青霉素过敏患者白细胞介素13血清浓度及其基因多态性

目的探讨青霉素类抗生素过敏反应与白细胞介素13(IL-13)及其基因多态性的关系。方法采用ELISA检测51例青霉素过敏患者和20例健康人血清IL-13浓度,放射过敏原吸附试验检测血清中8种青霉素特异性IgE抗体水平,聚合酶链反应-限制性片段多态性分析法检测IL-13+2044G/A多态性位点的基因型。结果青霉素过敏患者血清IL-13浓度的中位数为19.80(0.10,50.00)ng·L-1,显著高于健康对照组1.68(0.20,22.90)ng·L-1,而且血清IL-13浓度随着青霉素特异性IgE抗体阳性种类的增加而增加。IL-13+2044G/A多态性位点等位基因频率与健康对照组无明显差异,GG基因型患者血清氨苄西林主要抗原决定簇IgE抗体水平显著高于GA和AA基因型患者。结论青霉素过敏反应可能与血清IL-13浓度升高有关;IL-13+2044G/A基因多态性可能与某些青霉素特异性IgE抗体浓度升高有关。     

A simple exercise test in assessment of asthma

Exercise-induced asthma (EIA) is a manifestation of the bronchial hyper-responsiveness of asthmatic patients. Laboratory methods for measuring EIA are now well standardised. We compared a stepping test with a standard treadmill exercise test to determine whether the sensitivity of the latter could be maintained with the simplified test. We used heart rate as a measure of exercise intensity and changes in forced expiratory volume in 1 second (FEV1) to record bronchial responsiveness. In 32 adolescent asthmatic patients we demonstrated a fall in FEV1 of 10% or more in 27 following the treadmill test and in 25 following the stepping test. There was a strong correlation between the maximum falls of FEV1 following the two exercise challenges (r = 0.92 p less than 0.0001). There was poor agreement between the patient's history of EIA and the demonstration of a 10% fall of FEV1 after exercise in 11 patients. Notably all six patients who claimed no association of exercise with their asthma symptoms clearly demonstrated a fall in FEV1 of 10% or more following the treadmill challenge. We conclude that a simplified exercise test can be both objective and sensitive in detecting EIA and therefore useful in the assessment of the asthmatic patient and the effect of therapy.     

Pretreatment with albuterol versus montelukast for exercise-induced bronchospasm in children

STUDY OBJECTIVES: To compare pretreatment with albuterol versus montelukast added to the current asthma regimen for protection against exercise-induced bronchospasm in children with mild-to-moderate asthma, and to determine whether cysteinyl leukotriene (Cys-LT) concentrations measured in the exhaled breath condensate correlated with response to montelukast. DESIGN: Prospective, randomized, double-blind, double-dummy, crossover study. SETTING: Asthma clinic at a university-affiliated medical center. PATIENTS: Eleven children aged 7-17 years with physician-diagnosed mild-to-moderate asthma for at least 6 months and with self-reported exercise-induced bronchospasm (defined as > or = 15% decrease in forced expiratory volume in 1 sec [FEV(1)] at screening and baseline visit). INTERVENTION: Patients were randomly assigned to receive 3-7 days of oral montelukast 5-10 mg/day or 2 puffs of an albuterol metered-dose inhaler just before an exercise challenge and then were crossed over to the alternate therapy for the last visit. MEASUREMENTS AND MAIN RESULTS: Serial spirometry was performed before and at 0, 5, 10, 15, 30, 45, and 60 minutes after the exercise challenge at each visit. Measurement of exhaled breath condensate was performed at the screening visit and study visits 1 and 2. The primary outcome was the maximum change in FEV(1) after exercise. Secondary outcomes were the area under the curve for FEV(1) (expressed as percentage decrease from baseline) during the first 60 minutes (AUC(0-60)) after exercise and the proportion of patients in whom exercise-induced bronchospasm was prevented (defined as < 15% decrease in FEV(1) after exercise challenge). The mean +/- SD maximum decrease in FEV(1) was 27.5 +/- 7.9% at baseline. Patients receiving montelukast had an 18.3 +/- 13.7% decrease in FEV(1) compared with 0.7 +/- 1.6% in patients receiving albuterol (p=0.002, paired t test). Exercise-induced bronchospasm was prevented in 100% of the patients receiving albuterol compared with 55% receiving montelukast (p<0.05, McNemar's test). The AUC(0-60) was significantly smaller with albuterol compared with montelukast (p<0.001, Wilcoxon signed rank test). No correlations were found between Cys-LT concentration and the severity of exercise-induced bronchospasm or the response to montelukast. CONCLUSION: Pretreatment with albuterol is more effective than montelukast for prevention of exercise-induced bronchospasm in children with asthma.     

