孟鲁司特联合吸入糖皮质激素治疗小儿中度持续哮喘的疗效及机制

目的 观察孟鲁司特联合吸入糖皮质激素治疗小儿中度持续哮喘的临床疗效及探讨孟鲁司特的抗炎机制。方法 采用随机分组的方法，将60例2～5岁的中度持续哮喘患儿分为两组：孟鲁司特4mg／d口服联合吸入布地奈德200ug／d为A组（n=30）、单纯吸入布地奈德200ug／d为B组（n=30）进行3个月的治疗，于治疗开始、治疗第4周和第3个月进行临床评估，同时检测血清半胱氨酰白三烯（CysLTs）和IL-5水平。结果 治疗前，中度持续哮喘患儿血清CysLTs、IL-5水平均明显高于正常组（P〈0．01）；治疗3个月后，A组的患儿哮喘的症状评分、每次发作持续的天数、发作次数和全身使用糖皮质激素的总量均明显低于B组（P〈0．01），同时A组患儿血清CysLTs、IL-5水平较B组显著下降（P〈0．05，P〈0．01），而B组患儿治疗前后血清CysLTs水平差异无统计学意义（P〉0．05）。结论 孟鲁司特联合吸入糖皮质激素可佩著提高中度持续哮喘患儿的疗效，同时减少全身使用糖皮质激素的总量。孟鲁司特能降低中度持续哮喘患儿血清CysLTs、IL-5水平，抑制炎症介质释放，抑制效应可能是孟鲁司特抗哮喘呼吸道炎症的重要机制。

Anti-inflammation mechanism and effect of the combination therapy of montelukast and inhaled corticosteroid on the moderate continuous asthma in children

Objective To observe the clinical effect of the combined administration of montelukast and inhaled corticosteroid on children with moderate continuous asthma and investigate the anti-inflammation mechanism of montelukast. Methods 60 children with moderate continious asthma aged 2-5 years old were randomly divided into two groups, group A ：4 mg montelukast orally daily plus 200 ug budesonide inhaled daily（30 cases） and group B：200 ug budesonide inhaled daily（ 30 cases）. The duration of treatment was 3 months. 20 health children were served as normal control group. Before starting therapy ,4 weeks and 3 months later,clinical effects were observed ; the concentrations of serum CysteinyLTs （CysLTs） and Interleukin-5 （ IL-5 ） were measured. Results Before treatment, the levels of CysLTs and IL-5 in patients with asthma were significantly higher than those in normal control group（P 〈0.01 ）. After treatment, the asthmatic symptoms score, the length of each exacerbation episode,the number of exacerbation and the total amount of systemic corticosteroid used of group A were significantly lower than those of group B （P 〈 0.01 ） ; CysLTs and IL-5 levels decreased significantly in group A compared with those in group B（P 〈0. 05 ,P 〈0. 01 , ）. CysLTs levels in group B had no significantly difference both pre-treatment and post-treatment（ P 〉 0.05 ）. Conclusion The combination of montelukast and inhaled cortieosteroid is more effective than only inhaled eorticosteroid in children with moderate continuous asthma,it also can lower the total amount of systematic corticosteroid used. Montelukast can lower the levels of CysLTs and IL-5 in serum of children with moderate continuous asthma,inhibit the release inflammatory mediator. The suppressive effects may be an important mechanisms for montelukast to antagonize airway inflammation of asthma.