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目的:观察孟鲁司特钠联合糖皮质激素对中重度哮喘患儿肺功能影响及协同抗炎作用,探讨其临床作用机制。方法:将符合入选标准的70例中重度哮喘患儿按随机数字表法分为观察组35例和对照组35例。两组患儿急性期均给予常规方法治疗,对照组同时给予布地奈德100~200μg/d雾化吸入治疗,观察组给予孟鲁司特钠每晚5 mg口服联合布地奈德100~200μg/d雾化吸入治疗,疗程均为3个月。观察两组患儿治疗前后症状改善情况,并检测肺功能,采用IRMA法检测血浆lgE水平,常规方法测定血嗜酸粒细胞(EOS)计数,ELISA法测定血清IL-4、IL-5、IL-10、IL-25水平,并进行临床疗效评判。结果:①观察组和对照组治疗后FEV1%、FEF50%、FEF25%、PEF%均明显升高,但治疗后观察组FEV1%、FEF50%、FEF25%、PEF%均明显高于对照组,两组比较差异具有统计学意义;②观察组和对照组治疗后IL-4、IL-5、IL-10、IL-25、IgE水平和EOS计数均显著改善,但观察组IL-4、IL-5、IL-25、IgE水平和EOS计数明显低于对照组,IL-10水平明显高于对照组,两组比较差异具有统计学意义(P<0.05);③观察组和对照组的总有效率分别为91.43%和80.00%,两组比较差异有统计学意义(χ2=16.62,P<0.01)。结论:孟鲁司特钠联合糖皮质激素治疗中重度哮喘疗效确切,能够明显改善患儿肺功能,通过不同途径协同抑制气道炎症,明显降低患儿的气道高反应性,是治疗中重度哮喘的理想方法。
Objective: To observe the effect of montelukast combined with glucocorticoids on lung function and synergistic anti-inflammatory effect in children with moderate-severe asthma and to explore its clinical mechanism. Methods: Seventy patients with moderate-to-severe asthma who met the inclusion criteria were divided into observation group (n = 35) and control group (n = 35) according to random number table. The two groups of children were given routine treatment of acute phase, while the control group was given budesonide 100 ~ 200μg / d inhalation therapy, the observation group were given montelukast sodium 5 mg per night combined with budesonide 100 ~ 200μg / d inhalation therapy, treatment were 3 months. The symptoms of the two groups were observed before and after treatment. The lung function was measured. The plasma lgE levels were measured by IRMA. The counts of blood eosinophils (EOS) were measured by routine methods. The levels of IL-4, IL-5, IL -10, IL-25 levels, and clinical efficacy evaluation. Results: ① After treatment, the FEV1%, FEF50%, FEF25% and PEF% of the observation group and the control group were significantly increased, but the FEV1%, FEF50%, FEF25% and PEF% of the observation group and the control group were significantly higher than those of the control group The levels of IL-4, IL-5, IL-10, IL-25, IgE and EOS in the observation group and the control group were significantly improved after treatment. However, the levels of IL-4 and IL- 5, IL-25, IgE levels and EOS count were significantly lower than the control group, IL-10 levels were significantly higher than the control group, the difference between the two groups was statistically significant (P <0.05); ③ observation group and control group, total The efficiencies were 91.43% and 80.00%, respectively, with significant difference between the two groups (χ2 = 16.62, P <0.01). Conclusion: Montelukast combined with glucocorticoids in the treatment of moderate and severe asthma is effective, can significantly improve children’s lung function, synergistic inhibition of airway inflammation by different ways, significantly reduce airway hyperresponsiveness in children, is the treatment of moderate to severe The ideal method of asthma.