High-dose montelukast exposures in a 3-year-old and a 5-year-old child

The leukotriene receptor antagonists (LTRAs) is a relatively new class of asthma medication with a lack of toxicity for unintentional poisoningsituations. This makes it difficult to determine which exposures require aggressive decontamination or simple monitoring in the home setting: prompting the question, "What LTRA dose is likely to produce significant toxicity?" We report a case of an unintentional poisoning with 80 mg montelukast in a 3-y-o asthmatic child that was managed in the home with observation alone and a second case of untentional 135 mg montelukast poisoning in a 5-y-o asthmatic child managed in an emergency department. In both cases, symptoms were not observed. These cases and available literature suggest that doses < 4.5 mg/kg in children result in minimal toxicity.     

Prevention of exercise-induced asthma by a fixed combination of disodium cromoglycate plus reproterol compared with montelukast in young patients

BACKGROUND: The leukotriene inhibitor montelukast has been recommended against exercise-induced asthma (EIA), however, single-dose agents might be favourable in several aspects. OBJECTIVE: To compare the protective effects against EIA of a single inhalation of the combination disodium cromoglycate (DSCG, CAS 16110-51-3) and reproterol (REP, CAS 54063-54-6) with 3 days oral treatment of montelukast (MON, CAS 158966-92-8). METHODS: Open-label, cross-over, single-centre trial. Twenty-four 6 to 18-year-old children and adolescents, with reversible and stable airway obstruction, baseline FEV1 > or = 70%, predicted and proven EIA (i.e. a maximum decrease of FEV1 by > or = 20% compared with baseline) were treated with MON, orally for 3 days in the evening, or one single inhalation of DSCG/REP 20 min before the exercise challenge. The treatment sequence was randomised. The exercise test on a treadmill was performed under standardised conditions. RESULTS: 24 patients completed both periods. Both treatments clearly provided protection against EIA; however, protection of DSCG/REP was more pronounced than that of MON. This difference was statistically significant even if the data were adjusted for the increase in FEV1 between inhalation of DSCG/REP and challenge (DSCG/REP(adjusted). The nadir FEV1 level after exercise following prophylaxis with DSCG/REP was even higher than the pre-inhalation FEV1 value. From these data, protection indices of 66%, 81%, and 113% for MON, DSCG/REP(adjusted), and DSCG/REP(unadjusted), respectively, were estimated. CONCLUSIONS: Inhalation of DSCG/REP before exercise provides significantly better protection against EIA than three days treatment with MON.     

Bronchoconstriction provoked by exercise in a high-particulate-matter environment is attenuated by montelukast

