噻托溴铵联合孟鲁司特钠对咳嗽变异性哮喘患儿气道炎症及肺功能的影响

Effect of Tiotropium Bromide Combined with Montelukast Sodium on Airway Inflammation and Pulmonary Function in Children with Cough Variant Asthma

目的:观察在孟鲁司特钠基础上联合异丙托溴铵或噻托溴铵治疗咳嗽变异性哮喘(CVA)的获益对比,主要分析联合方案对患儿气道炎症及肺功能的影响并指导治疗。方法:选择2017年9月~2019年10月于本院接受治疗的CVA患儿,从中筛选符合条件的120例作为研究对象,采用随机数字表法将患者分为观察组和对照组,每组60例。对照组采用异丙托溴铵联合孟鲁司特钠治疗,观察组采用噻托溴铵联合孟鲁司特钠治疗,均以4周为1个疗程,持续2个疗程后评价治疗效果。记录并对比两组治疗前1天、治疗2个疗程时的气道炎症[呼出气一氧化氮(FeNO)、嗜酸性粒细胞(EOS)]、肺功能[第1 s用力呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)];记录并对比两组治疗期间的不良反应(口干、咳嗽、头痛)。结果:治疗2个疗程时,两组FeNO和EOS水平低于治疗前1天(P <0.05),且观察组低于对照组(P <0.05);治疗2个疗程时,两组患儿的FEV1和FEV1/FVC水平高于治疗前1天(P <0.05),且观察组高于对照组(P <0.05);两组治疗期间各不良反应发生率组间相比,无统计学差异(P> 0.05)。结论:在孟鲁司特钠基础上联合噻托溴铵对CVA的治疗获益高于联合异丙托溴铵,能更有效地缓解患儿的气道炎症,更利于改善患儿肺功能,且治疗期间未见不良反应增加、安全性较高。

Objective:To observe the benefit of montelukast sodium combined with ipratropium bromide or tiotropium bromide in the treatment of cough variant asthma(CVA),mainly through analyzing the effect of the combined regimen on airway inflammation and pulmonary function in children,and to guide the treatment.Methods:120 children with CVA who received treatment in our hospital from September 2017 to October 2019 were selected and divided into an observation group and a control group according to the random number table method,with 60 cases in each group.The control group was treated with ipratropium bromide combined with montelukast sodium,and the observation group with tiotropium bromide combined with montelukast sodium.4 weeks were taken as one treatment course.The effect was evaluated after 2 consecutive courses.The airway inflammation[fractional exhaled nitric oxide(FeNO),eosnophil(EOS)]and pulmonary function[forced expiratory volume in the first second(FEV 1),FEV 1/forced vital capacity(FEV 1/FVC)]in two groups were recorded and compared 1 day before treatment and at 2 treatment courses.The adverse reactions(dry mouth,cough,headache)in two groups during treatment were recorded and compared.Results:At 2 treatment courses,the levels of FeNO and EOS in two groups were lower than those recorded at 1 day before treatment(P<0.05),with lower levels found in the observation group than in the control group(P<0.05);At 2 courses of treatment,the levels of FEV 1 and FEV 1/FVC of children in two groups were higher than those found at 1 day before treatment(P<0.05),with higher results obtained in the observation group than in the control group(P<0.05);There was no statistical difference in the incidence of adverse reactions between two groups during treatment(P>0.05).Conclusion:Montelukast sodium combined with tiotropium bromide in treatment of CVA has higher benefit than combining with ipratropium bromide,which can effectively relieve airway inflammation,improve pulmonary function of children,without increasing adverse reactions during treatment,with high safety.