氟替卡松联合孟鲁司特钠对儿童支气管哮喘肺功能及细胞因子的影响

Effect of Fluticasone Combine with Montelukast on Lung Function and Cytokines of Children with Bronchial Asthma

目的 探讨氟替卡松联合孟鲁司特钠对儿童支气管哮喘肺功能及细胞因子的影响。方法选择2013年7月至2015年7月在安康市中心医院治疗的120例哮喘患儿,采用随机数字表法将患儿分为联合治疗组和氟替卡松组,每组60例。氟替卡松组患儿给予氟替卡松气雾剂治疗（〈4岁儿童每次50~100μg,每日2次;≥4岁儿童用量控制在500μg以下）,联合治疗组在氟替卡松组治疗的基础上加用孟鲁司特钠治疗（口服,每次4 mg,每日1次）。两组患儿均治疗90 d。比较两组患儿的临床疗效以及治疗前后肺功能、哮喘症状评分、血清白细胞介素4（IL-4）、IL-6、IL-8、肿瘤坏死因子α（TNF-α）以及免疫球蛋白E（Ig E）水平。结果 联合治疗组的总有效率显著高于氟替卡松组[93.3%（56/60）比76.7%（46/60）]（P〈0.05）。治疗后,联合治疗组用力肺活量（FVC）、第1秒用力呼气量（FEV1）以及最大呼气流量占预计值百分比（PEF%）显著高于氟替卡松组[（2.9±0.4）L比（2.4±0.3）L,（2.9±0.6）L比（2.3±0.6）L,（89.9±10.3）%比（81.6±11.1）%]（P〈0.05）;日间、夜间症状评分以及血清IL-4、IL-6,IL-8,TNF-α、Ig E水平显著低于氟替卡松组[（1.14±0.2）分比（2.04±0.4）分,（1.7±0.3）分比（2.8±0.5）分,（19.4±1.8）pg/L比（7.6±0.4）pg/L,（117.5±14.3）ng/L比（192.4±19.4）ng/L,（317.3±19.4）pg/L比（814.4±24.5）pg/L,（0.7±0.1）ng/L比（1.0±0.1）ng/L,（124.3±31.3）k U/L比（173.4±28.4）k U/L]（P〈0.05）。结论氟替卡松联合孟鲁司特钠治疗儿童支气管哮喘的疗效显著优于单用氟替卡松,其能改善患儿的肺功能,改善日间及夜间症状评分,降低机体IL-4、IL-6、IL-8、TNF-α和Ig E水平,抑制炎症反应程度。

Objective To explore the effect of fluticasone combined with montelukast on lung function and eytokines of children with bronchial asthma. Methods Total of 120 children with asthma treated in Ankang Central Hospital from Jul. 2013 to Jul. 2015 were included in the study and divided into a combined treatment group and a fluticasone group according to the random number method,60 patients each. The fluti- casone group was treated with fluticasone propionate aerosol,the dosages were 50-100 μg per time,2 times per day for children below 4 years old, and the dosage was controlled less than 500 μg for children ≥4 years old. The combined treatment group was added with montelukast （ 4 mg per time, 1 time per day, orally）. Both of the groups were treated for 90 days. After treatment, the curative effect was compared, and the pulmonary function,scores of symptoms of asthma,interleukin-4 （IL-4） , IL-6, IL-8, tumor necrosis factor-α （TNF-α） and immunoglobulin E （IgE） of the two groups were detected before and after treatment. RestlltS The total effective rate of the combined treatment group was significantly higher than the fluticasone greup[93.3% （ 56/60 ） vs 76. 7 % （ 46/60 ）, P 〈 0. 05 ]. After treatment, the forced vital capacity （ FVC ）, forced expiratory volume in 1 second （ FEV1 ）, the prediction percentage of peak expiratory flow （ PEF% ） of the combined treatment group were significantly higher than the fluticasone group [ （2. 9 ±0. 4） L vs （2. 4± 0.3 ） L, （2. 9±0. 6） L vs （2. 3±0. 6） L, （89.9 ± 10. 3 ） % vs （81.6 ± 11.1 ） % ,P 〈 0. 05 ]. After treatment,the daytime and nighttime scores of asthma symptoms, the levels of IL-4, IL-6, IL-8, T TNF-a and IgE of the combined treatment group were significantly lower than those in fluticasone group[ （ 1. 14 ±0. 2 ） scores vs （2.04±0.4） scores,（1.7±0.3） scores vs （2.8±0.5） scores,（7.6 ±0.4） pg/L vs （19.4±1.8） pg/L, （117.5±14.3） ng/L vs （192.4±19.4） ng/L,（317.3 ±19.4） pg/L vs （814.4 ±24.5） pg/L,（0.7 ±0.1） ng/Lvs （1.0 ±0.1） ng/L,（124.3 ±31.3） kU/L vs （173.4 ±28.4） kU/L] （P〈0.05）. Condusion The effect of fluticasone combined with montehikast is better than fluticasone alone, which can improve the lung function and daytime and nighttime symptom scores, decrease IL-4, IL-6, IL-8, TNF-α and IgE levels, and inhibit the inflammation degree.