匹多莫德联合孟鲁司特对咳嗽变异性哮喘患儿细胞免疫功能的影响及疗效观察

Influence and curative effect observation of Montelukast and Pidotimod on cellular immune function of children with cough variant asthma

目的探讨匹多莫德联合孟鲁司特对咳嗽变异性哮喘（CVA）患儿细胞免疫功能的影响及疗效。方法选取2013年1月~2014年4月在温州医科大学附属义乌医院儿科门诊就诊的CVA患儿84例,随机分为联合组和对照组。两组患儿均按照全球哮喘防治创议（GINA）制订的方案进行治疗。联合组患儿予以匹多莫德联合孟鲁司特,其中孟鲁司特钠咀嚼片5 mg/次,1次/d,连用3个月。匹多莫德颗粒0.4 mg/次,2次/d,2周后改为0.4 g/d,共连用3个月。对照组患儿予以单纯的孟鲁司特治疗,剂量、方法与疗程与联合组相同。观察并比较两组患儿治疗前和治疗3个月后细胞免疫功能指标的变化,并比较其临床疗效及药物不良反应情况。结果治疗3个月后,两组患儿CD4＋水平和CD4＋/CD8＋比值[（42.84±4.92）%、（1.81±0.26）、（37.82±4.52）%、（1.37±0.21）]较前[（32.87±3.93）%、（1.06±0.17）、（33.02±4.02）%、（1.08±0.19）]均有不同程度上升（t=2.87、3.58、2.29、2.45,P〈0.05或P〈0.01）,CD8＋水平[（23.72±2.95）%、（27.62±3.17）%]较前[（30.96±3.12）%、（30.48±3.42）%]均有不同程度下降（t=2.89、2.29,P〈0.05或P〈0.01）,且联合组上升或下降幅度明显大于对照组（t=2.15、2.21、2.46,均P〈0.05）;同时联合组患儿临床总有效率为95.24%,明显高于对照组的80.95%（χ2=4.09,P〈0.05）;对照组和联合组患儿治疗过程中分别发生药物不良反应3例和6例,症状均较轻微,两组患儿不良反应发生率比较差异无统计学意义（χ2=0.50,P〉0.05）。结论匹多莫德联合孟鲁司特治疗CVA患儿的效果显著,且安全性较佳,其作用机制可能与其能纠正患儿外周血T淋巴细胞亚群紊乱,上调血清CD4＋水平和CD4＋/CD8＋比值,下调CD8＋水平,激活并增强其细胞免疫功能密切相关。

Objective To discuss the influence and curative effect of Montelukast and Pidotimod on cellular immune function of children with cough variant asthma （CVA）. Methods Eighty four cases of children with CVA collected by the Yiwu Hospital Affiliated to Wenzhou Medical University from January 2013 to April 2014 were selected and divid-ed into combination group and control group at random. The children in two groups were both given the medical treat-ment in accordance with the therapeutic regimen created by Global Initiative for Asthma （GINA）. The children in com-bination group were given Pidotimod and Montelukast, Montelukast was 5 mg per time once a day for 3 months, and Pidotimod was 0.4 g per time twice a day, which was changed to 0.4 g per day for 3 months. The children in control group were only given Montelukast, the dose, method and courses were the same as the combination group. The changes of cellular immune function of children in two groups before and after 3 months＇ medical treatment were observed, and the curative effect and drug adverse reaction （DAR） were carried on as well. Results After 3 months＇ medical treatment treatment, CD4＋level and CD4＋/CD8＋ratio of peripheral blood of children in two groups [（42.84±4.92）%, （1.81±0.26）, （37.82±4.52）%, （1.37±0.21）] were obviously rose than before [（32.87±3.93）%, （1.06±0.17）, （33.02±4.02）%, （1.08±0.19）] （t =2.87, 3.58, 2.29, 2.45, P〈0.05 or P〈0.01）, while CD8＋level [（23.72±2.95）%, （27.62±3.17）%] were obviously de-clined than before [（30.96±3.12）%, （30.48±3.42）%] （t = 2.89, 2.29, P〈 0.05 or P〈 0.01）, and the rising or declining rate of children in combination group was much higher than that in control group （t = 2.15, 2.21, 2.46, all P〈 0.05）. Meanwhile, the total clinical efficiency of children in combination group was 95.24%, which was much higher than that in control group （80.95%） （χ2=4.09, P〈 0.05）. 3 and 6 cases of DAR were appeared in control group and combination group respectively with light symptom during treatment, compared with the DAR occurrence rates in two groups, no statistical difference was appeared （χ2=0.50, P〉0.05）. Conclusion Montelukast and Pidotimod has reliable curative ef-fect on children with CVA with high security, whose mechanism of action has close effect on adjusting the disorder of peripheral blood T lymphocyte subsets, increasing the CD4＋level and CD4＋/CD8＋ratio, decreasing the CD8＋level and improve the cellular immune function of the body.