孟鲁司特钠联合氢化可的松琥珀酸钠对PAB患儿炎性细胞因子及其转录因子表达的影响
|
摘要
目的探讨孟鲁司特纳联合氢化可的松琥珀酸钠治疗小儿喘息性支气管炎(PAB)的临床疗效及其机制。方法将2016年12月至2017年11月在我院呼吸内科确诊并接受治疗的130例PAB患儿随机分为对照组(58例,静脉滴注氢化可的松琥珀酸钠)和观察组(72例,静脉滴注氢化可的松琥珀酸钠联合口服孟鲁司特钠)。观察两组患儿的临床疗效,比较两组白介素-4(IL-4)、IL-10、IL-17、干扰素-γ(IFN-γ)等相关炎性因子及T-bet、GATA-3、RORγt、FOXP3转录因子水平的变化。随访3个月,记录患儿喘息发作次数、上呼吸道感染次数以及支气管哮喘的发生率。结果观察组患儿总有效率高于对照组(97.22%vs.84.48%,P<0.05)。观察组患儿平均喘息消失时间、咳嗽消失时间、肺部湿啰音消失时间、肺部哮鸣音消失时间均较对照组缩短(P<0.05)。治疗后,两组患儿IL-4、IL-17及RORγt水平均降低(P<0.05),而IL-10、IFN-γ、T-bet水平均升高(P<0.05),且两组上述指标比较差异均有统计学意义(P<0.05)。随访3个月后,观察组患儿喘息发作次数、上呼吸道感染次数少于对照组(P<0.05),支气管哮喘发生率低于对照组(P<0.05)。结论口服孟鲁司特钠联合静脉滴注氢化可的松琥珀酸钠可在短期内控制喘息性支气管炎的临床症状,通过调节Th1/Th2和Th17/Treg平衡,降低上呼吸道感染的发生率,最终减少喘息发作次数,降低支气管哮喘的发生率。
Objective To discuss the clinical efficacy and mechanism of montelukast sodium combined with hydrocortisone sodium succinate in the treatment of children with pediatric asthmatoid bronchitis(PAB).Methods Totally 130 PAB children treated in our hospital from December 2016 to November 2017 were randomly divided into control group(n=58,intravenous injection of hydrocortisone sodium succinate)and observation group(n=72,montelukast sodium combined with hydrocortisone sodium succinate).The clinical effect was observed.The changes of cytokines,such as IL-4,IL-10,IL-17 and IFN-γ,and the nuclear transcription factors,such as T-bet,GATA-3,RORγt,FOXP3 mRNAs were compared between the two groups.The times of wheezing onset and upper respiratory infection and the incidence of bronchial asthma were recorded after 3-month follow-up.Results After treatment,the total effective rate of observation group was higher than that of control group(97.22% vs.84.48%,P<0.05);the disappearance time of wheezing,cough,wet rales and polypnea symptom in observation group was shorter than that in control group(P<0.05);the serum levels of IL-4,IL-17 and RORγt of patients were decreased(P<0.05),while the levels of IL-10,IFN-γ and T-bet mRNAs were increased(P<0.05),and there were significant differences in the above indexes between the two groups(P<0.05).After being followed up for 3 months,the times of wheezing onset and upper respiratory infection and the incidence of bronchial asthma in observation group were less than those in control group(P<0.05).Conclusion Montelukast sodium combined with hydrocortisone sodium succinate can effectively improve the clinical symptoms of children with PAB in short term,and reduce the incidence of upper respiratory infection,the times of wheezing onset and the incidence of bronchial asthma by regulating Th1/Th2 and Th17/Treg balances.
Objective To discuss the clinical efficacy and mechanism of montelukast sodium combined with hydrocortisone sodium succinate in the treatment of children with pediatric asthmatoid bronchitis(PAB).Methods Totally 130 PAB children treated in our hospital from December 2016 to November 2017 were randomly divided into control group(n=58,intravenous injection of hydrocortisone sodium succinate)and observation group(n=72,montelukast sodium combined with hydrocortisone sodium succinate).The clinical effect was observed.The changes of cytokines,such as IL-4,IL-10,IL-17 and IFN-γ,and the nuclear transcription factors,such as T-bet,GATA-3,RORγt,FOXP3 mRNAs were compared between the two groups.The times of wheezing onset and upper respiratory infection and the incidence of bronchial asthma were recorded after 3-month follow-up.Results After treatment,the total effective rate of observation group was higher than that of control group(97.22% vs.84.48%,P<0.05);the disappearance time of wheezing,cough,wet rales and polypnea symptom in observation group was shorter than that in control group(P<0.05);the serum levels of IL-4,IL-17 and RORγt of patients were decreased(P<0.05),while the levels of IL-10,IFN-γ and T-bet mRNAs were increased(P<0.05),and there were significant differences in the above indexes between the two groups(P<0.05).After being followed up for 3 months,the times of wheezing onset and upper respiratory infection and the incidence of bronchial asthma in observation group were less than those in control group(P<0.05).Conclusion Montelukast sodium combined with hydrocortisone sodium succinate can effectively improve the clinical symptoms of children with PAB in short term,and reduce the incidence of upper respiratory infection,the times of wheezing onset and the incidence of bronchial asthma by regulating Th1/Th2 and Th17/Treg balances.
