沙美特罗联合孟鲁司特钠对小儿支气管哮喘肺功能及TNF-α、NO、ET表达的影响

Effects of salmeterol combined with montelukast sodium on pulmonary function and the expression of TNF-α,NO and ET in children with bronchial asthma

目的:探讨沙美特罗联合孟鲁司特钠对小儿支气管哮喘肺功能及肿瘤坏死因子(TNF-α)、一氧化氮(NO)、内皮素(ET)表达的影响。方法:选取2010年1月至2016年3月四川省成都市双流区第一人民医院儿科收治的支气管哮喘患儿103例,将其随机分为对照组(30例)、观察1组(35例)和观察2组(38例)。对照组采用常规抗炎、平喘等对症治疗,观察1组在对照组基础上加用沙美特罗治疗,观察2组在观察1组基础上加用孟鲁司特钠治疗。观察各组患儿治疗前、后的肺功能、生活质量(QOL)情况及TNF-α、NO、ET表达变化,随访6个月,记录哮喘复发率。结果:对照组治疗前、后1s用力呼气量(FEV1)、用力肺活量(FCV)、FEV1/FCV、最大呼气流量(PEF)比较,差异均无统计学意义(均P>0.05)。与治疗前比较,观察1组和观察2组治疗后FEV1、FCV、FEV1/FCV、PEF均有明显改善(均P<0.05),且观察1组改善情况更为显著(P<0.05)。对照组治疗前、后TNF-α、NO、ET表达水平比较,差异无统计学意义(P>0.05),观察1组和观察2组治疗后TNF-α、NO、ET表达水平均明显降低(均P<0.05),且观察2组降低更为明显(P<0.05)。对照组复发率为23.33%,观察1组为8.57%,观察2组为2.63%,组间两两比较,差异均具有统计学意义(均P<0.05)。观察1组与观察2组QOL量表各维度评分比较,差异均有统计学意义(均P<0.05)。结论:沙美特罗联合孟鲁司特钠治疗可有效改善支气管哮喘患儿的肺功能、QOL及预后,抑制TNF-α、NO、ET表达,值得临床推广应用。

Objective：To investigate the effect of salmeterol combined with montelukast sodium on pulmona- ry function and the expressions of tumor necrosis factor-α （TNF-α）, nitric oxide （NO） and endothelin （ET） in children with bronchial asthma. Metbods：A total of 103 children with bronchial asthma treated in our hospital from January 2010 to March 2016 were selected and randomly divided into three groups; con- trol group （30 cases）, observation group 1 （35 cases）, and observation group 2 （38 cases）. The patients in the control group received routine anti-inflammatory and antiasthma treatment. Patients in the observation group 1 were treated as the control group with addition of salmeterol, and those in the observation group 2 were treated as the control group with addition of salmeterol and montelukast sodium. The pulmonary function, the quality of life （QOL） and the expressions of TNF-α, NO and ET among three groups were compared before and after treatment. Results. No significant differences in 1 s force expiratory volume （FEV1）, forced vital capacity （FVC）, FEV1/FCV and peak expiratory flow （PEF） were found in the con- trol group before and after treatment （P〉0.05）. The FEV1, FCV, FEV1/FCV and PEF of patients in observation group 1 and observation group 2 were markedly improved after treatment （P〈0.05）, and the changes were more significant in observation group 1 （P〈0.05）. The expression levels of TNF-α, NO and ET were reduced in observation group 1 and 2 （P〈0.05）, and the reduction was more significant in obser- vation group 2 （P〈0.05）. The recurrence rate was 23.33% in control group, 8. 57% in observation group 1, and 2.63% in observation group 2 （P〈0.05）. There was significant difference in the recurrence rate between any of the three groups （P〈0.05）. There were statistical differences in QOL scale scores between observation group 1 and observation group 2 （P〈0. 05）. Conclusion. Salmeterol combined with montelukast sodium could improve the pulmonary function, QOL and prognosis in children with bronchial asthma, and the mechanism might be related to the down-regulation of the expressions of TNF-α, NO and ET.