Airborne ultrafine and fine particulate matter (PM1 from fossil-fueled internal combustion engines may cause abnormal airway narrowing. Because of high PM1 exposure from ice resurfacing machines, the ice-rink athlete is especially vulnerable to PM1 toxicity. The purpose of this study was to evaluate protection by a single dose of montelukast in college ice hockey players following PM1 exposure exercise. Nine male ice hockey players (age 19.3+/-1.22 yr) performed 4 randomized, double-blinded, high-intensity, 6-min cycle ergometer trials in low [PM1] (2260+/-500 particles/cm3) and high [PM1] (348,600+/-121,600 particles/cm3) after placebo or montelukast. Pre- and postspirometry showed similar peak FEV1 (forced expiratory volume in 1 s) falls between placebo and montelukast after low [PM1] trials (14.5+/-18.06 vs. 9.5+/-11.75% of baseline, respectively). Peak FEV1 falls after high [PM1] trials were greater for placebo than for montelukast (17.3+/-9.79% vs. 1.7+/-5.77% of baseline; p<.0001). High [PM1] FEV1 fall after exercise following montelukast ingestion was less than after exercise following placebo ingestion under high and low [PM1] conditions and after exercise following montelukast ingestion under low [PM1] conditions at 5, 10, and 15 min postchallenge (p<.004, .0006, .009, respectively). Montelukast provided greater protection against bronchoconstriction after exercise during high [PM1] than low [PM1] exposure (approximately 90% vs. approximately 35%), suggesting that bronchoconstriction from PM1 exposure is predominately leukotriene mediated. The precise mechanism of airborne PM1-induced leukotriene-mediated airway narrowing remains unclear.     

Montelukast modulates lung CysLT(1) receptor expression and eosinophilic inflammation in asthmatic mice

AIM: To determine the expressions of cysteinyl leukotriene receptors, CysLT1 and CysLT2, in airway eosinophilic inflammation of OVA-induced asthmatic mice and the modulation by montelukast, a CysLT1 receptor antagonist. METHODS: Asthma model was induced by chronic exposure to ovalbumin (OVA) in C57BL/6 mice. The eosino-phils in bronchoalveolar lavage (BAL) fluid and lung tissues were counted, IL-5 level in BAL fluid was measured, and CysLT1 and CysLT2 receptor mRNA expressions were detected by semi-quantitative RT-PCR. RESULTS: Montelukast (6 mg/kg, once per day for 20 d) significantly suppressed the increased eosinophils in BAL fluid and lung tissue, and increased IL-5 level in BAL fluid in OVA challenged mice. OVA challenge increased CysLT1 but decreased CysLT2 receptor mRNA expression. Montelukast inhibited the increased CysLT1 but not the reduced CysLT2 expression after OVA challenge. CONCLUSION: CysLT receptors are modulated immunologically, and montelukast inhibits up-regulation of CysLT1 receptor     

A review of montelukast in the treatment of asthma and allergic rhinitis

Montelukast sodium (Singulair, Merck) is a selective and orally-active leukotriene-receptor antagonist (LTRA) that inhibits the cysteinyl leukotriene 1 (CysLT1) receptor. Montelukast is an effective and well-tolerated preventative treatment for asthma and allergic rhinitis in adults and children. The upper and lower airway show similar inflammatory responses to allergen challenge. Leukotrienes are inflammatory mediators that are known as the slow-reacting substance of anaphylaxis produced by a number of cell types including mast cells, eosinophils, basophils, macrophages and monocytes. Synthesis of these mediators results from the cleavage of arachidonic acid in cell membranes and they exert their biological effects by binding and activating specific receptors. This occurs in a series of events that lead to contraction of the human airway smooth muscle, chemotaxis and increased vascular permeability. These effects have led to their important role in the diseases of asthma and allergic rhinitis. As these agents lead to the production of symptoms in patients that are asthmatic or allergic, the use of LTRAs, particularly montelukast, may seem appropriate. Clinical trials have shown that montelukast is effective and safe in the treatment of patients with asthma, allergic rhinitis or both diseases.     