引文
[1] Jartti T,Gern JE.Role of viral infections in the development and exacerbation of asthma in children[J].J Allergy Clin Immunol,2017,140(4):895-906.
[2] 魏向阳,滕永华.布地奈德、硫酸特布他林、异丙托溴铵气雾剂三联气泵雾化吸入治疗小儿喘息性支气管炎疗效观察[J].儿科药学杂志,2012,18(6):30-32.
[3] Brown PM,Schneeberger DL,Piedimonte G.Biomarkers of respiratory syncytial virus(RSV)infection:specific neutrophil and cytokine levels provide increased accuracy in predicting disease severity[J].Paediatr Respir Rev,2015,16(4):232-240.
[4] 郭玉兰,郦银芳,张莉.不同孟鲁司特钠方案预防特应质喘息性支气管炎患儿发作的研究[J].临床肺科杂志,2015,(12):2239-2243.
[5] Bakel LA,Hamid J,Ewusie J,et al.International variation in asthma and bronchiolitis guidelines[J].Pediatrics,2017,140(5):e20170092.
[6] 吴瑞萍,胡亚美,江载芳.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社.
[7] 吕海涛,董卓亚,周江瑾.盐酸丙卡特罗口服液佐治婴幼儿喘息性支气管炎疗效观察[J].儿科药学杂志,2014,20(8):16-18.
[8] Davoudi Z,Rabiee M,Houshmand B,et al.Development of chitosan/gelatin/keratin composite containing hydrocortisone sodium succinate as a buccal mucoadhesive patch to treat desquamative gingivitis[J].Drug Dev Ind Pharm,2018,44(1):40-55.
[9] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[10] 国家卫生部办公厅.糖皮质激素类药物临床应用指导原则[S].卫办医政发[2011]23号.2011.
[11] 韩松勇,马茂森,张艳雪.注射用氢化可的松琥珀酸钠的临床应用[J].天津医药,2013,(8):841-842.
[12] Di Filippo P,Scaparrotta A,Petrosino MI,et al.An underestimated cause of chronic cough:the protracted bacterial bronchitis[J].Ann Thorac Med,2018,13(1):7-13.
[13] Morina N,Haliti A,Iljazi A,et al.Comparison of effect of leukotriene biosynthesis blockers and inhibitors of phosphodiesterase enzyme in patients with bronchial hyperreactivity[J].Open Access Maced J Med Sci,2018,6(5):777-781.
[14] 梁小裕,侯跃辉,王鑫,等.玉屏风口服液联合孟鲁司特钠咀嚼片治疗慢性阻塞性肺疾病稳定期效果观察[J].中国医药,2017,12(1):55-58.
[15] 曾军,何丽雅.孟鲁司特钠预防儿童肺炎支原体感染后喘息发作的疗效[J].实用医学杂志,2018,34(12):2058-2060.
[16] 张海红,文芸.孟鲁司特钠治疗成人感染后咳嗽临床观察[J].临床军医杂志,2017,45(4):394-396.
[17] 朱向阳,辛玲,李慧玉,等.孟鲁司特钠联合多抗甘露聚糖肽对变应性鼻炎患者的影响[J].中国临床实用医学,2018,9(2):26-28.
[18] 李丽,娄春艳,李敏,等.孟鲁司特钠对哮喘小鼠气道重塑及Th17/CD4+CD25+Treg表达的影响[J].中国当代儿科杂志,2016,18(11):1174-1180.
[19] 应琴,邱悦波.孟鲁司特钠对小儿毛细支气管炎TH17/Treg的调节作用及疗效研究[J].儿科药学杂志,2016,21(5):20-22.
[20] Hu C,Li Z,Feng J,et al.Glucocorticoids modulate Th1 and Th2 responses in asthmatic mouse models by inhibition of notch1 signaling[J].Int Arch Allergy Immunol,2018,175(1-2):44-52.
