孟鲁司特钠联合丙酸氟替卡松对咳嗽变异性哮喘患儿外周血免疫球蛋白4及细胞间黏附分子-1调节作用分析

Regulation of montelukast and fluticasone propionate on peripheral blood immunoglobulin 4 and intercellular adhesion molecule-1 in children with cough variant asthma

目的探讨孟鲁司特钠(Montelukastsodium,MON)联合丙酸氟替卡松(Fluticasone propionate,FLU)对咳嗽变异性哮喘(Cough variant asthma,CVA)儿童的治疗效果以及对外周血免疫球蛋白4(IgG_4)和细胞间黏附分子-1(ICAM-1)的调节作用。方法选取咳嗽变异性哮喘患儿270例,按照随机数字表法分为3组,每组90例,试验组给予孟鲁司特钠联合丙酸氟替卡松进行治疗,对照组A单用口服孟鲁司特钠治疗,对照组B单用吸入丙酸氟替卡松治疗。治疗疗程均为8周,对治疗前后血清IgG_4、ICAM-1水平进行监测,评定各组治疗效果,并统计不良反应发生情况。结果治疗前组间血清IgG_4、ICAM-1水平比较,差异无统计学意义(P>0.05)。治疗后试验组血清IgG_4水平(10.24±2.28μg/m L)与对照组A为(7.79±2.02μg/m L)和对照组B为(8.10±1.78μg/m L)比较,差异有统计学意义(P<0.05);治疗后试验组ICAM-1水平为(87.70±20.25ng/L)与对照组A为(105.50±27.28ng/L)和对照组B为(112.26±31.75ng/L)比较差异具有统计学意义(P<0.05);试验组有效率(71.11%,64/90)与对照组A(37.78%,34/90)和对照组B(42.22%,38/90)比较差异具有统计学意义(P<0.05)。三组患儿治疗期间不良反应发生率比较差异无统计学意义(P>0.05)。结论孟鲁司特钠与丙酸氟替卡松的联合治疗能降低患儿血清ICAM-1水平,提高IgG_4水平,复发率较低。

Objective To investigate the effect of montelukast sodium(MON)and fluticasone propionate(FLU)on cough variant asthma(CVA)and the outcome of children with peripheral blood immunoglobulin 4(IgG 4)and intercellular adhesion molecule-1(ICAM-1).Methods From June 2013 to January 2016 in our hospital,270 children with cough variant asthma were randomly divided into 3 groups,90 cases in each group.The experimental group was given montelukast combined with fluticasone propionate treatment,the group A was given oral montelukast treatment,and the group B was given fluticasone propionate inhalation.The course of treatment was 8 weeks.The levels of serum IgG 4 and ICAM-1 were monitored before and after treatment.The therapeutic effects of each group were evaluated,and the incidence of adverse reactions was evaluated.Results There was no significant difference in serum levels of IgG 4 and ICAM-1 among the three groups before treatment(P>0.05).The serum level of IgG 4 was(10.24±2.28)g/mL in the experiment group,(7.79±2.02)g/mL in the group A,and(8.10±1.78)g/mL in the group B(P<0.05).After treatment,the level of ICAM-1 was(87.70±20.25)ng/L in the experiment group,which decreased significantly in the group A[(105.50±27.28)ng/L]and the group B[(112.26±31.75)ng/L](P<0.05).The effective rate was 71.11%(64/90)in the experimental group,37.78%(34/90)in the group A,and 42.22%(38/90)in the group B.The efficacy of the experimental group was better than that of the group A and the group B(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion The combination of montelukast and fluticasone propionate can reduce the level of ICAM-1,increase the level of serum IgG 4 in treatment of children with cough variant asthma,with a lower recurrence rate.