Microvascular theory of exercise-induced bronchoconstriction in asthma: potential implication of vascular endothelial growth factor

Exercise-induced bronchoconstriction (EIB) is used to describe the increase in airway resistance that follows exercise in asthmatic patients. To date, two major hypotheses, water- and heat-loss theory, have been put forward to explain the mechanism of EIB. However, there is increasing evidence that airway microcirculation has the potential to contribute to the pathophysiological mechanisms of EIB. Bronchial asthma is a chronic airway inflammatory disease associated with airway remodeling, including the growth and proliferation of new blood vessels. Airway microvascular remodeling is likely to be induced by several growth factors, such as vascular endothelial growth factor (VEGF). VEGF has powerful effects on vascular function and also increases microvascular permeability. In this respect, high expression of VEGF in asthmatic airways contributes to the pathogenesis of EIB via increased airway microvascular permeability. Moreover, endothelial cells in airway microcirculation stimulated by high levels of VEGF is sensitive to exercise challenge and therefore, the change in circulating thrombomodulin levels with exercise can be an index of functional properties in endothelial cells. In this review, we will demonstrate the possible roles of VEGF on EIB in asthmatic patients in details. I will then propose a molecular mechanism explaining the microvascular theory of EIB based on functional abnormalities of endothelial cells in newly generated microvessels in asthmatic airways. These findings suggest that the intervention against VEGF offers a possible new strategy for the treatment of EIB in asthmatic patients.     

孟鲁司特对哮喘患儿胸腺和活化调节趋化因子的干预作用

目的探讨孟鲁司特对哮喘患儿胸腺和活化调节趋化因子（TARC）的干预作用,探寻儿童哮喘新的治疗方案。方法100例哮喘患儿随机分两组,哮喘孟鲁司特治疗组（50例）予口服孟鲁司特,哮喘布地奈德治疗组（50例）予布地奈德雾化吸入,同期在该院儿科住院的急性支气管炎无喘患儿50例为对照组雾化吸入生理盐水,检测各组用药前及用药后血清、痰液TARC的含量。结果用药前哮喘组TARC的含量明显高于对照组（P〈0．05）,用药后孟鲁司特治疗组与布地奈德治疗组TARC的含量均明显下降（P〈0．05）,下降幅度与对照组比较差异有统计学意义（P〈0．05）,孟鲁司特治疗组与布地奈德治疗组TARC的下降幅度无明显差异（P〉0．05）。结论TARC参与了儿童哮喘气道炎症的发生,孟鲁司特可减轻哮喘患儿TARC的水平,缓解患儿哮喘症状,且用药方便、安全性高。     

A review of montelukast in the treatment of asthma and allergic rhinitis

Montelukast sodium (Singulair^®, Merck) is a selective and orally-active leukotriene-receptor antagonist (LTRA) that inhibits the cysteinyl leukotriene 1 (CysLT1) receptor. Montelukast is an effective and well-tolerated preventative treatment for asthma and allergic rhinitis in adults and children. The upper and lower airway show similar inflammatory responses to allergen challenge. Leukotrienes are inflammatory mediators that are known as the slow-reacting substance of anaphylaxis produced by a number of cell types including mast cells, eosinophils, basophils, macrophages and monocytes. Synthesis of these mediators results from the cleavage of arachidonic acid in cell membranes and they exert their biological effects by binding and activating specific receptors. This occurs in a series of events that lead to contraction of the human airway smooth muscle, chemotaxis and increased vascular permeability. These effects have led to their important role in the diseases of asthma and allergic rhinitis. As these agents lead to the production of symptoms in patients that are asthmatic or allergic, the use of LTRAs, particularly montelukast, may seem appropriate. Clinical trials have shown that montelukast is effective and safe in the treatment of patients with asthma, allergic rhinitis or both diseases.     

