICAM - 1.