孟鲁司特钠联合糖皮质激素对中重度哮喘患儿肺功能影响及协同抗炎作用

Synergistic Anti-inflammatory Effects of Montelukast Sodium and Glucocorticoids in the Treatment of Moderate or Severe Asthma in Children and its Influence on Pulmonary Function

目的:观察孟鲁司特钠联合糖皮质激素对中重度哮喘患儿肺功能影响及协同抗炎作用,探讨其临床作用机制。方法:将符合入选标准的70例中重度哮喘患儿按随机数字表法分为观察组35例和对照组35例。两组患儿急性期均给予常规方法治疗,对照组同时给予布地奈德100~200μg/d雾化吸入治疗,观察组给予孟鲁司特钠每晚5 mg口服联合布地奈德100~200μg/d雾化吸入治疗,疗程均为3个月。观察两组患儿治疗前后症状改善情况,并检测肺功能,采用IRMA法检测血浆lgE水平,常规方法测定血嗜酸粒细胞(EOS)计数,ELISA法测定血清IL-4、IL-5、IL-10、IL-25水平,并进行临床疗效评判。结果:①观察组和对照组治疗后FEV1%、FEF50%、FEF25%、PEF%均明显升高,但治疗后观察组FEV1%、FEF50%、FEF25%、PEF%均明显高于对照组,两组比较差异具有统计学意义;②观察组和对照组治疗后IL-4、IL-5、IL-10、IL-25、IgE水平和EOS计数均显著改善,但观察组IL-4、IL-5、IL-25、IgE水平和EOS计数明显低于对照组,IL-10水平明显高于对照组,两组比较差异具有统计学意义(P<0.05);③观察组和对照组的总有效率分别为91.43%和80.00%,两组比较差异有统计学意义(χ2=16.62,P<0.01)。结论:孟鲁司特钠联合糖皮质激素治疗中重度哮喘疗效确切,能够明显改善患儿肺功能,通过不同途径协同抑制气道炎症,明显降低患儿的气道高反应性,是治疗中重度哮喘的理想方法。

Objective： To observe synergistic anti-inflammatory effects of montelukast sodium and glucocorticoids in the treatment of moderate or severe asthma in children and its influence on pulmonary function, and to explore the mechanism. Methods： Seventy children with moderate or severe asthma met the inclusion criteria were randomly divided into an observation group and a control group equally. Both groups were all given conventional therapy. The control group was given budesonide inhalation 100 -200 ixg/d; the observation group was given montelukast 5 mg orally every evening and budesonide inhalation 100 ~ 200 p^g/d. Both groups had been treated for three months. The symptoms were observed. Pulmonary function, serum IL-4, IL-5, IL-10, and IL-25 was detected. Serum IgE was detected by IRMA, and blood eosinophil count （EOS） was detected by conventional methods. Clinical efficacy was evaluated. Results： （~） FEVI%, FEFS0%, FEF25% and PEF% of the observation group and the control group after treatment were significantly higher than those before treatment, but FEVI% , FEFS0%, FEF25% and PEF% of the observation group were significantly higher than those of the control group; the difference was statistically significant. （~） IL-4, IL-5, IL-10, IL-25, IgE and EOS of the observation group and the control group after treatment were significantly improved, but L-4, IL-5, IL-25, IgE and EOS of the observation group were significantly lower than those of the control group; IL-10 of the observation group was significantly higher than that of the control group; the difference was statistically significant. （~） The total effective rate of the observation group and the control group were 91.43% vs 80.00% ; there were a statistically significant difference （X2 = 16.62, P〈0.01 ）. Conclusions： The therapy containing montelukast sodium and glucocorticoids has exact efficacy in the treatment of children with moderate or severe asthma. It can significantly improve lung function, inhibit airway inflammation by different ways, and significantly reduce airway hyperresponsiveness, and is an ideal method in the treatment of moderate or severe asthma.