布地奈德/福莫特罗和孟鲁司特对咳嗽变异性哮喘的疗效观察

Comparison of the efficacy between budesonide/formoterol and montelukast for treating cough variant asthma

目的探讨布地奈德/福莫特罗和白三烯受体拮抗剂(孟鲁司特)分别对咳嗽变异性哮喘(CVA)患者的疗效,为目前CVA的治疗提供更合理、更个体化的治疗方案。方法选取2012年3月至2013年7月在东莞康华医院呼吸内科门诊初次确诊为CVA且符合入组标准的69例患者为研究对象,采用随机数字表法将69例CVA患者分为A组35例(布地奈德/福莫特罗组,给予160/4.5μg/吸,1吸/次,2次/d),B组34例(孟鲁司特组,10 mg/次,口服,1次/d)。治疗1月后进行疗效评价,治疗显效的患者维持原方案治疗至疗程满3个月;治疗效果欠佳的患者改为两药的联合治疗,总疗程3个月,治疗结束后随访6个月。用SPSS 17.0软件对数据进行t检验、χ2检验和秩和检验。结果 A组咳嗽症状完全缓解比例(85.2%)高于B组(54.2%),差异有统计学意义(P<0.05);两组痰嗜酸性粒细胞(EOS)百分比均明显下降:A组由2.63%±1.79%下降至0.59%±0.72%,B组由2.56%±1.84%下降至0.67%±0.76%,差异均有统计学意义(P<0.01);A组PD20-FEV1(第1秒用力呼气量较基础值下降20%时吸入组胺的累积量)治疗后[(5.03±2.94)μmol]较治疗前[(3.37±3.01)μmol]明显升高,差异有统计学意义(P<0.05),而B组无明显变化[分别为(2.83±2.93)、(3.03±2.98)μmol];A组支气管激发试验阴转率为18.5%,B组为8.3%。随访6个月A组复发率为25.9%,B组为33.3%,差异无统计学意义(P>0.05)。联合治疗的有效率为84.6%,支气管激发试验阴转率为18.2%,随访6个月复发率为15.4%。结论 CVA患者给予2种药物3个月的疗程均能有效地改善咳嗽症状,布地奈德/福莫特罗镇咳及降低气道高反应性的作用优于白三烯受体拮抗剂,部分患者需要两药联合治疗才能获得更好的疗效。

Objective To explore the effectiveness of budesonide/formoterol and montelukast for treating cough variant asthma （CVA）, and to provide the reasonable and individualized therapy protocol for CVA. Methods Sixty-nine patients with newly diagnosed CVA during March of 2012 to July of 2013 in Kanghua hospital served as the subjects, the subjects were randomly divided into A group （35 cases ） with budesonide/formoterol （160/4.5 p^g, bid ） and B group （34 cases） with oral montelukast （10 rag, qd）. After treatment for one month, the efficacy of two groups was assessed. The patients with good response continued to use the same therapy protocol for 2 months. The patients with worse response would use the combination of two medications for 2 months. Total course was 3 months. All patients were followed up for 6 months after treatment. Results The rate （85.2%） of complete remission of cough in A group was higher than that （54.2%） in B group （P〈0.05）. The rates （2.63%± 1.79% and 2.56% ±1.84%） of sputum eosinophil （EOS） significantly reduced to 0.59%±0.72% and 0.67%±0.76% （P〈0.01）. The PD20-FEV1 （3.37±3.01 μmol） in A group significantly enhanced to （5.03±2.94） μmol （P〈0.05）. But the PD20-FEVI in B group did not significantly improve （P〉0.05）. The negative conversion rates of bronchial provocation test （BPT） in A and B groups were 18.5% and 8.3%, respectively. The relapse rates after following-up for 6 months in A and B groups were 25.9% and 33.3%, respectively. There were no significant differences between two groups （P〉0.05）. The efficacy rate, negative conversion rate and relapse rates after following-up for 6 months for combinative therapy were 84.6%, 18.2% and 15.4%, respectively. Conclusion In patients with CVA, three months of treatment with budesonide/formoterol or montelukast could effectively reduce cough symptoms; but the antitussive effect and in decreasing airway hyper-responsiveness effect in A group are better than those in B group. The combinative therapy has better efficacy for some patients.