G894T polymorphism of eNOS gene is a predictor of response to combination of inhaled corticosteroids with long-lasting β(2)-agonists in asthmatic children

Aim: Nitric oxide synthase enzymes have an important role in airway inflammation in asthmatic children. In the present study, the association between eNOS gene polymorphisms and response to inhaled corticosteroids (ICS) and long-lasting β(2)-agonists (LABAs) was investigated. Patients & methods: A total of 81 asthmatic children treated with ICS plus LABAs and 96 healthy controls were genotyped for eNOS G894T and -786T/C polymorphisms and their haplotypes using the PCR-RFLP method. Results: G894T and -786T/C polymorphisms were not associated with asthma susceptibility. Among asthmatic children, 894TT carriers had higher change in forced expiratory volume in 1 s (FEV(1)) in response to ICS plus LABAs compared with 894GG carriers (21.9 ± 3.8 vs 1.6 ± 1.9%; p < 0.001). In responders (FEV(1) change ≥7.5%), frequency of 894TT genotype was significantly higher than in nonresponders (26.2 vs 2.6%, p < 0.001). Results for the -786T/C polymorphism alone were less clear and in most cases nonsignificant. Conclusion: The G894T polymorphism was associated with response to ICS and may serve as a useful pharmacogenetic marker of response to ICS plus LABAs in asthmatic children. Original submitted 10 May 2012; Revision submitted 13 July 2012.     

The effect of physiological manoeuvres on the absorption of inhaled nedocromil sodium.

In a previous study we showed, in both asthmatic patients and in healthy subjects, a marked increase in plasma concentration of nedocromil immediately following an exercise challenge with associated FEV1 measurements. To identify which component of the exercise challenge is responsible, we have now studied the effect of various manoeuvres on plasma nedocromil concentration in eight healthy subjects after inhalation of 1 ml nedocromil solution (1% w/v) via a Wright nebuliser. Each patient was dosed on six occasions, separated by at least 3 days. Between 15 and 23 min after dosing one of the following manoeuvres was performed: control (no manoeuvre); steady exercise for 8 min, a series of FEV1 measurements, exercise plus FEV1 measurements, three Valsalva manoeuvres and hyperventilation for 3 min. Mean plasma drug concentrations under control conditions were similar at 15 and 23 min after dosing. However, there were significant increases in plasma drug concentration following exercise, FEV1 manoeuvres and exercise plus FEV1 manoeuvre. There were no significant changes in plasma drug concentration following Valsalva manoeuvres and hyperventilation. The results suggest that certain manoeuvres increase the absorption of nedocromil sodium, probably as a consequence of an increase in lung volume.     

丙卡特罗联合孟鲁司特治疗儿童支气管哮喘的疗效观察

目的:探讨丙卡特罗联合孟鲁司特治疗儿童支气管哮喘的疗效及其对趋化素样因子-1(CKLF-1)、嗜酸粒细胞阳离子蛋白(ECP)、白细胞介素-12(IL-12)、IL-13水平及肺功能的影响。方法:选取我院2017年8月至2019年4月收治的支气管哮喘患儿94例,按随机数表法分为对照组和观察组各47例,两组患儿均接受抗炎、平喘、扩张支气管等常规治疗,对照组给予孟鲁司特钠片,观察组在对照组治疗基础上给予丙卡特罗治疗,比较两组患儿治疗后的临床疗效,分析治疗前后两组CKLF-1、ECP、IL-12、IL-13水平及肺功能变化情况。结果:观察组总有效率高于对照组(P<0.05),不良反应发生率(8.51%)与对照组(4.26%)比较差异无统计学意义(P>0.05)。治疗前,两组患儿CKLF-1、ECP、IL-12、IL-13水平及肺功能指标比较差异无统计学意义(P>0.05);治疗后观察组IL-12、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、呼气峰流速值(PEF)、呼气高峰流量(PEFR)水平高于对照组,CKLF-1、ECP、IL-13水平低于对照组(P<0.05)。结论:丙卡特罗联合孟鲁司特治疗儿童支气管哮喘可改善肺功能,调节CKLF-1、ECP、IL-12、IL-13表达水平,提高临床疗效,且不增加不良反应。     

H2-receptor blockade and exercise-induced asthma.

