丙酸氟替卡松、孟鲁斯特钠、酮替芬治疗儿童咳嗽变异性哮喘的临床疗效观察

Clinical effect of fluticasone propionate, montelukast sodium and ketotifen in treatment of cough variant asthma in children

目的观察丙酸氟替卡松(Flu)、孟鲁斯特钠(Mon)与酮替芬(Ket)的不同联合用药方案治疗儿童咳嗽变异性哮喘(CVA)的效果。方法将2015年6月至2018年1月于呼吸科门诊收治的280例CVA患儿随机分为Flu+Mon+Ket组、Flu+Mon组、Flu+Ket组、Mon+Ket组、Flu组、Mon组、Ket组(n=40)。每组根据各自的用药方案给予相应药物,疗程均为3个月。评估患儿在治疗后2个月及3个月时的咳嗽情况及评分、肺功能和药物不良反应,并随访复发情况。结果随治疗时间,7组患儿咳嗽评分均呈下降趋势,第1秒用力呼气容积占预计值的百分比(FEV1%)、最大呼气流量占预计值的百分比(PEF%)均呈上升趋势。治疗2个月后,Flu+Mon+Ket组咳嗽评分均低于其他组,FEV1%、PEF%均高于其他组(P<0.05);治疗2个月后及治疗3个月后,Ket组咳嗽评分明显高于其他组,FEV1%、PEF%明显低于其他组(P<0.05);其他各组在治疗3个月后,组间咳嗽评分、FEV1%、PEF%比较差异均无统计学意义(P>0.05)。7组不良反应发生率低且差异无统计学意义(P>0.05)。Ket组咳嗽复发率明显高于其他组(P<0.001),其他各组间咳嗽复发率比较差异无统计学意义(P>0.0024)。结论 Flu、Mon、Ket三药联合使用治疗儿童CVA在2个月时的疗效较两药联用及单药使用显著,且用药安全;但用药3个月后,单用Flu或单用Mon的疗效不差于联合用药;单用Ket疗效不佳,且停药后复发率较高。

Objective To study the clinical effect of different combinations of fluticasone propionate(Flu),montelukast sodium(Mon) and ketotifen(Ket) in the treatment of children with cough variant asthma(CVA). Methods A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence. Results After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second(FEV1%) and percentage of predicted peak expiratory flow(PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups(P<0.05). After 2 and 3 months of treatment, the Ket group had a significantly higher cough symptom score and significantly lower FEV1% and PEF% than the other groups(P<0.05). After 3 months of treatment, there were no significant differences in cough symptom score, FEV1% and PEF% among the other groups(P>0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups(P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups(P<0.001), while there was no significant difference in this rate among the other groups(P>0.0024). Conclusions For children with CVA,a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination.Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.