孟鲁斯特治疗特发性肺纤维化的临床观察  

Montelukast treatment in idiopathic pulmonary fibrosis

作　　者：李承红[1] 罗瑛[1] 王传海[1] 孟庆华[1] 叶胜兰[1] 王小江[1] 李发久[1] 江城[1] 

机构地区：[1]江汉大学附属医院呼吸内科,湖北武汉430015

出　　处：《中国医院药学杂志》2010年第11期943-946,共4页Chinese Journal of Hospital Pharmacy

摘　　要：目的:探讨孟鲁斯特在特发性肺纤维化(idiopathic pulmonary-fidrosis,IPF)的作用。方法:采用随机、对照的方法,将60例IPF患者分为2组,2组患者给予相同的基础治疗(吸氧、抗感染、化痰、止咳、平喘治疗),治疗组在基础治疗上加用孟鲁斯特片10mg,每晚口服1次,疗程均为6个月;对照组在基础治疗上加用口服甲泼尼松片0.4mg·kg-1·d-1,4周后减量为0.2mg·kg-1·d-1,连续8周之后再减量为4mg·d-1,3个月。治疗前、治疗后3个月和6个月分别记录临床症状、体征;肺部CT;肺功能;动脉血气分析;白介素-2(IL-2)、白介素-4(IL-4)、白介素-8(IL-8);6min步行距离及不良反应等。结果:治疗3,6个月后治疗组临床症状、体征改善均明显优于对照组,组间差异有显著性(P<0.01),总疗效治疗组明显优于对照组(P<0.01);治疗后3,6个月肺功能和PaO2二组都有明显改善(P<0.05),但治疗6个月与3个月比较肺功能和PaO2没有进一步的改善;治疗后治疗组纠正缺氧明显优于对照组(P<0.05),但2组改善肺功能无明显差异;2组患者在治疗前IL-2、IL-4、IL-8增高,治疗3,6个月后在治疗组IL-2、IL-4、IL-8有明显改善(P<0.01),作用明显优于对照组(P<0.01);治疗后3,6个月6min步行距离2组都有明显提高(P<0.01);治疗组明显优于对照组(P<0.01);对照组中有3例出现血糖轻度升高,5例出现兴奋、失眠,而治疗组未见不良反应发生。结论:孟鲁斯特能阻断花生四烯酸脂氧化酶通路,抑制白三烯产生的肺泡炎、成纤维细胞迁移、增殖和细胞外基质的形成。从而改善临床症状提高生活质量,但不能逆转已形成的纤维化。说明孟鲁斯特通过调节细胞因子网络可能为肺纤维化的更有效治疗带来一定的希望。OBJECTIVE To investigate the therapeutic role of montelukast in idiopathic pulmonary fibrosis （IPF）. METHODS A randomized, placebo-controlled method was adopted, 40 cases of IPF patients were divided into two groups, and treated with the same basic therapy （oxygen, anti-infection, phlegm, relieving cough and asthma medications）, treatment group was added with montelukast tablets 10mg, oral administration once every night, for 6 months; the control group was added with oral methylprednisolone tablets 0. 4 mg·kg^-1·d^-1, for 4 weeks, after that then reducing to 0. 2 mg·kg^-1·d^-1, for 8 weeks followed by a further reduction to 4 mg·d^-1 , for 3 months. Before and after treatment, in 3 months and 6 months the clinical symptoms and signs; lung CT; pulmonary function; arterial blood gas analysis; interleukin-2 （IL-2）, interleukin-4 （IL-4）, interleukin-8 （IL-8） ; six minutes walking distance and drug adverse reactions were recorded. RESULTS In treatment group after 3,6 months the clinical symptoms and signs were significantly better than the control group, difference between the two groups was significant （P〈0. 01 ）, the overall efficacy in the treatment group was significantly better than the control group （P〈0. 01）; 3.6 months after treatment the pulmonary function and PaO2 in two groups significantly improved （P〈0. 05）, but compared lung function between 6 months and 3 months treatment , there was no further improvement in PaO2; after treatment the treatment group showed that hypoxia corrected significantly better than that of the control group （P〈0. 05）, but no significant difference between the two groups to improve lung function; two groups before treatment in patients with IL- 2, IL-4, IL-8 increased in 3.6 months after therapy in the treatment group IL-2, IL-4, IL-8 are significantly improved （P〈0. 01）, which was superior to the control group （P〈0. 0l ） ; after treatment for 3,6 months a six minute walk from the two groups had markedly improved

关 键 词：特发性肺纤维化 孟鲁斯特 治疗 

分 类 号：R974[医药卫生—药品]