| 摘要: |
| 目的:探讨白三烯受体拮抗剂辅助治疗肺炎支原体肺炎(MPP)伴喘息患儿的临床疗效及其对外周血白三烯C4(LTC4)和Th1/Th2细胞因子水平的影响。方法:将90例MPP伴喘息的住院患儿随机分为3组——常规治疗组、孟鲁司特干预组、布地奈德干预组,分别在入院时和治疗2周后采用酶联免疫吸附试验(ELISA)检测血清白三烯C4(LTC4)水平;双抗体夹心ABC-ELISA 法检测血清IL-4、IFN-γ、总IgE水平;并于入院时、治疗2周后进行咳嗽、喘息症状的评估。出院后随访6个月,通过电话询问和定期哮喘门诊复诊,由主治医师评估患儿咳嗽、喘息情况。另选取20例健康儿童为对照组。结果:干预后布地奈德干预组、孟鲁司特干预组患儿IL-4、总IgE水平低于常规治疗组,IFN-γ水平高于常规治疗组,差异有统计学意义(P<0.01);布地奈德干预组和孟鲁司特干预组的IL-4、IFN-γ、总IgE水平比较差异无统计学意义(P>0.05)。干预后布地奈德干预组与常规治疗组血清LTC4水平比较差异无统计学意义,但两组均明显高于孟鲁司特干预组,差异有统计学意义(P<0.01)。临床症状消失时间布地奈德干预组、孟鲁司特干预组与常规治疗组比较差异有统计学意义(P<0.01),布地奈德干预组与孟鲁司特干预组比较差异无统计学意义(P>0.05);孟鲁司特干预组与布地奈德干预组和常规治疗组比较6个月内喘息再发生率明显减少(P<0.01)。结论:白三烯受体拮抗剂能够调节Th1/Th2的失衡,减少白三烯C4的释放,减轻气道炎症和气道高反应性,从而可以控制MPP伴喘息患儿急性期的症状,并能减少喘息发作,对支原体肺炎合并喘息患儿发生哮喘有积极的预防作用。 |
| 关键词: 肺炎支原体肺炎 喘息 白三烯受体拮抗剂 干扰素-γ 白细胞介素-4 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2017.10.004 |
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| 基金项目:江苏大学医学临床科技发展基金项目,编号JLY20140098 |
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| Effect of Leukotriene Receptor Antagonist on the Prognosis of Children with Mycoplasma Pneumoniae Pneumonia and Wheezing |
| Cui Zhen, Jin Xiaoqun, Li Yonglian, Li Li, Su Yujie, Gui Liqiong, Gong Jianmei |
| (Putuo District People's Hospital of Shanghai, Shanghai 200333, China) |
| Abstract: |
| Objective: To explore the clinical efficacy of leukotriene receptor antagonist in the adjuvant therapy of children with Mycoplasma pneumoniae pneumonia (MPP) and wheezing, and its affection on the levels of leukotriene C4 (LTC4) and Th1/Th2 cytokine in their peripheral blood. Methods: Ninety hospitalized children with MPP and wheezing were randomly divided into three groups: conventional treatment group, montelukast intervention group and budesonide intervention group. On admission and two weeks after treatment, ELISA method was employed to detect LTC4 concentration, and double antibody sandwich ABC-ELISA method was employed to detect the concentrations of serum IL-4, IFN-γ and total IgE for each group. Furthermore, cough and wheezing were assessed on admission and two weeks after treatment. At 6-month follow-up, cough and wheezing were assessed by attending physicians by telephones or regular return visit to the asthma outpatient department. Results: After treatment, the levels of IL-4 and total IgE in the montelukast intervention group and budesonide intervention group were lower than those in the conventional treatment group, and the levels of IFN-γ in those two groups were higher than that in the conventional treatment group, which were showing statistically significant differences (P<0.01). There were no significant differences in the levels of IL-4, IFN-γ and total IgE between the montelukast intervention group and budesonide intervention group (P>0.05). After treatment, there was no statistically significant difference in the level of serum LTC4 between the budesonide intervention group and conventional intervention group, and those in both groups were higher than that in the montelukast intervention group, which were showing statistically significant differences (P<0.01). The improvements in clinical symptoms in the budesonide intervention group and montelukast intervention group were statistically different compared with those in the conventional treatment group (P<0.01), but there was no obvious difference between the budesonide intervention group and montelukast intervention group (P>0.05). Budesonide intervention group and montelukast intervention group had lower recurrence of asthma (P<0.01). Conclusion: The leukotriene receptor antagonists could regulate the imbalance of Th1/ Th2, reduce wheezing onset, and it play a role in the prevention of asthma. |
| Key words: Mycoplasma pneumoniae pneumonia wheezing leukotriene receptor antagonist IFN-γ IL-4 |
