吸人糖皮质激素与口服孟鲁司特治疗咳嗽变异型哮喘的疗效比较及随访研究

目的 比较吸入糖皮质激素(ICS)和口服白三烯调节剂(LTM)对儿童咳嗽变异型哮喘(CVA)的疗效,探讨儿童CVA的最佳治疗方案,并探讨CVA发展为典型哮喘的相关危险因素.方法 将84例年龄(3.9±1.2)岁(2～6岁)的CVA患儿随机分为ICS组(42例)和LTM组(42例).ICS组患儿通过定量气雾剂+储雾罐规律吸人二丙酸倍氯米松200 μg/d维持治疗,LTM组患儿每晚口服孟鲁司特5 mg维持治疗,治疗时间6个月,停用试验药物治疗后继续随访18个月.结果 ICS组平均止咳天数为(14±9)d,LTM组平均止咳天数为(13±9)d,两组问比较差异无统计学意义(Z=1.12,P=0.25).在24个月的研究观察期间,ICS组出现喘息的比率(7.1%)明显低于LTM组(33.3%)(x2=8.92,P=0.003).喘息组患儿湿疹和变应性鼻炎的患病率分别为47.1%和58.8%,明显高于无喘息组(分别为19.4%和31.3%)(x2分别为4.16和4.40,P均＜0.05).多因素逐步回归分析结果显示,湿疹和变应性鼻炎是CVA发展为典型哮喘的危险因素,OR值分别为7.668和3.855(P分别为0.002和0.049),而规律吸入ICS是有效的保护因素,其OR值为0.128(P=0.008).结论 CVA患者可转化为典型哮喘,接受ICS治疗的患儿出现喘息的比率低于接受LTM治疗的患儿,湿疹和过敏性鼻炎是CVA发展为典型哮喘的危险因素.

Therapeutic efficacy and follow-up study of inhaled corticosteroids vs. oral montelukast in treatment of cough variant asthma

Objective To compare the effects of inhaled corticosteroids(ICS)and oral leukotriene modifier(LTM)montelukast on the prognosis of children with cough variant asthma(CVA),and to identify the related risk factors for the development of classic asthma in children with CVA.Methods Eighty-four children with CVA(2-6 yrs)were randomized to receive inhaled beclomethasone dipropionate 200 μg/d through pressurized metered-dose inhaler(MDI)plus spacer with mask or oral montelukast 5 mg,once at bedtime for 6 months,then followed by 18 months observation period after the end of the study medication.Results There was no significant difference in antitussive days between the two groups(ICS group:14±9 days,LTM group:13±9 days,Z=1.12,P=0.25).Wheezing developed in 7.1% of the children in ICS group during 24 months follow-up period,which was significantly lower than that in LTM group(33.3%,x2=8.92,P=0.003).The prevalence of eczema or allergic rhinitis was higher in children who developed wheezing than those who did not develop wheezing(eczema:47.1% vs.19.4%,x2=4.16,P:0.042;allergic rhinitis:58.8% vs.31.3%,x2=4.40,P=0.036).Logistic regression analysis confirmed that eczema and allergic rhinitis were risk factors for wheezing development in children with CVA,the odds ratio was 7.668 and 3.855 respectively(P＜0.05 for all).But administration of ICS was negatively correlated with the development of wheezing by an odds ratio of 0.128(P=0.008).Conclusions Children with CVA may progress to classic asthma;eczema and allergic rhinitis are two risk factors for wheezing development in children with CVA.Both ICS and LTM are effective antitussive treatment,but ICS may be more effective than LTM on preventing the progression of CVA to classic asthma.