咳嗽变异性哮喘患儿白三烯水平变化及其拮抗剂对其的影响

摘要

目的：研究咳嗽变异性哮喘（CVA）患儿及经白三烯受体拮抗剂LTRAs治疗前后白三烯（LTs）的变化，探讨LTs在CVA发病中的作用及关系，分析LTRAs对CVA治疗的影响。方法60例CVA患儿中30例接受常规治疗和LTRAs治疗，30例只接受常规治疗，30例健康对照，分别测定血白三烯LTC4和尿白三烯LTE4的值。结果 CVA患儿急性期所有病例LTE4水平为(240.7±32.14)ng/L、LTC4水平为(247.8±35.08)ng/L；缓解期所有病例LTE4水平为(152.2.±28.52)ng/L、LTC 4水平为(140.3±31.45)ng/L，CVA病例治疗前后LTE 4水平、LTC 4水平差异有统计学意义(P<0.001)。孟鲁司特治疗组：CVA急性期LTE 4水平为(245.16±35.56)ng/L、LTC 4水平为(246.98±42.99)ng/L，缓解期LTE 4水平为(137.82±31.03)ng/L、LTC 4水平为(128.68±29.94) ng/L，该组患儿治疗前后LTC 4、LTE 4水平比较差异有统计学意义(P<0.001）。常规治疗组：CVA发作期LTE 4水平为(235.43±29.50)ng/L、LTC 4水平为(249.23±47.97)ng/L，缓解期LTE 4水平为(167.11±15.38)ng/L、LTC 4水平为(152.30±28.71)ng/L，该组治疗前后LTC 4、LTE 4水平差异有统计学意义（P<0.001）。孟鲁司特治疗组与常规治疗组治疗前、后LTE 4、LTC 4水平下降差值的比较：2组病例治疗后LTE 4水平、LTC 4水平均有下降。孟鲁司特治疗组LTE 4水平下降差值为(107.33±52.32)ng/L、LTC 4水平下降差值为(118.30±43.31)ng/L；常规治疗组LTE 4水平下降差值为(68.32±35.03)ng/L、LTC 4水平下降差值为(54.85±66.20)ng/L，2组治疗效果差异有统计学意义(P<0.05)。CVA缓解期孟鲁司特治疗组和常规治疗组LTE 4水平、LTC 4水平与健康对照组的比较：CVA缓解期孟鲁司特治疗组LTE 4水平为（137.82±31.03)ng/L，LTC 4水平为（128.68±29.94）ng/L；常规治疗组LTE 4水平为(167.11±15.38)ng/L， LTC 4水平为（152.30±28.71）ng/L；健康对照组LTE 4水平为(100.70±32.67)ng/L，LTC 4水平为（109.26±23.44）ng/L；孟鲁司特治疗组LTE 4、LTC 4水平低于常规治疗组，同时病例组缓解期LTE 4、LTC 4水平仍高于健康对照组，差异有统计学意义(P<0.05)。LTRAs治疗CVA儿童对于降低LTs水平差异有统计学意义。结论 LTs参与CVA发病的病理生理过程，且LTRAs对于控制CVA的症状有一定的疗效。%Objective To explore the changes of the leukotriene in the children with Cough Variant asthmatic (CVA) and the infl uence of the leukotriene receptor antagonist, and symptom, and provides support for CAV controlled.Methods 60 children with CVA were analysed, 30 cases were accepted routine treatment and leukotriene receptor antagonist (LTRAs) treatment, 30 cases only accepted routine treatment, 30 children were selected as health control group, then leukotriene C4 (LTC4) and leukotriene E4 (LTE4) of level were measured respectively.Results Compare the level of LTE4、LTC4 in the stage of attack with in the CVA: In montelukast group, in the stage of attack, the level of LTE4 is (245.15+35.56) ng/L and the level of LTC4 is (246.98±42.99) ng /L; in the stable stage ,the level of LTE4 is (137.82±31.03) ng /L and the level of LTC4 is (128.68±29.94) ng /L. The level of LTE4、LTC4 in the stage of attack were signifi cant higher than that in the stable stage (P<0.001). In routine treatment group, in the stage of attack, the level of LTE4 is (235.43±29.50) ng /L and the level of LTC4 is (249.23±47.97) ng /L; in the stable stage, the level of LTE4 is (167.11±15.38) ng /L and the level of LTC4 is (152.30±28.71) ng /L. The level of LTE4、LTC4 in the stage of attack were signifi cant higher than that in the stable stage (P<0.001). Compare the decline of LTE4、LTC4 in the montelukast group with routine treatment group. In two groups, the level of LTE4, LTC4 decreased after therapy. In montelukast group, the decline of LTE4 is ((107.33±52.32) ng/L and LTC4 is (118.30±43.31) ng/L; In the routine treatment group, the decline of LTE4 is (68.32±35.03) ng/L and LTC4 is (54.85±66.20) ng /L, the treatment effect was difference in statistics (P<0.05). In the acute of CVA, the decline of LTE4、LTC4 in montelukast group were signifi cant higher than that in the routine treatment . In stable of CAV, compare the level of LTE4、LTC4 in montelukast group, routine treatment group with the healthy control group. In montelukast group, the level of LTE4 is (137.82±31.03) ng /L and the level of LTC4 is (128.68±29.94) ng /L;In routine treatment group,the level of LTE4 is (167.11±15.38) ng /L and the level of LTC4 is (152.30±28.71) ng /L;In the healthy control group the level of LTE4 is (100.70±32.67) ng /L and the level of LTC4 is (109.26±23.44) ng/L, there was signifi cant difference each other in statistics. LTRAs proved to be treated the children with CVA had the difference being statistically signifi cant in reducing level of LTs.Conclusion LTs was related with pathological and physiological process of CVA, and LTRAs has a certain effect to control the symptoms of CVA.