孟鲁司特对咳嗽变异性哮喘患者超敏C反应蛋白、白介素4和肿瘤坏死因子-α水平的影响及疗效观察

Influence and curative effect observation of Montelukast on high -sensitivity C-reactive protein, interleukin-4 and tumor necrosis factor-α levels of cough variant asthma patients

目的 探讨孟鲁司特对咳嗽变异性哮喘患者血清超敏C反应蛋白（hs-CRP）、白介素（IL）-4和肿瘤坏死因子（TNF）-α水平的影响及疗效观察.方法 选择2012年2月～2013年2月台州市中西医结合医院的咳嗽变异性哮喘患者68例,随机分为孟鲁司特组和对照组.两组患者均予以沙美特罗/丙酸氟替卡松吸入,1吸/次,2次/d.孟鲁司特组加用孟鲁司特咀嚼片10 mg,1次/d,口服,连用12周.观察两组患者治疗前后血清hs-CRP、IL-4和TNF-α水平的变化,并进行临床疗效及不良反应观察.结果 治疗12周后,两组患者血清hs-CRP、IL-4和TNF-α水平较前均有明显下降（t=3.16、3.57、2.87、2.27、2.43、1.35,P＜0.01或P＜0.05）,且孟鲁司特组下降的幅度均较对照组更明显（t=2.35、2.39、2.15,μ＜0.05）；同时孟鲁司特组的临床总有效率（94.12％）明显高于对照组（76.47％）（x2=4.22,P＜0.05）；对照组和孟鲁司特组治疗中分别出现不良反应2例（5.88％）和5例（14.71％）,症状均较轻,未发生严重药物不良反应.两组药物不良反应发生率比较差异无统计学意义（x2=0.64,P＞0.05）.结论 孟鲁司特治疗咳嗽变异性哮喘具有较好的疗效及安全性,作用与降低hs-CRP、IL-4和TNF-α水平、抑制气道慢性炎症密切相关.

Objective To discuss the influence and curative effect observation of Montelukast on high-sensitivity C- reactive protein （hs-CRP）, interleukin-4 （IL-4） and tumor necrosis factor-α （TNF-α） levels of cough variant asthma patients. Methods 68 cases of cough variant asthma patients from February 2012 to February 2013 collected by Taizhou Integration of Traditional and Western Medicine Hospital were selected and divided into Montelukast group and control group. The patients in two groups were given the inhibition of Salmeterol/Fluticasone Propionate one suc- tion per time, for 2 times daily. The patients in Montelukast group were given 10 mg Montelukast dulcets through the mouth one time daily for 12 weeks. The changes of serum hs-CRP, IL-4 and TNF-α levels of patients in two groups before and after medical treatment were observed, and the clinical curative effect and untoward effect observation were carried on as well. Results After 12 weeks＂ medical treatment, the serum hs-CRP, IL-4 and TNF-α levels of patients in two groups declined obviously than before （t = 3.16, 3.57, 2.87, 2.27, 2.43, 1.35, P 〈 0.01 or P 〈 0.05）, and the de- clining rate in Montelukast group was much higher than that in control group （t = 2.35, 2.39, 2.15, P 〈 0.05）. Mean- while, the total clinical efficiency in Montelukast group （94.12%） was much higher than that in control group （76.47%） （X2=4.22, P 〈 0.05）. 2 and 5 cases of untoward effect appeared in control group （5.88%） and Montelukast group （14.71%） respectively with light symptom but not serious drug adverse reaction （DAR）. After comparing the DAR oc- currence rates in two groups, there was no statistically significant difference （X2=0.64,P 〉 0.05）.. Conclusion Mon- telukast has reliable clinical curative effect on cough variant asthma patients with security, whose mechanism of action has close effect on reducing the hs-CRP, IL-d and TNF-α levels, and the inhibition of airway inflammation.