孟鲁司特治疗呼吸道合胞病毒毛细支气管炎患儿的临床疗效研究

Efficacy of montelukast on children with pediatric RSV capillary bronchitis

目的:探讨孟鲁司特对呼吸道合胞病毒(Respiratory Syncytial Virus,RSV)毛细支气管炎患儿血清肺表面活性蛋白D(Surface Active Protein D,SP-D)、转化生长因子-β(Transforming Growth Factor-β,TGF-β)、白细胞介素-17(Interleukin-17,IL-17)水平的影响。方法:筛选RSV毛细支气管炎患儿共88例作为研究对象,按随机数字表法分为治疗1组和治疗2组,各44例。同期选取在本院体检健康儿童50例为对照组。治疗1组予常规治疗措施;治疗2组在治疗1组治疗基础上加用孟鲁司特。比较RSV毛细支气管炎患儿和对照组血清SP-D、TGF-β、IL-17水平。分析RSV毛细支气管炎患儿血清SP-D、TGF-β、IL-17水平与二氧化碳分压(PaCO2)、血氧分压(PaO2)的相关性。连续治疗2周后,比较治疗1组和治疗2组患儿PaCO2、PaO2、肺功能。结果:RSV毛细支气管炎患儿血清SP-D和IL-17水平显著高于对照组,TGF-β明显少于对照组(P<0.01),且随着疾病严重度增加患儿血清SP-D和IL-17水平显著增加以及TGF-β明显下降(P<0.01)。Spearman相关性分析显示RSV毛细支气管炎患儿血清SP-D、IL-17水平与PaCO2呈正相关及与PaO2呈负相关,TGF-β与PaCO2呈负相关及与PaO2呈正相关(P<0.01)。治疗后,两组患儿潮气量(Tidal Volume,TV)、达峰时间比(tPTEF/tE)、达峰容积比(VTEF/VE)差异无统计学意义(P>0.05)。治疗后,治疗2组血清SP-D和IL-17水平显著低于治疗1组,TGF-β明显高于治疗1组(P<0.01)。结论:RSV毛细支气管炎患儿血清SP-D、TGF-β及IL-17水平与其疾病严重程度相关,孟鲁司特可抑制RSV毛细支气管炎患儿血清SP-D和IL-17水平同时上调TGF-β水平。

Objective:To investigate the effects of montelukast on levels of SP-D,TGF-β,IL-17 in serum of chirdren with respiratory syncytial virus capillary bronchitis.Methods:88 cases were selected as research objects and were randomly divided into the 1 st treatment group and the 2 nd treatment group,with 44 cases in each group.50 medical healthy children were chosen at the same time.The 1 st treatment group was given routine therapy,and the 2 nd treatment group was given montelukast more.Results:The levels of SP-D and IL-17 in patients were obviously higher than the control group,while TGF-βwas remarkably lower than that in the control group(P<0.01).The levels of SP-D and IL-17 were obviously increased and TGF-βwas significantly decreased as disease severity increases(P<0.01).The levels of SP-D and IL-17 of the patients were positively correlated with PaCO2 and negatively correlated with PaO2 while TGF-βwas positively correlated with PaCO2 and negatively correlated with PaO2 according to Spearman correlation analysis(P<0.01).After treatment,the difference in VT,tPTEF/tE,and VTEF/VE between the treatment groups was not significant(P>0.05).The levels of SP-D and IL-17 in the 2 nd treatment group were obviously lower,while TGF-βwas higher,than those in the 1 st treatment group after treatment(P<0.01).Conclusion:The levels of SP-D,TGF-β,and IL-17 in serum of the patients is closely related to the severity of the disease;and montelukast can down-regulate levels of SP-D and IL-17 and increase TGF-βlevel in serum of the patients.