孟鲁司特联合丙酸氟替卡松对儿童变应性鼻炎的疗效及血清IgE和炎性因子的影响

摘要

目的 观察孟鲁司特与丙酸氟替卡松联合治疗儿童变应性鼻炎(allergic rhinitis,AR)的临床疗效及其对患者血清炎性细胞因子的影响.方法2014年1月~2015年1月在我科治疗的AR患儿84例,随机分入观察组和对照组,每组42例.对照组予以丙酸氟替卡松喷鼻剂治疗,观察组在对照组基础上加用孟鲁司特片口服.观察比较两组治疗前、治疗开始第2周和第4周末的症状评分、疗效水平、不良反应,以及治疗前后血清屋尘螨变应原特异性IgE(sIgE)、肿瘤坏死因子α(TNF-α)、白介素-17(IL-17)水平变化趋势.结果 两组患儿治疗开始第2周和第4周末的症状评分均较治疗前显著降低(P<0.01),但以观察组下降为更显著(P<0.01);疗程结束时,观察组总有效率92.9%,明显高于对照组的76.2(P<0.05).治疗开始后第4周末,两组患儿血清屋尘螨sIgE均较治疗前显著降低(P<0.01),尤以观察组下降更为显著(P<0.01);两组TNF-α、IL-17水平均显著低于治疗前(P<0.01),但观察组降低更为明显(P<0.01).所有患儿在用药过程中均未见严重不良反应.结论 孟鲁司特与丙酸氟替卡松联合疗法能更加有效地缓解儿童AR症状,减轻炎症反应.%Objective To observe the clinical therapeutic effect of a combined therapy with montelukast and fluticasone propionate nasal spray on children of allergic rhinitis (AR) and its impact in serum levels of dermatophagoides pteronyssinus specific IgE(sIgE)and inflammatory cytokines.Methods Included in this trial were 84 children cases with AR treated in our hospital from Jan. ,2004 to Jan.,2015,randomly divided into observation group(OG)and control group(CG), with 42 in each. Cases in CG were treated only by fluticasone propionate nasal spray, while those in OG treated by orally taken montelukast tablets on the basis of nasal spray therapy as used for CG. Compared between the two groups were symptom scores, the level of therapeutic effect, and side effects before the treatment and following the therapy by the end of 2nd and 4th weeks respectively,as well as the changing tendency in serum levels of dermatophagoides pteronyssinus sIgE as well as inflammatory cytokines TNF-α and IL-17 determined before and after treatment.. Results As shown from the scores evaluated by the end of 2nd and 4th weeks, the scores of symptom were significantly lowered when compared with those before treatment (P<0.01), with much larger decreased magnitude in OG than in CG (P<0.01). By the end of therapeutic course,the total effective rate of OG was 92.9%,obviously higher than that of CG(P<0.05).Furthermore,the serum levels of sIgE were declined significantly in both groups by the end of 4th week following the therapy given,with the much higher declined level in OG than that in CG (P<0.01). Also being the same tendency, the serum levels of TNF-α and IL-17 were markedly decreased in both groups by the end of 4th week following the therapy given, with the much higher declined level in OG than that in CG (P<0.01). There were no significant side effects seen during the whole therapeutic course in both groups.Conclusion The combined therapy with montelukast and fluticasone propionate nasal spray can bring about much higher therapeutic effect on children with AR to effectively relieve or eliminate the associated symptoms and reduce the inflammatory response of the patients.