持续性变应性鼻炎患者白三烯代谢水平与抗白三烯治疗反应的相关性研究

目的 探讨持续性变应性鼻炎(AR)患者白三烯代谢水平与抗白三烯治疗临床疗效的关系,为临床选择用药提供指导.方法 对78例持续性AR患者进行4周孟鲁司特治疗试验.观察症状/体征评分、血嗜酸细胞百分比(Eos％)分类计数、血清总IgE、尿白三烯D4 (urinary leukotrieneu D4,uLTD4)的变化.二分类Logistic回归分析观察指标与治疗反应的相关性.结果 48例有明显临床改善(有效组),30例无明显改善(无效组).有效组患者uLTD4质量浓度明显高于无效组[(1755.3±375.1)pg/ml creatinine vs (225.5±346.4) pg/ml creatinine,P＜0.05);而Eos％、血清IgE差异均无统计学差异(P＞0.05).Spearman回归分析提示,有效组治疗前症状/体征与uLTD4存在负相关性(r=-0.352,P＜0.05).Logistic回归分析示孟鲁司特疗效与uLTD4有相关性.当治疗前uLTD4≥1200 pg/ml creatinine时,其OR=3.5,95％CI为(1.7,15.8);其他指标则无相关性.结论 uLTD4水平与孟鲁司特治疗临床疗效密切相关,可作为选择抗白三烯类药物的参考标志物.

Study on relationship between urinary levels of leukotriene D4 and clinical response to anti- leukotriene treatment in patients with persistent allergic rhinitis

OBJECTIVE To investigate the relationship between urinary leukotriene D4 level （uLTD4） and clinical response to montelukast treatment in patients with persistent allergic rhinitis. METHODS Seventy eight patients with persistent allergic rhinitis received 84 weeks treatment with to montelukast. The symptom/sign score, serum total IgE level, blood white cell counts were recorded before and after treatment. RESULTS There were 48 patients improved and 30 patients with no improvement. The uLTD4 level was much higher in improved patients than that in no improved patients （P〈0.05） , but there were no difference between the two groups in Eos% and serum total IgE level （P〉0.05） . The Spearman regression analysis showed that the symptom/sign score before treatment in improved group had a negative relation with uLTD4 level. When the uLTD4≥ 1200 pg/ml creatinine before treatment, the OR=3.5, 95% Clwas （1.7, 15.8） . CONCLUSION The uLTD4 level has a correlation with the efficacy of montetukast and it can be used as a biomarker for selecting anti-leukotriene treatment in persistent allergic rhinitis patients.