[21] Wright BL,Nguyen N,Shim KP,et al.Increased GATA-3 and T-bet expression in eosinophilic esophagitis versus gastroesophageal reflux disease[J].J Allergy Clin Immunol,2018,141(5):1919-1921.
[22] Yang X,Zhang JH,Deng WS,et al.Imbalance of γδT17/γδTreg cells in the pathogenesis of allergic asthma induced by ovalbumin[J].Braz J Med Biol Res,2018,51(9):e7127.
[2] 魏向阳,滕永华.布地奈德、硫酸特布他林、异丙托溴铵气雾剂三联气泵雾化吸入治疗小儿喘息性支气管炎疗效观察[J].儿科药学杂志,2012,18(6):30-32.
[3] Brown PM,Schneeberger DL,Piedimonte G.Biomarkers of respiratory syncytial virus(RSV)infection:specific neutrophil and cytokine levels provide increased accuracy in predicting disease severity[J].Paediatr Respir Rev,2015,16(4):232-240.
[4] 郭玉兰,郦银芳,张莉.不同孟鲁司特钠方案预防特应质喘息性支气管炎患儿发作的研究[J].临床肺科杂志,2015,(12):2239-2243.
[5] Bakel LA,Hamid J,Ewusie J,et al.International variation in asthma and bronchiolitis guidelines[J].Pediatrics,2017,140(5):e20170092.
[6] 吴瑞萍,胡亚美,江载芳.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社.
[7] 吕海涛,董卓亚,周江瑾.盐酸丙卡特罗口服液佐治婴幼儿喘息性支气管炎疗效观察[J].儿科药学杂志,2014,20(8):16-18.
[8] Davoudi Z,Rabiee M,Houshmand B,et al.Development of chitosan/gelatin/keratin composite containing hydrocortisone sodium succinate as a buccal mucoadhesive patch to treat desquamative gingivitis[J].Drug Dev Ind Pharm,2018,44(1):40-55.
[9] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[10] 国家卫生部办公厅.糖皮质激素类药物临床应用指导原则[S].卫办医政发[2011]23号.2011.
[11] 韩松勇,马茂森,张艳雪.注射用氢化可的松琥珀酸钠的临床应用[J].天津医药,2013,(8):841-842.
[12] Di Filippo P,Scaparrotta A,Petrosino MI,et al.An underestimated cause of chronic cough:the protracted bacterial bronchitis[J].Ann Thorac Med,2018,13(1):7-13.
[13] Morina N,Haliti A,Iljazi A,et al.Comparison of effect of leukotriene biosynthesis blockers and inhibitors of phosphodiesterase enzyme in patients with bronchial hyperreactivity[J].Open Access Maced J Med Sci,2018,6(5):777-781.
[14] 梁小裕,侯跃辉,王鑫,等.玉屏风口服液联合孟鲁司特钠咀嚼片治疗慢性阻塞性肺疾病稳定期效果观察[J].中国医药,2017,12(1):55-58.
[15] 曾军,何丽雅.孟鲁司特钠预防儿童肺炎支原体感染后喘息发作的疗效[J].实用医学杂志,2018,34(12):2058-2060.
[16] 张海红,文芸.孟鲁司特钠治疗成人感染后咳嗽临床观察[J].临床军医杂志,2017,45(4):394-396.
[17] 朱向阳,辛玲,李慧玉,等.孟鲁司特钠联合多抗甘露聚糖肽对变应性鼻炎患者的影响[J].中国临床实用医学,2018,9(2):26-28.
[18] 李丽,娄春艳,李敏,等.孟鲁司特钠对哮喘小鼠气道重塑及Th17/CD4+CD25+Treg表达的影响[J].中国当代儿科杂志,2016,18(11):1174-1180.
[19] 应琴,邱悦波.孟鲁司特钠对小儿毛细支气管炎TH17/Treg的调节作用及疗效研究[J].儿科药学杂志,2016,21(5):20-22.
[20] Hu C,Li Z,Feng J,et al.Glucocorticoids modulate Th1 and Th2 responses in asthmatic mouse models by inhibition of notch1 signaling[J].Int Arch Allergy Immunol,2018,175(1-2):44-52.
[21] Wright BL,Nguyen N,Shim KP,et al.Increased GATA-3 and T-bet expression in eosinophilic esophagitis versus gastroesophageal reflux disease[J].J Allergy Clin Immunol,2018,141(5):1919-1921.
[22] Yang X,Zhang JH,Deng WS,et al.Imbalance of γδT17/γδTreg cells in the pathogenesis of allergic asthma induced by ovalbumin[J].Braz J Med Biol Res,2018,51(9):e7127.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |