粉尘螨滴剂联合孟鲁司特钠治疗对粉尘螨皮肤点刺试验阳性支气管哮喘患儿的效果

Effects of Dermatophagoides Farinae Drops combined with montelukast sodium children patients with bronchial asthma and positive skin prick test of dermatophagoides farinae

目的研究粉尘螨滴剂联合孟鲁司特钠治疗粉尘螨皮肤点刺试验阳性支气管哮喘患儿的疗效及其对患儿炎症状态和停药后复发率的影响。方法将2015年3月至2016年3月深圳市儿童医院和深圳市宝安区松岗人民医院收治的86例粉尘螨皮肤点刺试验阳性哮喘患儿依据随机数字表法均分为观察组(粉尘螨滴剂联合孟鲁司特钠)和对照组(孟鲁司特钠)进行治疗,疗程12个月,比较两组患儿治疗6、12个月时自我症状积分,治疗期间哮喘急性发作和药物不良反应发生情况,治疗12个月时炎症指标、肺功能,治疗结束后12个月内哮喘复发率。结果治疗前、治疗3个月、治疗6个月和治疗12个月,两组患儿自我症状积分均呈下降趋势,组内不同时间比较差异有统计学意义(P<0.05),且观察组治疗3、6、12个月时自我症状积分低于对照组,差异有统计学意义(P<0.05);治疗期间,观察组哮喘急性发作次数、平均持续时间均明显少于对照组(P<0.05),其中两组间平均轻、中度哮喘发作次数差异有统计学意义(P<0.05),两组平均重度哮喘发作次数差异无统计学意义(P>0.05);治疗12个月时,两组嗜酸性粒细胞计数、血清白细胞介素(IL)-4、IL-5、IL-13水平及呼出气一氧化氮浓度(FeNO)均降低(P<0.05),且观察组血清IL-4、IL-5、IL-13、FeNO水平及治疗前后差值均低于对照组,差异有统计学意义(P<0.05);治疗期间两组不良反应发生率差异无统计学意义(P>0.05);随访1年,观察组和对照组完全控制率分别为90.70%和72.09%(P<0.05),复发率分别为6.98%和23.26%(P<0.05)。结论粉尘螨滴剂联合孟鲁司特钠治疗粉尘螨皮肤点刺试验阳性支气管哮喘患儿可有效调节其机体免疫状态,减轻炎症反应水平,缓解患儿症状,控制哮喘发作,改善患儿肺功能,降低停药后复发率,是一种安全有效的治疗儿童哮喘的方案。

Objective To study the efficacy of Dermatophagoides Farinae Drops combined with montelukast sodium on children with bronchial asthma and positive skin prick test of dermatophagoides farinae and its effects on inflammatory states and relapse rate after drug withdrawal. Methods 86 cases of asthmatic children patients with positive skin prick test of dermatophagoides farinae who were treated in Shenzhen Children's Hospital and Baoan District Songgang People's Hospital of Shenzhen from March 2015 to March 2016 were evenly divided into observation group (Dermatophagoides Farinae Drops combined with montelukast sodium) and control group (montelukast sodium)according to the random number table method, and they were treated for 12 months. The self symptoms scores at 6 months and 12 months of treatment,acute asthma attack and occurrence of adverse drug reactions during treatment, inflammation indexes and lung function at 12 months of treatment and asthma relapse rate within 12 months after the end of treatment were compared between the two groups. Results Before treatment and after 3 months,6 months and 12 months of treatment, the self symptoms scores in the two groups showed decreasing trend, and the difference was significant at different times within-groups ( P <0.05), and the self symptoms score in observation group were lower than those in control group at 3, 6 and 12 months of treatment ( P <0.05). During treatment, the acute asthma attack frequency and average duration of asthma in observation group were significantly shorter than those in control group ( P <0.05), and there were significant differences between the two groups in the average light and moderate attack frequencies ( P <0.05), and there was no significant difference in the average severe attack frequency between the two groups ( P >0.05). At 12 months of treatment, the levels of eosinophil count, serum IL-4, IL-5, IL-13, and exhaled nitric oxide (FeNO) were significantly decreased in the two groups ( P < 0.05), and the levels of serum IL-4, IL-5, IL-13 and FeNO and the differences of above indexes before and after treatment in observation group were lower than those in control group( P <0.05). There was no significant difference in the incidence rate of adverse reactions during treatment between the two groups ( P > 0.05). At 1-year of follow-up, the complete control rates of observation group and control group were 90.70% and 72.09% respectively ( P <0.05), and the relapse rates were 6.98% and 23.26% respectively ( P <0.05). Conclusion Dermatophagoides Farinae Drops combined with montelukast sodium for children with bronchial asthma and positive skin prick test of dermatophagoides farina can effectively regulate the body’ s immune status, reduce the inflammatory response, relieve symptoms, control asthma attack, improve lung function and reduce relapse after drug withdrawal. Therefore it is a safe and effective treatment program for childhood asthma.