孟鲁司特钠治疗儿童呼吸道合胞病毒感染毛细支气管炎的疗效及对炎症标志物的影响

Effect of montelukast on treatment of children with bronchiolitis induced by respiratory syncytial virus and influence on inflammatory markers

目的分析应用孟鲁司特钠治疗呼吸道合胞病毒(RSV)感染的毛细支气管炎患儿的疗效及对炎症标志物的影响,为制订合理的临床治疗方案提供客观依据。方法选取2015年1月-2016年10月医院收治的180例RSV感染毛细支气管炎患儿为研究对象,将其随机分为研究组和对照组,每组各90例;对照组患儿于常规对症支持疗法基础上应用布地奈德混悬液雾化吸入治疗,研究组患儿于对照组疗法的基础上应用口服孟鲁司特钠治疗;对两组患儿的临床疗效、喘息改善时间、住院时间进行评价和比较;对两组患儿治疗前及治疗后第7天的血清半胱氨酰白三烯(CysLTs)、嗜酸粒细胞阳离子蛋白(ECP)水平进行比较;比较两组患儿治疗12周内再次喘息发生率。结果两组患儿的临床有效率分别为97.8%和87.8%,研究组患儿的临床有效率高于对照组(P<0.05);研究组患儿的喘息改善时间、平均住院时间均显著短于对照组(P<0.05);研究组患儿在治疗7d后的血清CysLTs、ECP水平显著低于对照组(P<0.05);研究组和对照组患儿治疗后12周内的再次喘息发生率分别为17.8%和34.4%;研究组患儿的再次喘息发生率显著低于对照组(P<0.05)。结论在常规对症支持疗法基础上加用孟鲁司特钠治疗RSV感染毛细支气管炎,可显著提高治疗效果,降低血清炎症标志物水平,缓解气道炎症反应,降低再次喘息的发生率。

OBJECTIVE To observe the effect of montelukast on treatment of children with bronchiolitis induced by respiratory syncytial virus（RSV）and analyze the influence on inflammatory markers so as to provide objective basis for clinical treatment.METHODS A total of 180 children with RSV-induced bronchiolitis who were treated in the hospital from Jan 2015 to Oct 2016 were recruited as the study objects and randomly divided into the observation group and the control group,with 90 cases in each group.The control group was treated with aerosol inhalation of budesonide suspension on basis of the conventional symptomatic supportive therapy,while the observation group was given additional oral administration of montelukast on basis of the treatment of the control group.The clinical curative effect,time of improvement of wheezing and length of hospital stay were observed and compared between the two groups of children,the levels of serum cysteinyl leukotrienes（CysLTs）and eosinophil cationic protein（ECP）were compared between the two groups of children before the treatment and after the treatment for7 days,and the incidence of recurrence of wheezing was compared between the two groups of children within 12 weeks after the treatment.RESULTS The effective rate of clinical treatment of the observation group was 97.8%,higher than 87.8% of the control group（P〈0.05）.The time of improvement of wheezing and average length of hospital stay were significantly shorter in the observation group than in the control group（P〈0.05）.The levels of serum CysLTs and ECP of the observation group were significantly lower than those of the control group（P〈0.05）.The incidence rate of recurrence of wheezing of the observation group was 17.8%,significantly lower than34.4% of the control group,and there was significant difference between the two groups（P〈0.05）.CONCLUSION The conventional symptomatic supportive therapy combined with montelukast may significantly improve the curative effect of the bronchiolitis induced by RSV,reduce the levels of serum inflammatory markers,alleviate the airway inflammations and reduce the incidence rate of recurrence of wheezing.