孟鲁司特治疗对婴幼儿呼吸道合胞病毒毛细支气管炎气管炎症和再次喘息的影响  

Effects of Montelukast on Airway Inflammation and the Risk of Recurrence of Wheezing in Infants with RSV Bronchiolitis

作　　者：李兰[1] 蒋虹[1] 张立[2] 王智斌[1] 李敏[1] 陈昌辉[1] 

机构地区：[1]四川省医学科学院四川省人民医院儿科,四川成都610072 [2]四川省第四人民医院检验科,四川成都610016

出　　处：《中国呼吸与危重监护杂志》2013年第2期186-189,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：四川省卫生厅科学研究基金资助项目(编号:030044)

摘　　要：目的探讨孟鲁司特治疗呼吸道合胞病毒(RSV)感染的毛细支气管炎12周后对气管炎症和再次喘息的影响。方法纳入2010年12月至2011年12月四川省人民医院收治的60例6～24个月的RSV毛细支气管炎患儿,按入院先后顺序随机分为孟鲁司特组(30例)和常规治疗组(30例)。常规治疗组给予布地奈德雾化吸入等综合治疗,孟鲁司特组在综合治疗的基础上加用孟鲁司特维持治疗(4 mg,每晚1次口服,治疗12周)。同期门诊体检健康儿童30例为正常对照组,除外特应症及近期呼吸道感染者。治疗前和12周后检测血清中半胱氨酰白三烯(CysLTs)、总IgE(T-IgE)、嗜酸粒细胞阳离子蛋白(ECP)、呼出气一氧化氮(FeNO)水平。在门诊及电话随访12个月内统计两组再次喘息患儿例数。结果两组RSV毛细支气管炎患儿治疗前CysLTs、ECP和FeNO水平均显著高于正常对照组(P<0.05),治疗后CysLTs和FeNO水平均较治疗前显著降低(P<0.05)。常规治疗组ECP水平治疗前后无明显变化(P>0.05),孟鲁司特组治疗后ECP水平较治疗前显著降低(P>0.05)。孟鲁司特组治疗后CysLTs和FeNO水平显著降低,并显著低于常规治疗组治疗后水平(P<0.05)。孟鲁司特组在12个月内累计再次喘息患儿例数显著低于常规治疗组(P<0.028)。结论毛细支气管炎急性期治疗后予孟鲁司特维持治疗可以显著抑制气道炎症,减少喘息复发的风险。Objective To investigate the effects of montelukast （MK） on the airway inflammation and the risk of the recurrence of wheezing in the treatment of infants with RSV bronchiolitis. Methods 60 infants （aged 6-24 months） with RSV bronchiolitis admitted between December 2010 and December 2011 were recruited in the study. They were randomly assigned into a conventional group and a MK group （ n = 30 in each group）. All patients received conventional treatments including inhalation of budsonide and so on. The subjects in the MK group received oral montelukast （4 mg qn for 12 weeks） additionally. The levels of serum cysteinyl leukotrienes （ CysLTs ）, total immunoglobuline E （ T-IgE ）, eosinophil cationic protein （ECP） and fractional exhaled nitric oxide （FeNO） were assayed before and after the treatments. The number of recurrence of wheezing was recorded through outpatient and telephone follow-up for 12 months. 30 healthy infants participating the health examination in outpatient were selected as control, and those who got atopic disease or respiratory tract infections recently were excluded. Results The levels of CysLTs,ECP and FeNO of the patients with RSV bronchiolitis before treatment were significantly higher than those in the normal control group, and the levels of CysLTs and FeNO were significantly decreased after treatment （P 〈 0. 05）. The levels of CysLTs and FeNO after treatment in the MK group was significantly lower than those in the conventional group. The level of ECP was significantly decreased after treatment in the MK group （P 〈 0. 05）,which was not significantly changed in the conventional group （ P 〉 0.05 ）. The number of recurrence of wheezing in the MK group was more less that that in the conventional group （ P 〈0. 05 ）. Conclusion Maintenance treatment with montelukast after the treatment of the acute phase of bronchiolitis can prevent recurrence of wheezing by suppressing airway inflammation in infants with RSV bronchiolitis.

关 键 词：毛细支气管炎 呼吸道合胞病毒 白三烯 孟鲁司特 

分 类 号：R725.6[医药卫生—儿科]