鼻用糖皮质激素联合白三烯受体拮抗剂对有合并症小儿腺样体肥大疗效及炎症因子的影响  

Effect of nasal glucocorticoid combined with leukotriene receptor antagonist on adenoidal hypertrophy with complications and inflammatory factors in children

作　　者：刘晓峰[1] 杜娟 崔莉[1] 王亚芳[1] 王登茂[1] 宋英鸾[1] 单春光[3] 耿江桥[1] LIU Xiaofeng;DU Juan;CUI Li;WANG Yafang;WANG Dengmao;SONG Yingluan;SHAN Chunguang;GENG Jiangqiao(Department of Otorhinolaryngology,Children's Hospital of Hebei Province,Pediatric Clinica Research Centre of Hebei Province,Shijiazhuang,Hebei 050031,China;Department of Thoracic Surgery,Children's Hospital of Hebei Province,Pediatric Clinica Research Centre of Hebei Province,Shijiazhuang,Hebei 050031,China;Department of Otorhinolaryngology Head and Neck Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北省儿童医院耳鼻咽喉科/河北省儿童健康与疾病临床研究中心,河北石家庄050031 [2]河北省儿童医院胸外科/河北省儿童健康与疾病临床研究中心,河北石家庄050031 [3]河北医科大学第二医院耳鼻咽喉头颈外科,河北石家庄050000

出　　处：《中国优生与遗传杂志》2022年第12期2179-2183,共5页Chinese Journal of Birth Health & Heredity

基　　金：河北省卫生健康委员会医学科学研究课题(20210839)。

摘　　要：目的探讨鼻用糖皮质激素联合白三烯受体拮抗剂对伴合并症的腺样体肥大(AH)患儿的疗效并探讨作用机制。方法纳入2020年1月至2022年1月就诊于河北省儿童医院耳鼻喉科门诊的AH患儿共135例。根据是否合并过敏性鼻炎或分泌性中耳炎分为有合并症组(46例)和无合并症组(89例)。给予所有患儿糠酸莫米松鼻喷雾剂联合孟鲁司特钠治疗3个月。主要观察指标为用药后的症状改善和不良反应发生情况,次要观察指标为血清炎症因子水平。获取治疗前后血清样本,通过酶联免疫吸附实验(ELISA)检测血清半胱氨酰白三烯(CysLTs)、白细胞介素2(IL-2)、白细胞介素6(IL-6)水平。通过对比用药前后症状改善率和不良反应发生率分析药物治疗的有效性与安全性。通过对比用药前后细胞因子差异分析药物作用机制。结果有合并症组患儿用药后的A/N值、打鼾、睡眠不安或多动、张口呼吸改善率显著高于无合并症组(均P<0.05);两组不良反应发生率无统计学差异(P=0.635);有合并症组用药前CysLTs、IL-2、IL-6水平均显著高于无合并症组(均P<0.05);有合并症组CysLTs、IL-2、IL-6改善程度显著高于无合并症组(均P<0.05)。结论对于有合并症AH患儿,鼻用糖皮质激素联合白三烯受体拮抗剂具有较好的治疗效果,其可能通过抑制机体的炎症因子水平发挥治疗作用。Objective To investigate the efficacy and mechanism of nasal glucocorticoid combined with leukotriene receptor antagonist in children with adenoid hypertrophy(AH). Methods A total of 135 children with AH who were admitted to the otolaryngology department of Children’s Hospital of Hebei Province from January 2020 to January 2022 were enrolled. According to whether allergic rhinitis or secretory otitis media was complicated, the children were divided into complication group(46 cases) and non-complication group(89 cases). All children were treated with mometasone furoate nasal spray combined with Montelukast odium for three months. The main observation indicators were symptom improvement and adverse reactions, and the secondary observation indexes were serum inflammatory factors. Serum samples were collected before and after treatment, and the levels of serum cysteine leukotriene(Cys LTs), interleukin 2(IL-2) and interleukin 6(IL-6) were determined by enzyme-linked immunosorbent assay(ELISA). The efficacy and safety of drug therapy were analyzed by comparing the rate of symptom improvement and the incidence of adverse reactions before and after treatment. The action mechanism of drugs was analyzed by comparing cytokine differences. Results The A/N value, snoring, restless or hyperactive sleep and improvement rate of mouth breathing in children of complication group were significantly higher than those in non-complication group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P=0.635). The levels of Cys LTs, IL-2 and IL-6 in complication group were significantly higher than those in non-complication group(ALL P<0.05). The improvement of Cys LTs, IL-2 and IL-6 in complication group was significantly higher than that in non-complication group(P<0.05). Conclusion For children with AH complicated allergic rhinitis or secretory otitis media, nasal glucocorticoid combined with leukotriene receptor antagonist has a good therapeutic effect, which mainly plays a thera

关 键 词：腺样体肥大 糠酸莫米松 孟鲁司特钠 过敏性鼻炎 分泌性中耳炎 

分 类 号：R766[医药卫生—耳鼻咽喉科]