毛细支气管炎及哮喘患儿分泌型磷脂酶A2水平对白三烯受体拮抗剂疗效的影响  

Study of secretory phospholipase A2 level in children with bronchiolitis and asthma and its effect on the curative efficacy of leukotriene receptor antagonist

作　　者：郭青[1] 沈照波 孙晓敏[1] 陈丹[1] 康平 GUO Qing;SHEN Zhao-bo;SUN Xiao-min;CHEN Dan;KANG Ping(Inpatient Area of General Internal Department of Western Hospital,the Affiliated Children's Hospital of Zhengzhou University (Henan Children's Hospital,Zhengzhou Children's Hospital),Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学附属儿童医院(河南省儿童医院,郑州儿童医院)西区普内一病区,河南郑州450000 [2]郑州大学附属儿童医院(河南省儿童医院,郑州儿童医院)呼吸科,河南郑州450000

出　　处：《广东医学》2019年第5期665-670,共6页Guangdong Medical Journal

基　　金：郑州市科技发展计划项目(编号:20150158)

摘　　要：目的探讨毛细支气管炎及支气管哮喘患儿外周血分泌型磷脂酶A2(secretory phospholipase A2,sPLA2)水平的意义及其对白三烯受体拮抗剂疗效的影响。方法收集毛细支气管炎患儿(毛支组)和支气管哮喘患儿(哮喘组)各80例,同时收集健康对照患儿40例(对照组),毛支组和哮喘组均采用孟鲁司特药物方案进行治疗。检测各组治疗前后外周血sPLA2、白三烯C4(leukotriene C4,LTC4)、白细胞介素-4(interleukin-4,IL-4)、γ干扰素(interferon-γ,IFN-γ)、免疫球蛋白E(immunoglobulin E,IgE)和尿白三烯E4 (leukotriene E4,LTE4)水平并比较;分析sPLA2与各指标相关性;比较不同sPLA2水平组间疗效差异。结果毛支组和哮喘组sPLA2水平均显著高于对照组(P<0.05);sPLA2水平与白三烯及炎症指标均有显著相关性(P<0.05);毛支组不同sPLA2水平组疗效差异有统计学意义(χ~2=7.683,P=0.021),高sPLA2组患儿病情严重程度、发热和咳嗽消失时间以及复发比例均高于低sPLA2组(P<0.05);哮喘组不同sPLA2水平组疗效差异无统计学意义(χ~2=3.360,P=0.186),但高sPLA2组患儿呼出气一氧化氮高于低sPLA2组(P<0.05)。两组的低sPLA2组对炎症因子水平改善情况均优于高sPLA2组。结论 sPLA2水平与毛细支气管炎患儿病情及白三烯受体拮抗剂疗效密切相关,与哮喘患儿的气道炎症程度相关,但与其疗效无显著相关性。Objective To discuss the significance of secretory phospholipase A2(sPLA2) in children with bronchiolitis and asthma and its effect on the curative efficacy of leukotriene receptor antagonist. Methods Eighty children with bronchiolitis, 80 children with asthma and 40 health controls were selected. The patients were treated with leukotriene receptor antagonist. The sPlA2, leukotriene C4(LTC4), interleukin-4(IL-4), interferon-γ(IFN-γ) and immunoglobulin E(IgE) in peripheral blood and urinary leukotriene E4(LTE4) were measured and compared before and after treatment. The correlations of sPLA2 with other indexes were analyzed and the curative effect were compared. Results The sPLA2 in bronchiolitis group and asthma group were significantly higher than controls(P<0.05). The sPLA2 was significantly correlated with the leukotriene indexes and inflammation indexes(P<0.05). In bronchiolitis group, the curative efficacies among different sPLA2 level groups were significantly different(χ^2=7.683, P=0.021). The clinical crisis, fever disappeared time, cough disappeared time and recurrence ratio in high sPLA2 group were significantly higher than low sPLA2 group(P<0.05). In asthma group, there was no significant difference in curative efficacies among different sPLA2 level groups(χ^2=3.360, P=0.186), but the fractional exhaled nitric oxide in high sPLA2 group were significantly higher than low-sPLA2 group(P<0.05). In the both groups, the index improvement in low sPLA2 group were significantly better than high sPLA2 group(P<0.05). Conclusion The level of sPLA2 is correlated with the state and curative effect of leukotriene receptor antagonist for bronchiolitis children;is correlated with the airway inflammation but not with the curative efficacy for asthma.

关 键 词：分泌型磷脂酶A2 白三烯 毛细支气管炎 支气管哮喘 炎症 

分 类 号：R725.6[医药卫生—儿科] R562.2[医药卫生—临床医学]