白细胞三烯C4在慢性阻塞性肺疾病急性加重期作用及孟鲁司特治疗效果观察

Role of leukotrienes C4 in acute exacerbation of chronic obstructive pulmonary disease and effect of montelukast

目的探讨白细胞三烯C4(leukotrienes C4,LTC4)与慢性阻塞性肺疾病急性加重期的相关性及孟鲁司特干预治疗的效果。方法 80例慢性阻塞性肺疾病急性加重期患者,随机分为对照组和治疗组各40例,对照组仅行氧疗、抗感染、平喘祛痰等常规治疗,治疗组在常规治疗基础上加用孟鲁司特10mg,1次/d;2组疗程均10d。分别于治疗前、后测定患者血清LTC4水平及第1秒用力呼气容积占预计值的百分比(the percentage of the forced expiratory volume in one second to the predicted value,FEV1%),并进行比较。结果治疗前2组LTC4、FEV1%比较差异无统计学意义(P>0.05);治疗后治疗组LTC4、FEV1%分别为(306.0±176.3)ng/L、66.0±7.4,对照组分别为(489.6±325.2)ng/L、58.9±8.1,与治疗前(治疗组(504.8±339.3)ng/L、51.2±8.4,对照组(519.4±336.3)ng/L、50.4±7.9)比较差异有统计学意义(P<0.05),且治疗组以上指标改善较对照组明显(P<0.05);治疗组FEV1%改善与LTC4下降呈负相关(r=-0.844)。结论慢性阻塞性肺疾病急性加重期患者血清LTC4水平下降与肺功能改善呈负相关,孟鲁司特对患者病情及肺功能的改善作用可能与降低血清LTC4水平有关。

Objective To analyze the relationship between leukotriene C4（LTC4）and acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and to explore the effect of montelukast.Methods Eighty patients with AECOPD were randomly divided into treatment group and control group,with 40 patients in each group.Control group received routine therapy as oxygen therapy,anti-infection,anti-asthma and expelling phlegm for ten days.Treatment group received 10 mg montelukast once a day for ten days besides the above routine therapy in control group.The level of LTC4 and the percentage of the forced expiratory volume in one second to the predicted value（FEV1%）were measured and compared before and after treatment between two groups.Results The level of LTC4 and FEV1% were（504.8±339.3）ng/L and 51.2±8.4in treatment group,and（519.4±336.3）ng/L and 50.4±7.9in control group before treatment,significantly different from those after treatment（（306.0±176.3）ng/L,66.0±7.4;（489.6±325.2）ng/L,58.9±8.1）（P〈0.05）.LTC4 and FEV1% were improved more obviously in treatment group than in control group（P〉0.05）,and there were no significant differences before treatment between two groups（P 〈0.05）.FEV1% was negatively correlated with LTC4 level in treatment group（r=-0.844）.Conclusion The decreased LTC4 level is negatively correlated with pulmonary function improvement in patients with AECOPD.Montelukast improves pulmonary function by decreasing LTC4 level.