孟鲁司特对儿童过敏性紫癜Toll样受体表达的影响及临床疗效观察

The Clinical Effect and the Expressions of Toll-like Receptors in Children with Henoch-Schonlein Purpura Treated by Montelukast

目的：探讨孟鲁司特对儿童过敏性紫癜Toll样受体表达的影响及临床疗效。方法：将86例过敏性紫癜（HSP）患儿,按照随机数字法分为治疗组和对照组各43例。对照组采用常规综合治疗,治疗组在对照组治疗基础上加用孟鲁司特,2-6岁4 mg/d,〉6岁-14岁5 mg/d,每日一次,睡前服用。比较两组患儿的临床疗效并观察皮疹消退、腹痛缓解及关节肿痛缓解时间;实时荧光定量PCR技术检测外周血单核细胞中TLR2、TLR5及TLR9 mRNA的基因相对表达量,ELISA检测患者血清中IL-6和IL-8浓度。结果：（1）治疗组总有效率97.7%,明显高于对照组的81.4%（P〈0.05）,治疗组患儿的皮疹消退、腹痛缓解及关节肿痛缓解时间均显著短于对照组（P〈0.05）;（2）治疗组和对照组治疗后与治疗前比较,外周血单核细胞TLR2、TLR5及TLR9mRNA相对表达量均显著降低（P〈0.05）,且治疗后观察组外周血单核细胞TLR2、TLR5及TLR9 mRNA相对表达量均明显低于对照组（P〈0.05）;（3）两组过敏性紫癜患儿治疗后血清中IL-6和IL-8的表达均明显低于治疗前（P〈0.05）,且治疗后观察组血清中IL-6和IL-8的表达明显低于对照组（P〈0.05）。结论：孟鲁司特治疗儿童HSP临床疗效显著,TLR2、TLR5及TLR9活化可能参与了HSP的免疫发病机制,孟鲁司特能影响Toll样受体（TLR2、TLR5及TLR9）以及IL-6和IL-8的蛋白表达,对儿童HSP的治疗发挥积极作用。

Objective： To investigate the clinical effect of montelukast treatment in children with Henoch-Sch？nlein purpura and the expression of Toll-like receptor. Methods： Eighty-six cases of children with Henoch-Sch？nlein purpura were randomly divided into treatment group and control group. Forty three cases of control group were preformed with routine comprehensive treatment. On this basis,43 cases in the treatment group were preformed with montelukast sodium orally,2 - 6 years old took 4 mg a time,6 - 14 years old took 5 mg a time,once every night before going to bed. The effects of the two groups were observed and compared. The time of deflorescence,remission time of abdominal pain,joint swelling and pain were observed. The expression of TLR2,TLR5 and TLR9 mRNA were detected by real-time fluorescence quantitative PCR detection in peripheral blood mononuclear cells. The levels of IL-6 and IL-8 were detected by ELISA. Results：（ 1） Total effective rate in the treatment group was 97. 7%,control group was 81. 4%,there was significant difference between the two groups（ P 0. 05）. The time of deflorescence,remission time of abdominal pain,joint swelling and pain in the treatment group were significantly shorter than those in the control group. There were significant differences between the two groups（ P〈0. 05）.（ 2） The expressions of TLR2,TLR5 and TLR9 mRNA were lower than those in both groups before treatment. The expression of TLR2,TLR5 and TLR9 mRNA in the treatment group were significantly lower than those in the control group after treatment（ P〈0. 05）.（ 3） The levels of IL-6 and IL-8 in serum were lower than those in both groups before treatment. The levels of IL-6 and IL-8 in serum in the treatment group were significantly lower than those in the control group after treatment（ P〈0. 05）. Conclusion： Montelukast sodium in treating children with Henoch-Sch？nlein purpura has definite effects. The TLR2,TLR5 and TLR9 may be involved in the pathogenesis of of Henoch-Sch？nlein purpura,montelukast can affect the expression of toll-like receptors（ TLR2,TLR5 and TLR9）,IL-6 and IL-8. It can quickly relieve symptoms,shorten the course of disease,and is worthy of clinical use.