糠酸莫米松联合氯雷他定治疗小儿变应性鼻炎的研究

Study on mometasone furoate nasal spray combined with loratadine for the treatment of allergic rhinitis in children

目的糠酸莫米松喷鼻剂联合氯雷他定对小儿变应性鼻炎白介素(IL)-10和IL-17的影响。方法选取于2016年5月至2017年12月在舟山医院耳鼻喉科治疗的小儿变应性鼻炎患儿共120例为研究对象,按不同治疗方法随机分为两组,每组各60例。对照组使用氯雷他定治疗,观察组在对照组的基础上加用糠酸莫米松喷鼻剂,共治疗5周。对治疗前、治疗5周时两组的鼻腔检查及鼻炎症状评分、血清IL-17和IL-10水平、治疗总有效率、不良反应发生率、患者鼻结膜炎相关生活质量问卷(RQLQ)分值进行比较分析。结果治疗后观察组鼻腔检查及鼻炎症状评分均降低且低于对照组(t=7.90~25.04,均P<0.05);治疗后观察组血清IL-17降低且低于对照组(t=34.17,P<0.05),IL-10升高且高于对照组(t=16.22,P<0.05);观察组治疗总有效率为98.33%,高于对照组(83.33%),差异有统计学意义(χ2=13.02,P=0.0003);观察组不良反应发生率为6.67%,与对照组(5.00%)比较差异无统计学意义(P>0.05);治疗后观察组RQLQ各项评分降低且低于对照组(t=10.26~39.83,均P<0.05)。结论糠酸莫米松喷鼻剂联合氯雷他定治疗小儿变应性鼻炎能显著改善IL-17和IL-10水平,效果优于单用氯雷他定,缓解临床症状,改善了患儿的生活质量,不增加不良反应,值得推荐。

Objective To investigate the effects of mometasone furoate nasal spray combined with loratadine on serum interleukin （IL） -10 and IL-17 in children with allergic rhinitis. Methods A total of 120 children with allergic rhinitis treated at the ENT Department of Zhoushan Hospital during May 2016 to December 2017 were selected as study subjects, and they were randomly divided into two groups according to different treatment methods with 60 cases in each group. The children in the control group were treated with loratadine, and on the basis of the control group, the children in the observation group were treated with additional mometasone furoate nasal spray. Both groups were treated for 5 weeks. The scores of nasal cavity examination and rhinitis symptom, serum IL-17 and IL-10 levels, total effective rate, incidence of adverse reactions and the scores of rhinoconjunctivitis quality of life questionnaire （RQLQ） were compared between two groups before and after 5 weeks of treatment. Results After treatment, the scores of nasal examination and rhinitis symptom of children in the observation group were decreased and both were lower than those in the control group （t value ranged 7.90 25.04, both P〈0.05）. And after treatment, the IL17 levels of children in the observation group were decreased and lower than those in the control group （t= 34.17, P 〈0.05）, while the IL-10 levels of children in the observation group were elevated and higher than those in the control group （t 16.22, P〈0.05）. In the observation group, the total effective rate was 98.33 %, which was higher than that of the control group （83.33 %） with significant difference （Z2-13.02,P：0.0003）. The incidence of adverse reactions in the observation group was 6.67%, which was not significantly different from that in the control group （5.00%） （P 〉 0.05）. After treatment, the RQI.Q scores of the observation group were lower than those of the control group （t value ranged 10. 26- 39.83, all P 〈 0.05）. Conclusion The mometasone furoate nasal spray combined with loratadine for the treatment of allergic rhinitis in children can significantly improve the levels of IL-17 and IL-10, whose effect is superior to that of loratadine only. The combined treatment can relieve clinical symptoms and improve quality of life for children without extra adverse reactions, which is worth recommending.