While in vitro studies suggest that H2-receptor blockade enhances mediator release from bronchial mast cells and leads to bronchoconstriction, in vivo studies have given conflicting results. Eight asthmatic subjects were given cimetidine 800 mg and placebo double-blind on different days. Baseline values of forced expiratory volume in one second (FEV1) were obtained before an 8 min standardized exercise test using a bicycle ergometer. Subjects inhaled cold, dry air and exercise on cimetidine and placebo days was matched for ventilation and thermal load. FEV1 was measured immediately, 5, 10, 15, and 20 min after exercise. No significant differences were observed between mean baseline FEV1, immediate post exercise FEV1, or maximum percentage fall from baseline after exercise on cimetidine or placebo days. Cimetidine does not appear to effect lung function or bronchial responses to cold air exercise challenge.     

白三烯拮抗剂孟鲁斯特钠联合舒利迭治疗老年哮喘的疗效

目的 探讨白三烯拮抗剂孟鲁斯特钠联合舒利迭治疗老年哮喘的临床疗效.方法 将我院老年哮喘患者62例随机分为两组,两组患者均给予常规治疗.对照组31例,在常规治疗基础上给予舒利迭雾化吸入治疗(每日2次,每次250μg);实验组31例,在常规治疗基础上给予白三烯拮抗剂孟鲁斯特钠(每晚1次,每次10 mg)联合舒利迭雾化吸人(每日2次,每次250μg)治疗,比较两组患者的治疗效果.结果 两组患者治疗后的症状和肺部功能均有明显效果(总有效率分别为90.32％、70.97％),其中实验组患者治疗后的临床症状与肺部功能改善更佳[一秒量( FEV1.0):(2.24±0.41)L vs.(1.92±0.27)L,一秒率(FEV1.0％):( 0.45±0.11)vs.(0.37±0.09),用力吸气峰流速(PEF):(4.55±0.12) L/s vs.(4.03±0.27) I/s],两组比较差异有统计学意义(P＜ 0.05).结论 白三烯拮抗剂孟鲁斯特联合吸入舒利迭治疗老年哮喘具有较好的治疗效果,值得在临床应用.     

Early protective effects of tiotropium bromide in patients with airways hyperresponsiveness

Tiotropium is an anticholinergic drug for Chronic Obstructive Pulmonary Disease (COPD) patients, with a peak bronchodilator effect observed after 1.5 to 2 hours and a long duration of action. The aim of our study was to quantify the early protection of a single dose of inhaled tiotropium against methacholine-induced bronchoconstriction in asthmatic patients with airway hyperresponsiveness. Ten subjects (7M, 3F), with history of asthma and a baseline FEV(1) (Forced Expiratory Volume 1 sec) > 80% of predicted, were enrolled in the study. Each subject performed three methacholine challenge tests, with a time of 72 hours between each challenge: Test A (methacholine challenge test), and successively, at random, Test B (methacholine 30 minutes after inhaled Tiotropium) and Test C (methacholine 30 minutes after inhaled Placebo). PD20 (Provocative Dose causing a 20% decrease in basal FEV(1) value) was reached to assess airways responsiveness. All the subjects showed in Test A and Test C a mild-moderate airway hyperresponsiveness. In Test B no PD20 was reached at the inhaled maximum dose of methacholine (1600 microg), FEV(1) before tiotropium was 88.6% +/- 4.4, beginning test FEV(1) 92.6% +/- 4.3, end test FEV(1) 85.7% +/- 4.6. Inhaled tiotropium bromide 18 microg has shown a protective effect against methacholine-induced bronchoconstriction in asthmatic patients, with mild-moderate airways hyperresponsiveness, already 30 minutes after its administration.     

