白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

白三烯受体拮抗剂(顺尔宁)治疗小儿毛细支气管炎疗效观察

目的 观察白三烯受体拮抗剂(顺尔宁)对小儿毛细支气管炎的临床疗效.方法 将60例毛细支气管炎患儿随机分为对照组(30例)及顺尔宁治疗组(30例).顺尔宁治疗组患儿除常规治疗外,予以口服顺尔宁,每天4mg,每晚1次,共服28d;对照组除未服顺尔宁外,其余治疗同顺尔宁治疗组.比较两组患儿临床症状的改善情况、治疗有效率以及喘息复发率.结果 顺尔宁与常规治疗有效率分别为96.7%和80.0%,差异有显著性(X2=4.04,P＜0.05).顺尔宁治疗组咳嗽消失、喘憋消失、肺部哮鸣音消失及平均治疗天数明显短于对照组,差异有显著性(P＜0.05).两组复发率差异无显著性(P＞0.05).结论 顺尔宁能明显改善毛细支气管炎患儿的咳喘症状,疗效较好.     

呼吸道合胞病毒毛细支气管炎患儿血和痰中白三烯测定及临床意义

目的 探讨呼吸道合胞病毒(respiratory syncytial virus,RSV)毛细支气管炎(毛支炎)患儿血、痰中白三烯C4(leukotriene C4,LTC4)水平的变化及临床意义.方法轻-中度毛支炎组22例,重度毛支炎组11例,另选择无喘息非RSV感染性肺炎患儿12例作为对照(肺炎组).采用双抗体夹心酶联免疫吸附试验测定血清和痰中LTC4水平,并进行对比分析.结果急性期轻-中度毛支炎组、重度毛支炎组、肺炎组血清LTC4水平分别为(76.96±28.19)pg/ml、(103.53±16.85)pg/ml、(18.14±7.49)pg/ml;痰中LTC4水平分别为(31.83±19.14)pg/ml、(67.11±15.11)pg/ml、(6.81±2.90)pg/ml;恢复期血清LTC4水平分别为(36.04±16.38)pg/ml、(52.27±17.03)pg/ml、(18.14±7.49)pg/ml,3组间差异有统计学意义(F=48.09,P＜0.001;F=15.50,P＜0.001;F=44.43,P＜0.001).治疗后轻-中度和重度毛支炎组血清LTC4水平明显降低,但仍高于肺炎组,差异有统计学意义(P＜0.05).结论RSV毛支炎患儿血和痰中LTC4水平明显增高,并与病情的轻重相关.     

Montelukast does not prevent reactive airway disease in young children hospitalized for RSV bronchiolitis

Aim:  To evaluate the long-term effect of montelukast on symptoms of cough and wheeze following RSV bronchiolitis.
Methods:  Fifty eight patients (aged ≤ 24 months) hospitalized with a first episode of RSV bronchiolitis were enrolled in this double blind prospective randomized trial comparing montelukast (n = 31) vs placebo (n = 27).
Results:  During the 3-month treatment period, there were no statistical significant differences between the two groups for symptom-free days and nights (48.5 [interquartile range 33.0.0–66.0] for montelukast vs 57.0 [29.0–71.0] for placebo p = 0.415) nor disease-free days and nights (44.5 days [26.0–54.0] vs 53.0 [22.3–71.0]; p = 0.266). During the 1 year follow-up, there were 41 exacerbations in the montelukast group vs 54 exacerbations in the placebo group (p = 0.57). Time to first exacerbation was not different. Number of unscheduled visits and need to start inhaled steroids were comparable in the two groups.
Conclusion:  Treatment with montelukast after hospital admission for RSV bronchiolitis in children younger than 2 years of age did not reduce symptoms of cough and wheeze. We cannot exclude that a subgroup of children may, however, benefit from this treatment.     

