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.

Effect of leukotriene receptor antagonist on the airway inflammation in bronchiolitis after respiratory syncytial virus infection

Objective To explore the effect of leukotriene receptor antagonist on the airway inflammation in bronchiolitis after respiratory syncytial virus(RSV)infection and the prevention of post-bronchiolitis asthma by studying the changes of serum concentration of inflammatory cellular factors including ECP,IL-12,IL-13 and LTE4.Methods 156 children with mild and moderate RSV bronchiolitis were recruited in the study and they were randomly divided into three groups after alleviation of asthmatic symptoms:the intervention group with montelukast sodium tablets oral;hormone intervention group with Budesonide suspension spray;control group.Blood samples were collected on the first day on admission,before treatment,3 months after medication.Serum concentrations of ECP,IL-12,IL-13 and LTE4 were measured by ELISA.Clinical and telephone follow up was done for one year.Results Compared to control group,the ECP,IL-13 and LTE4 levels of 156 RSV bronchiolitis in acute phase and recovery phase were signifieantly increased,while the IL-12 level was significantly decreased.The ECP,IL-13levels of singulair intervention group and the hormone intervention group were decreased after intervention,and the IL-12 level rise to normal;the LTE4 level of singulair intervention group and the hormone intervention group decreased significantly than before intervention,singulair intervention group recovered to normal levels(t=1.0866,P＞0.05),but hormone treatment group did not recover to normal levels(t=3.4355,P＜0.01).Singulair intervention group had lower recurrence of asthma(χ2=7.8156,P＜0.01).Conclusion The leukotriene receptorantagonists could regulate the imbalance of Th1/Th2,reduce the release of LTE4 and the activation of eosinophils,alleviate airway inflammation and airway hyperreactivity,reduce wheezing,and it play a role in the prevention of asthma.