孟鲁司特联合布地奈德治疗儿童间歇性哮喘的疗效研究

Effect of montelukast combined with budesonide in the treatment of children with intermittent asthma

目的分析孟鲁司特联合布地奈德治疗儿童间歇性哮喘的效果及对气道重塑、T辅助细胞1(Th1)/T辅助细胞2(Th2)相关细胞因子的影响。方法采用前瞻性研究的方法,选取2021年12月至2023年2月黄骅市人民医院收治的120例间歇性哮喘患儿,按照随机数字表法分为对照组(雾化吸入布地奈德治疗)、观察组(在对照组基础上联合孟鲁司特治疗)各60例,比较两组临床疗效、气道重塑指标[气道总面积(Ao)、气道外径(D)、气道壁面积占气道总截面积百分比(WA%)]、肺功能[呼气峰流速值(PEF)、第1秒最大用力呼气量(FEV_(1))/用力肺活量(FVC)、用力呼出25%肺活量(MEF25%)]、Th1/Th2相关细胞因子、炎性反应指标[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-4、IL-6、γ-干扰素(IFN-γ)]、复发与不良反应发生率。结果观察组治疗总有效率高于对照组[90.00%(54/60)比75.00%(45/60)](P<0.05);治疗后观察组Ao、D、WA%均小于对照组[(17.58±1.89)mm^(2)比(19.22±1.94)mm^(2)、(4.25±0.48)mm比(4.48±0.49)mm、(63.75±6.49)%比(69.22±7.14)%],差异有统计学意义(P<0.05);治疗后观察组PEF、FEV_(1)/FVC、MEF25%均高于对照组[(3.13±0.34)L/s比(2.86±0.35)L/s、(87.45±8.86)%比(83.59±8.42)%、(87.63±8.86)%比(82.15±8.43)%](P<0.05);治疗后观察组Th1、Th1/Th2水平高于对照组[(14.13±1.46)%比(10.27±1.25)%、3.46±0.39比1.88±0.25],Th2水平低于对照组[(3.96±0.45)%比(5.48±0.56)%](P<0.05);治疗后观察组TNF-α、IFN-γ较对照组更高[(76.15±7.78)ng/L比(66.38±6.47)ng/L、(7.15±0.74)ng/L比(6.14±0.66)ng/L],IL-4、IL-6低于对照组[(77.85±7.96)ng/L比(86.42±8.74)ng/L、(37.25±3.89)mg/L比(44.23±4.57)mg/L],差异有统计学意义(P<0.05);观察组的复发率较对照组更低[3.33%(2/60)比15.00%(9/60)],差异有统计学意义(P<0.05),两组间不良反应发生率比较差异无统计学意义(P>0.05)。结论孟鲁司特联合布地奈德可降低儿童间歇性哮喘气道重塑,改善患儿的肺功能、Th1/Th2相关细胞因子、炎性反应指标,降低复发率,安全性好,值得在临床推广实践。

Objective To analyze the effect of montelukast combined with budesonide in the treatment of children with intermittent asthma,and the impact on airway remodeling and T helper type 1(Th1)/T helper type 2(Th1/Th2)related cytokines.Methods A prospective study was conducted among 120 children with intermittent asthma admitted to Huanghua Municipal People's Hospital from December 2021 to February 2023.The children were randomly divided into the control group(60 children treated with budesonide atomizationinhalation)and the observation group(60 children treated with montelukast on the basis of the treatment of control group).Clinical efficacy,airway remodeling indicators[total area of airway(Ao),outer diameter of airway(D)and wall area to total airway cross-sectional area(WA%)],pulmonary function[peak expiratory flow(PEF),forced expiratory volume in 1 second(FEV_(1))/forced vital capacity(FVC)and the maximum expiratory flow at 25%of vital capacity(MEF25%)],Th1/Th2 related cytokines,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6)and interferon-gamma(IFN-γ)],recurrence,and the incidence of adverse reactions were compared between the two groups.Results The total effective rate in the observation group was higher than that in the control group:90.00%(54/60)vs.75.00%(45/60)(P<0.05).After treatment,Ao,D and WA%in the observation group were lower than those in the control group:(17.58±1.89)mm^(2) vs.(19.22±1.94)mm^(2),(4.25±0.48)mm vs.(4.48±0.49)mm,(63.75±6.49)%vs.(69.22±7.14)%(P<0.05).PEF,FEV_(1)/FVC and MEF25%in the observation group were higher than those in the control group:(3.13±0.34)L/s vs.(2.86±0.35)L/s,(87.45±8.86)%vs.(83.59±8.42)%,(87.63±8.86)%vs.(82.15±8.43)%(P<0.05).The levels of Th1 and Th1/Th2 in the observation group were higher than those in the control group:(14.13±1.46)%vs.(10.27±1.25)%,3.46±0.39 vs.1.88±0.25,and the level of Th2 was lower than that in the control group:(3.96±0.45)%vs.(5.48±0.56)%(P<0.05).After treatment,the levels of TNF-αand IFN-γin the observation group were higher than those in the control group:(76.15±7.78)ng/L vs.(66.38±6.47)ng/L,(7.15±0.74)ng/L vs.(6.14±0.66)ng/L.The levels of IL-4 and IL-6 were lower than those in the control group:(77.85±7.96)ng/L vs.(86.42±8.74)ng/L,(37.25±3.89)mg/L vs.(44.23±4.57)mg/L(P<0.05).The recurrence rate in the observation group was lower than that in the control group:3.33%(2/60)vs.15.00%(9/60)(P<0.05).The incidence rates of adverse reactions in the two groups were without statistically significant difference between the groups(P>0.05).Conclusions Montelukast combined with budesonide can reduce airway remodeling in children with intermittent asthma,improve their pulmonary function,Th1/Th2 related cytokines and inflammatory response indicators,and reduce recurrence rate,with good safety.