Exercise-induced bronchoconstriction

Exercise-induced asthma, or more appropriately, exercise-induced bronchoconstriction (EIB), occurs in 80 to 90% of individuals with asthma and in approximately 11% of the general population without asthma. EIB is characterised by post-exercise airways obstruction resulting in reductions in forced expiratory volume in 1 second (FEV(1)) of greater than 10% compared with pre-exercise values. The mechanism of EIB remains elusive, although both cooling and drying of airways play prominent roles. Cold, dry inhaled air during exercise or voluntary hyperventilation is the most potent stimulus for EIB. Inflammatory mediators play central roles in causing the post-exercise airways obstruction. Diagnosis of EIB requires the use of an exercise test. The exercise can be a field or laboratory based test, but should be of relatively high intensity (80 to 90% of maximal heart rate) and duration (at least 5 to 8 minutes). Pre- and post-exercise pulmonary function should be compared, and post exercise pulmonary function determined over 20 to 30 minutes for characterisation of EIB. A pre- to post-exercise drop in FEV(1) of greater than 10% is abnormal. Approaches to treatment of EIB include both nonpharmacological and pharmacological strategies. A light exercise warm up prior to moderate to heavy exercise reduces the severity of EIB. More recently, studies have supported a role for dietary salt as a modifier of the severity of EIB, suggesting that salt restrictive diets should reduce symptoms of EIB. Short acting, inhaled beta(2)-agonists constitute the most used prophylactic treatment for EIB. However, antileukotriene agents are emerging as effective, well tolerated, long-term treatments for EIB.     

Dyphylline versus theophylline: a double-blind comparative evaluation

This study was a randomized double-blind evaluation of three doses of dyphylline, theophylline, and placebo for blocking exercise-induced bronchospasm (EIB). Twenty patients aged 12 to 17 years took one of the following on five separate days prior to an exercise challenge: 10, 15, or 20 mg/kg dyphylline; 6 mg/kg anhydrous theophylline; or placebo. Linear relationships were found between the log of dyphylline doses and per cent changes from baseline for PEFR, FEV1 and FEF25-75%. The 15 and 20 mg/kg doses differed significantly from placebo in preventing declines in PEFR, FEV1, and FEF25-75%. While significant, these changes were one half to one third those found with 6 mg/kg theophylline. Tremor was twice as common with theophylline. While dyphylline has therapeutic effectiveness compared to placebo for blocking EIB, its benefit is small. Further evaluations are needed to elucidate optimal dosaging for maximal effectiveness.     

白三烯受体拮抗剂对毛细支气管炎后气道炎症的影响

目的 通过检测炎性因子嗜酸性粒细胞阳离子蛋白（ECP）、白细胞介素12（IL-12）、白细胞介素13（IL-13）及白三烯FA（LTE4）的变化,探讨白三烯受体拮抗剂对毛细支气管炎后气道炎症的作用及对毛细支气管炎后发生哮喘倾向的预防作用.方法 选择156例轻中度毛细支气管炎患儿作为研究对象,所有患儿应用常规治疗,症状控制（喘息基本消失）后随机分成三组：孟鲁司特干预组应用孟鲁司特钠口服;激素干预组应用布地奈德混悬液氧喷;空白对照组不予任何干预治疗.分别在住院当日、干预前、干预后抽取静脉血,ELISA法检测各组患儿血清中ECP、IL-12、IL-13及LTE4的浓度,并随访一年.结果 156例毛细支气管炎患儿ECP、IL-13及LTE4水平在急性期、恢复期均较对照组明显升高,而IL-12水平明显降低.孟鲁司特干预组及激素干预组患儿干预结束后ECP、IL-13水平均下降,IL-12水平上升,其水平基本恢复至正常;LTE4水平较干预前明显下降,孟鲁司特干预组基本恢复至正常水平（t=1.0866,P＞0.05）,但激素干预组未恢复到正常水平（t=3.4355,P＜0.01）.孟鲁司特干预组喘息再次发作率明显减少（χ^2=7.8156,P＜0.01）.结论 白三烯受体拮抗剂能够调节Th1/Th2的失衡,减少LTE4的释放,降低嗜酸性粒细胞的活化程度,减轻气道炎症和气道高反应性,减少喘息发作,对毛细支气管炎后发生哮喘倾向有积极的预防作用.