24例23SrRNA A2063G基因突变肺炎支原体肺炎临床分析

目的 分析23SrRNA A2063G基因突变引起肺炎支原体肺炎(MPP)的临床特征,从而提高对该疾病的诊治能力.方法 对36例MPP患儿痰标本进行MP-DNA及23SrRNA基因测序,检测耐药基因,在此基础上分为24例大环内酯类耐药组与12例大环内酯类敏感组.比较两组患儿的临床表现、实验室检查、影像学、治疗等资料.结果 36例MPP患儿中24例检出大环内酯类抗生素耐药基因,均为23SrRNA V区A2063G突变,12例为大环内酯类敏感组.大环内酯类耐药组患儿在住院时间(P=0.025),总咳嗽时间(P=0.035),总发热时间(P=0.008),抗生素治疗后发热时间(P=0.010)及病程(P=0.048)方面均高于大环内酯类敏感组.大环内酯类耐药组患儿白细胞计数及CRP较大环内酯类敏感组更高.大环内酯类耐药组12例患儿仅应用大环内酯类治疗5d内体温消退,3例需改用喹诺酮类抗感染;另10例联合激素,6例加用静脉丙种球蛋白,所有患儿预后良好.大环内酯类敏感组8例患儿在大环内酯类治疗后12h~3d体温消退.结论 相比大环内酯类敏感组,23SrRNA A2063G基因突变引起的耐药MPP患儿在住院时间、总咳嗽时间、总发热时间和抗生素治疗后发热时间、病程上更长,白细胞计数及CRP更高.大环内酯类抗生素对部分耐药MPP治疗有效,病情严重者需联合糖皮质激素和静脉丙种球蛋白或根据病情酌情更改抗生素.     

丙种球蛋白治疗RSV毛细支气管炎的临床及免疫学研究

为评估静脉注射丙种球蛋白(IVIG)治疗呼吸道合胞病毒毛细支气管炎(RSV毛支)的临床疗效及免疫学机理,比较26例IVIG治疗组和30例常规治疗组患儿症状体征消失时间及住院天数,同时检测治疗前后血清白介素6(IL-6)、白介素8(IL-8)及肿瘤坏死因子-α(TNF-α)水平。结果:与常规治疗组相比,IVIG治疗组喘憋和肺部体征消失时间明显缩短(4.0天±1.1天比5.2天±1.4天,5.4天±1.5天比6.5天±1.8天,P分别<0.001和<0.05),而住院天数则无显著差异(9.0天±2.2天比10.3天±3.1天,P>0.05)。治疗前两组患儿血清IL-6、IL-8及TNF-α水平均高于正常对照组;IVIG治疗后3种细胞因子水平明显降低.但与常规治疗组相比无显著差异。结论:细胞因子参与了RSV毛支的发病过程。IVIG治疗有较确切的临床疗效,但单剂(0.25g/kg)对血清细胞因子的抑制作用不明显。     

血管细胞间黏附分子-1在毛细支气管炎患儿中的表达及意义

目的 检测血管细胞间黏附分子-1（ICAM-1）在毛细支气管炎患儿血清和诱导痰上清液中的表达,探讨其在毛细支气管炎患儿发病中的作用和意义。方法 选取2015年7月至2017年1月确诊的毛细支气管炎住院患儿67例为研究对象,按诊断标准分为轻度组（n=22）、中度组（n=24）、重度组（n=21）。选取同期在我院行健康体检的20例婴幼儿为健康对照组。采用ELISA法检测各组毛细支气管炎患儿急性期及恢复期,以及健康对照组婴儿血清及诱导痰上清液中ICAM-1水平。结果 与健康对照组比较,急性期毛细支气管炎轻度组、中度组、重度组血清及痰液ICAM-1水平均显著升高（P < 0.01）;与轻度组比较,急性期中度组、重度组血清及痰液ICAM-1水平均显著升高（P < 0.01）;与中度组比较,急性期重度组血清及痰液ICAM-1水平显著升高（P < 0.01）;与毛细支气管炎各组患儿急性期比较,恢复期轻、中、重度组毛细支气管炎患儿血清及痰液ICAM-1水平均显著下降（P < 0.01）。相关性分析结果显示,毛细支气管炎患儿急性期痰液与血清ICAM-1水平呈正相关（r=0.875,P < 0.001）。结论 ICAM-1参与了毛细支气管炎的发病过程,且和病情严重程度相关。     

