孟鲁司特联合舒利迭治疗老年支气管哮喘的效果

Effect of montelukast combined with fluticasone propionate/salmeterol DISKUS inhalation powder in the treatment of elderly patients with bronchial asthma

目的探讨孟鲁司特联合舒利迭治疗老年支气管哮喘的效果及FEV1改善情况分析。方法将2020年1月至2021年6月治疗的132例老年支气管哮喘患者随机分为2组,对照组使用舒利迭治疗,观察组使用孟鲁司特联合舒利迭治疗,对比2组的临床疗效、Th1/Th2细胞因子、气道重塑细胞因子、气道功能指标、诱导痰细胞中炎性细胞比例。结果观察组治疗有效率为95.45%,明显高于对照组的77.27%(P<0.05);观察组治疗后IL-2、IFN-γ水平明显高于对照组,IL-4、IL-10水平明显低于对照组(P<0.05);观察组治疗后CGRP水平明显高于对照组,MMP-9、TGF-β水平明显低于对照组(P<0.05);观察组治疗后FEF25%、FEF50%、FEF75%、FEV1、FEV1/FVC均明显高于对照组(P<0.05);观察组治疗后中性粒细胞、嗜酸性粒细胞比例明显低于对照组,单核-巨噬细胞、气道上皮细胞比例明显高于对照组(P<0.05),淋巴细胞比例相当(P>0.05)。结论孟鲁司特联合舒利迭治疗老年支气管哮喘的效果显著,能有效抑制气道炎症反应,减少诱导痰中炎症细胞比例,调整Th1/Th2细胞因子平衡,抑制气道重塑,改善气道功能,具有积极的临床意义。

Objective To explore the effect of montelukast combined with fluticasone propionate/salmeterol DISKUS inhalation powder(Advair Diskus)in the treatment of elderly patients with bronchial asthma and its influence on improving the forced expiratory volume in the first second(FEV1).Methods A total of 132 elderly patients with bronchial asthma treated in our hospital from January 2020 to June 2021 were randomly divided into control group and observation group.Patients in control group and observation group were medicated by Advair Diskus,and montelukast combined with Advair Diskus,respectively.The clinical efficacy,Th1/Th2 cytokines,airway remodeling cytokines,airway function indexes and the proportion of inflammatory cells in induced sputum cells were compared between the two groups.Results The effective rate was significantly higher in the observation group than that in the control group(95.45%vs 77.27%,P<0.05).After treatment,interleukin-2(IL-2)and IFN-gamma(IFN-γ)levels in the observation group were significantly higher than those in the control group,while IL-4 and IL-10 levels were significantly lower(P<0.05).The level of calcitonin-gene related peptide(CGRP)in the observation group was significantly higher than that in the control group,while matrix metalloproteinase-9(MMP-9)and TGF-βlevels in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the forced expiratory flow at 25%,50%and 75%(FEF25%,FEF50%,FEF75%),FEV1 and the ratio of the forced expiratory volume in the first second to the forced vital capacity(FEV1/FVC)in the observation group were significantly higher than those in the control group(P<0.05).After treatment,the proportion of neutrophils and eosinophils in the observation group was significantly lower than that in the control group,but the proportion of mononuclear macrophages and airway epithelial cells was significantly higher(P<0.05).The proportion of lymphocytes was similar between groups(P>0.05).Conclusion Montelukast combined with Advair Diskus has a significant effect on the treatment of elderly patients with bronchial asthma,which can effectively inhibit airway inflammation,reduce the proportion of inflammatory cells in induced sputum,adjust the balance of Th1/Th2 cytokines,inhibit airway remodeled and improve airway function,showing a positive clinical significance.