孟鲁司特联合丙酸氟替卡松对变应性鼻炎患儿的临床疗效及免疫功能评价

Effect and mechanism of montelukast and flixonase in treatment of children with allergic rhinitis

目的评价孟鲁司特联合丙酸氟替卡松对变应性鼻炎患儿的临床疗效及免疫调节作用。方法收集2014年1月-2016年12月惠州市中心人民医院第一分院收治的变应性鼻炎患儿140例,使用数字法随机分为丙酸氟替卡松单药治疗对照组和孟鲁司特联合丙酸氟替卡松治疗观察组,每组70人。ELISA法检测免疫球蛋白Ig E、白介素(IL)-17、IL-10因子表达。比较两组的临床疗效和临床不良反应。结果治疗前两组症状体征评分无显著差异,治疗后均较治疗前有显著降低(P<0.01),且观察组评分降低作用显著优于对照组(P<0.05);对照组临床有效率为80.0%,显著低于观察组的94.3%(P<0.05);治疗前两组Ig E、IL-17和IL-10表达无显著差异,治疗后两组Ig E和IL-17表达显著降低、IL-10表达显著升高(P<0.01),且观察组对Ig E和IL-17的减低作用以及对IL-10的升高作用优于对照组(P<0.05)。Ig E表达与IL-17呈显著正相关(r=0.392,P<0.05),与IL-10呈显著负相关(r=-0.364,P<0.05)。观察组不良反应发生率为14.3%,对照组的为11.4%,治疗期间两组临床不良反应发生率无显著差异。结论孟鲁司特钠联合丙酸氟替卡松治疗小儿变应性鼻炎临床疗效显著,使用安全,调节IL-17/IL-10因子失衡可能是其起效的作用机制。

Objective To observe the immunomodulatory effects of montelukast and flixonase on children with allergic rhinitis and to explore its clinical efficacy. Methods A total of 140 cases of allergic rhinitis children were sellected, who were randomly divided into two groups： flixonase control group（n = 70） and montelukast and flixonase observation group（n = 70）. The expression of Ig E, IL-17, and IL-10 was determined by ELISA analysis. The clinical effect and adverse reactions were compared. Results Before treatment, there was no significant difference of symptom and sign scores between two groups. After treatment, the symptom and sign scores were significantly decreased in the two groups（P〈0.01）. But the decreasing of symptom and sign scores was better in observation group than in control group（P〈0.05）. The clinic effective rate of control group was 80.0%, which was lower than 94.3% in observation group（P〈0.05）. Before treatment, there was no significant difference of Ig E, IL-17, and IL-10 expression between two groups. After treatment, the expression of Ig E and IL-17 in two groups was significantly decreased（P〈0.01）, and IL-10 was significantly increased（P〈0.01）. But the moderating effect of Ig E, IL-17, and IL-10 was better in observation group than in control group（P〈0.05）. Ig E expression was positively correlated with IL-17（r = 0.392, P〈0.05）, and negatively correlated with IL-10（r =-0.364, P〈0.05）. The rate of adverse reactions was 14.3% in observation group and 11.4% in control group. There was no significant difference between the two groups（P〈0.05）. Conclusion Montelukast and flixonase showed effectively clinical efficacy and safty to treat children with allergic rhinitis, and the regulation of IL-17/IL-10 imbalance may be the mechanism of its effect.