孟鲁司特钠联合维生素D治疗婴幼儿喘息的疗效及对肺功能和细胞因子的影响

Efficacy of montelukast sodium combined with vitamin D in treatment of wheezing in infants and changes of lung function and cytokines

目的探讨孟鲁司特钠联合维生素D治疗婴幼儿喘息的临床疗效,同时检测P13K、NF-κB和STAT1在喘息婴幼儿外周血单个核细胞(PBMC)中的表达水平,探讨其意义。方法选择2016年1月至2018年6月于本院呼吸科住院治疗确诊为喘息婴幼儿640例为研究对象,对婴幼儿喘息的发作期、缓解期进行潮气呼吸肺功能检测;对入院后160例喘息缓解期婴幼儿进行分组,其中对照组80例,给予孟鲁司特钠咀嚼片4 mg/d,每晚顿服;治疗组80例在对照组基础上口服维生素D 0.25μg/d,时间均为12周。比较孟鲁司特钠联合维生素D治疗前后喘息婴幼儿肺功能变化;比较患儿治疗前后ALP、25-(OH)D_3、IgA水平;通过RT-qPCR和Western blot法分别检测外周血单个核细胞中P13K、NF-κB和STAT1 mRNA和蛋白表达水平变化。结果婴幼儿喘息发作期的RR比对照组明显加快,而发作期VT/kg、TPTEF/TE和VPEF/VE低于对照组,差异均有显著性(P <0.05);治疗组治疗4、12周后婴幼儿活动后咳嗽/喘息、喘息、咳嗽与基础值比较,两者差异均有统计学意义(P <0.05);与对照组及治疗前相比,治疗组患儿治疗后ALP、25-(OH)D_3、IgA水平均明显上升(P <0.05);治疗组外周血单个核细胞(PBMC)中P13K、NF-κB和STAT1mRNA和蛋白表达水平较治疗前均明显下降(P <0.05);治疗12周后,治疗组PTEF(mL/s)、TPTEF/TE、VPEF/VE与治疗前相比均明显提高(P <0.05)。结论孟鲁司特钠与维生素D联合治疗婴幼儿喘息性疾病可显著缓解患儿症状和体征,并对相关实验室指标也有明显改善。

Objective To explore the clinical efficacy of Montelukast Sodium combined with vitamin D in the treatment of infant wheezing,and to detect the expression level of P13K,NF-kappa B and STAT1 in peripheral blood mononuclear cells(PBMC)in infants,and to explore its significance. Methods A total of 640 children diagnosed as infant wheezing from January 2016 to June 2018 were selected as the research subjects and 160 cases of infants with wheezing remission were divided into control group with 80 cases given Montelukast Sodium Chewable Tablets 4 mg/d,and treatment group with 80 cases additionally taken vitamin D 0.25 g/d for 12 weeks. The changes of pulmonary function in infants and the levels of ALP,25-(OH)D3 and IgA were compared before and after the treatment. The levels of P13K,NF-κB and STAT1 mRNA and protein in peripheral blood mononuclear cells were detected by RT-qPCR and Western blot respectively. Results The RR in the infantile asthmatic stage of attack was significantly faster than that in the control group,while the VT/kg,TPTEF/TE and VPEF/VE in the onset period in the treatment group were also lower than those in the control group and the difference was significant(P < 0.05). There were significant differences in cough / wheezing,wheezing,cough and basic values after treatment for 4 and 12 weeks in the treatment group(P < 0.05). Compared with those in the control group and before the treatment,the levels of ALP,25-(OH)D3 and IgA in the treatment group increased significantly after the treatment(P < 0.05). The expression levels of P13K,NF-κB and STAT1 mRNA and protein in PBMC of the treatment group were significantly lower than those before the treatment(P < 0.05). After 12 weeks of treatment,the PTEF(mL/s),TPTEF/TE,and VPEF/VE in the treatment group were significantly higher than those before the treatment(P < 0.05). Conclusion The combination of Montelukast Sodium and vitamin D in the treatment of infants with asthmatic disease can significantly alleviate the symptoms and signs of children,and also significantly improve the related laboratory indicators.