重症腺病毒肺炎临床特点及并发闭塞性细支气管炎危险因素分析

目的　总结重症腺病毒肺炎（severe adenovirus pneumonia,SAP）的临床特点,分析其并发闭塞性细支气管炎（bronchiolitis obliterans,BO）的危险因素。方法　对南京医科大学附属儿童医院呼吸科2017年1月至2019年12月住院的125例SAP患儿进行回顾分析,总结其临床特点。根据是否发展为BO将患儿分为BO组和非BO组,并对临床资料进行分析。结果　发病年龄≤24月龄80例（64%）;热峰≥39℃者115例（94.3％）,热程≥10 d者89例（72.9％）;气喘82例（65.6%）;单纯腺病毒感染35例（28%）,72%的患儿合并其他病原体感染［肺炎支原体（MP）40.8%,细菌35.2%］;并发呼吸衰竭32例（25.6%）,肺外并发症以循环系统（36%）和消化系统并发症（22.4%）多见。实访122例SAP患儿,53例（43.4%）最终发展为BO。多因素Logistic回归分析显示呼吸衰竭和合并MP感染是SAP后BO的独立危险因素（P＜0. 05）。结论　SAP主要发生于2岁以下的婴幼儿,多为高热且持续时间长,多数患儿存在喘息,混合感染率高;最常见的并发症是呼吸衰竭、 心功能不全、 肝功能损害和中毒性脑病。呼吸衰竭和合并MP感染是SAP后BO的独立危险因素。     

Reduced lung function both before bronchiolitis and at 11 years.

BACKGROUND AND AIMS: We have previously shown an association between reduced premorbid lung function (V'maxFRC) and bronchiolitis. We hypothesised that individuals with bronchiolitis will go on to have reduced lung function and increased respiratory symptoms in childhood. METHODS: V'maxFRC was measured at 1 month of age; individuals with bronchiolitis were prospectively identified. Annual symptom questionnaires were completed from 3 to 6 years. At 11 years of age, children underwent an assessment including questionnaire, lung function, airway response to histamine (AR), and skin prick testing. RESULTS: Eighteen individuals with bronchiolitis were ascertained from 253 cohort members. Children with bronchiolitis had increased viral induced wheeze at 3 (OR 5.8, 95% CI 1.4 to 25.2; n = 103) and 5 years (OR 5.3, 95% CI 1.1 to 25.5; n = 101). At 11 years of age, 194 children were assessed including 16 with past bronchiolitis. These 16 individuals had reduced mean z scores for % V'maxFRC compared with other children (-0.56 and 0.06 respectively) and mean z scores for % FEF(25-75) at 11 years (-0.53 and 0.06 respectively). At 11 years, FEV(1), FVC PEF, AR, atopy, wheeze, and diagnosed asthma were not different between groups. CONCLUSIONS: Reduced lung function is present before and after bronchiolitis; the level of reduction is comparable. The mechanism for wheeze and reduced lung function after bronchiolitis appears to be related to premorbid lung function and not bronchiolitis per se.     

