口服白三烯受体拮抗剂与吸入糖皮质激素治疗小儿咳嗽变异型哮喘合并变应性鼻炎的对比研究

目的对比研究口服白三烯受体拮抗剂（LTRA）与吸入糖皮质激素（ICS）对dxJL咳嗽变异型哮喘合并变应性鼻炎的防治效果。方法54例2-5岁患儿随机分为LTRA组（27例）和ICS组（27例）。LTRA组口服孟鲁司特钠，每次4mg，睡前服用1次；ICS组患儿规律吸入布地奈德气雾剂，每日200-400μg，采用储雾罐辅助吸入。药物治疗3个月后继续随访观察15个月。结果LTRA组与ICS组比较．控制症状所需的平均天数为（8．31±3．69）d和（7．20±2．78）d；症状缓解率为92．6％和96．3％，差异无统计学意义（P〉0．05）。在病程的18个月LTRA组复发率（36．0％）显著高于ICM组（15．4％）。转化为典型哮喘者。LTRA组7例（28．0％），ICS组2例（7．7％），差异有统计学意义（P〈0．05）。结论口服LTRA控制小儿咳嗽变异型哮喘合并变应性鼻炎的近期疗效与ICS相当。可作为一线药物使用。但接受LTRA治疗的患儿远期复发率或者转化为典型哮喘的比率高于ICS治疗的患儿。

Comparative Study of Oral Leukotriene Receptor Antagonist Verses Inhaled Corticosteroid in Treatment of Cough Variant Asthma with Allergic Rhinitis

Objective To evaluate the therapeutic effects of oral leukotriene receptor antagonist （LTRA） and inhaled corticosteroid （ICS） on infantile cough variant asthma with allergic rhinitis. Method 54 children with cough variant asthma and allergic rhinitis （2-5 years） were randomized to receive oral montelukast 4 mg, once at bedtime or inhaled budesonide 200-400μg/d for 3 months, then followed by 15 months observation after the end of the drug therapy. Result There were no significant differences in the period of time required for controlling symptoms and the remission rate after 4 weeks treatment between LTRA group and ICS group （8.31±3.69）d vs（7.20±2.78）d; 92.6% vs 96.3%]. The Recurrence rate of symptoms and the incidence of classic asthma in LTRA group were significantly higher than those in ICSgroup at the end of the follow-up period （36.0% vs 15.4%; 28.0% vs 7.7%）. Conclusion Oral LTRA is equivalent to ICS on controlling the symptoms of infantile cough variant asthma with allergic rhinitis and can be used as a first-line drug.