孟鲁司特钠治疗慢性阻塞性肺疾病122例临床疗效观察

Observation on the effect of montelukast in treating 122 cases of chronic obstructive pulmonary disease

目的探讨孟鲁司特钠治疗COPD的临床疗效。方法将122例COPD患者随机分为对照组和观察组，各61例。对照组采用抗感染、氧疗、祛痰、支气管舒张剂等常规治疗，观察组在对照组的基础上加用孟鲁司特钠10mg，每晚睡前服用，疗程为4周。测定和分析治疗前和治疗4周后患者的肺功能、血气分析指标。ELISA法检测血清细胞因子肿瘤坏死因子α（TNF—α）、IL-8及基质金属蛋白酶9（MMP9）的水平，并对治疗4周后2组临床疗效进行比较。结果治疗前2组患者的肺功能（FEV1％ pred、FEV1／FVC、MVV％pred），血气分析（PaO2、PaCO2）及血清细胞因子（TNF-a、IL-8，MMP-9）的差异无统计学意义（P〉0．05）。治疗4周后，FEV1％pred[（80．3±15．8）％vs（71．3±18．5）％]，FEV1／FVC[（86．2±9．8）％vs（67．3±16．6）％]，MVV％pred[（49．3±13．9）％vs（42．1±12．3）％]和PaO2[（83．3±4．9）mmHg vs（76．1±4．5）mmHg]观察组明显高于对照组。PaCO2[（53．3±6．23）mmHg vs （61．3±5．32）mmHg]，血清细胞因子TNF-α[（25．2±6．3）ng／L vs （33．1±8．5）ng／L]，IL-8[（53．6±11．5）ng／L vs（66．5±131）ng／L]及MMP-9[（38．9±12．3）ng／L vs（46．6±13．2）ng／L]观察组的含量明显低于对照。观察组的总有效率（96．72％）明显高于对照组的总有效率（86．89％），2组比较差异有统计学意义（P〈0．05）。结论孟鲁司特钠能有效减轻COPD患者的炎症症状，改善肺功能，疗效显著，值得在临床上推广。

Objective To investigate the effect of montelukast in treatment of chronic obstructive pulmonary disease （COPD） clinical efficacy. Methods One hundred and twenty-two patients with COPD were randomly divided into the control group （61 cases） and the observation group （61 cases）. The control group was treated with conventional treatment of anti-infective, oxygen therapy, expectorant, bronchodilator agents, while the observation group was given with add on 10 mg montelukast orally quaque nocte for 4 weeks on the basis of the treatment of control group. The lung function and blood gas analysis of all patients were examined before and after the 4 week treatment. The content of serum TNF-α, IL-8 and MMP-9 were detected by ELISA. The clinical efficacy of the two groups were compared after 4 weeks of treatment. Results Before treatment, the pulmonary function （FEV1% pred, FEV1/FVC, MVV%pred）,blood gas analysis （PaO2,PaCO2） and serum （TNF-α,IL-8,MMP-9） between the two groups were not statistically different （ P〉0.05）. After 4 weeks of treatment, the FEV1% pred [（80.3±15.8）% vs （71.3±18.5）%],FEV1/FVC [（86.2±9.8）% vs （67.3±16.6）%],MVV%pred E（49.3±13.9）% vs （42.1±12.3）%] and PaO2 [（83. 3±4. 9） mmHg vs （76.1±4.5） mmHg] in the observation group were significantly higher than that in the control group. The PaCO2 E（53.3±6.23） mmHg vs （61.3±5.32） mmHg] ,serum TNF-α [（25.2±6.3） ng/L vs （33.1±8.5） ng/L] ,IL-8 [（53.6±11.5） ng/l. vs （66.5±13.1） ng/L] and MMP-9 [（38.9±12.3） ng/L vs （46.6±13.2） ng/L] in the observation group were significantly lower than that in the control group. The total effective rate in observation group （96.72%） was significantly higher than that in control group （86.89%）, which shows statistical difference between the two groups （ P〈0.05）. Conclusions The montelukast can effectively reduce the inflammatory symptoms of COPD, and improve the lung function. The obvious efficacy proves the application worthy of the montelukast in clinical practice.