Reduced lung function both before bronchiolitis and at 11 years

Background and Aims: We have previously shown an association between reduced premorbid lung function (V‘maxFRC) and bronchiolitis. We hypothesised that individuals with bronchiolitis will go on to have reduced lung function and increased respiratory symptoms in childhood. Methods: V‘maxFRC was measured at 1 month of age; individuals with bronchiolitis were prospectively identified. Annual symptom questionnaires were completed from 3 to 6 years. At 11 years of age, children underwent an assessment including questionnaire, lung function, airway response to histamine (AR), and skin prick testing. Results: Eighteen individuals with bronchiolitis were ascertained from 253 cohort members. Children with bronchiolitis had increased viral induced wheeze at 3 (OR 5.8, 95% CI 1.4 to 25.2; n = 103) and 5 years (OR 5.3, 95% CI 1.1 to 25.5; n = 101). At 11 years of age, 194 children were assessed including 16 with past bronchiolitis. These 16 individuals had reduced mean z scores for % V‘maxFRC compared with other children (-0.56 and 0.06 respectively) and mean z scores for % FEF_25–75 at 11 years (-0.53 and 0.06 respectively). At 11 years, FEV₁, FVC PEF, AR, atopy, wheeze, and diagnosed asthma were not different between groups. Conclusions: Reduced lung function is present before and after bronchiolitis; the level of reduction is comparable. The mechanism for wheeze and reduced lung function after bronchiolitis appears to be related to premorbid lung function and not bronchiolitis per se.     

孟鲁司特对毛细支气管炎患儿白三烯水平的影响

目的 观察孟鲁司特对毛细支气管炎患儿治疗前后血清白三烯B4 及尿白三烯E4 水平的影响。方法 将2014 年6~12 月诊断为毛细支气管炎的患儿75 例随机分为孟鲁司特治疗组(n=38)和对照组(n=37),两组患儿均进行常规综合治疗,治疗组在此基础上加用孟鲁司特片(4 mg),每晚1 次,连续口服7 d;采用ELISA 法检测两组治疗前后血清白三烯B4 及尿白三烯E4 水平,并进行临床疗效分析;采用Pearson 分析对血清白三烯B4 及尿白三烯E4 水平进行相关性分析。结果 治疗后两组患儿血清白三烯B4 及尿白三烯E4 水平比治疗前明显下降(PPPr=0.723,P结论 孟鲁司特治疗毛细支气管炎临床疗效确切,其作用机制与降低毛细支气管炎患儿血清白三烯B4 及尿白三烯E4 水平有关。     

A randomized controlled trial on the effect of montelukast on sputum eosinophil cationic protein in children with corticosteroid-dependent asthma

Previous adult studies demonstrated the clinical efficacy of an additional treatment with leukotriene receptor antagonists on steroid-dependent asthma, but there is little knowledge about anti-inflammatory add-on effects within the lung. In this study, we hypothesized that steroid-treated children exhibit a decrease in bronchial inflammation in induced sputum under additional treatment with montelukast. Twenty-five asthmatic children aged 6 to 14 y, who had been taking inhaled corticosteroids (400-800 microg/d budesonide) regularly for at least 12 wk, were randomized to receive additional treatment with either montelukast (5 mg orally, once daily) or placebo over a 4-wk period. As primary efficacy variable, eosinophil cationic protein (ECP) in induced sputum as direct measurement of bronchial inflammation was assessed before and after treatment. To assure a baseline level of inflammation, an ECP concentration above 100 microg/L was required. Sputum eosinophil count, concentration of exhaled nitric oxide, urinary excretion of eosinophil protein X, and quality-of-life items were considered as secondary outcome variables. After treatment with montelukast, ECP in sputum was significantly reduced (montelukast: median -975 microg/L [5 to 95% confidence interval: -4295 to 583 microg/L]; placebo: 561 microg/L [-1335 to 3320 microg/L]; p < 0.01) and the quality-of-life score had significantly improved (p < 0.05) compared with placebo. Partly explained by low baseline levels, no statistically significant change in concentration of exhaled nitric oxide (p > 0.05), urinary excretion of eosinophil protein X (p > 0.05), or eosinophil count (p > 0.05) was found. In conclusion, add-on treatment with montelukast can suppress sputum ECP in children with steroid-dependent asthma, while at the same time an improvement in quality of life items occurs.