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目的探讨孟鲁司特对不同病原感染毛细支气管炎患儿呼吸道高反应(BHR)的疗效是否一致,明确病原种类对孟鲁司特治疗毛细支气管炎疗效的影响。方法收集2006年1月-2007年12月在本院儿科住院且符合毛细支气管炎纳入标准的150例患儿,将其分为呼吸道合胞病毒(RSV)组(70例)与非RSV组(24例),均给予常规治疗加孟鲁司特(4mg·d-1口服,连用7d),比较2组疗效、平均住院天数及哮喘发生率的差异,治疗前后IFN-γ、IL-4、血清IgE、嗜酸性粒细胞阳离子蛋白(ECP)的差异。结果非RSV组使用孟鲁司特的疗效与RSV组比较无统计学差异(Pa>0.05)。2组除腮腺炎病毒、柯萨奇病毒外其余病原感染后毛细支气管炎患儿治疗前后血清IgE、ECP水平的变化均有统计学差异(Pa<0.05)。2组除百日咳杆菌、腮腺炎病毒、柯萨奇病毒外其余病原感染后毛细支气管炎患儿IFN-γ、IL-4水平均有统计学差异(Pa<0.05)。RSV组发生哮喘5例,非RSV组发生哮喘13例,2组哮喘发生率比较差异无统计学意义(χ2=2.71,P>0.05)。结论孟鲁司特可减轻非RSV感染后毛细支气管炎的临床症状,改善其所激发的BHR,降低毛细支气管炎后哮喘发生率;非RSV感染后毛细支气管炎患儿细胞因子水平的变化与RSV感染后一致;病原种类对孟鲁司特疗效的影响不大。
Objective To investigate whether the effect of montelukast on the airway hyperresponsiveness (BHR) in children with bronchiolitis infection of different pathogens is consistent and to clarify the effect of the species on montelukast in the treatment of bronchiolitis. Methods A total of 150 children hospitalized in our hospital from January 2006 to December 2007 were enrolled in our hospital and were eligible for bronchiolitis. The patients were divided into three groups: RSV group (70 cases) and non-RSV group 24 patients were treated with montelukast (4 mg · d-1 orally for 7 days). The difference in the two groups, the average hospitalization days and the incidence of asthma were compared. The levels of IFN-γ, IL-4, Serum IgE, eosinophil cationic protein (ECP) differences. Results The efficacy of montelukast in non-RSV group was not significantly different from that in RSV group (Pa> 0.05). There were significant differences in serum IgE and ECP levels between the two groups (P <0.05) before and after the treatment of other pathogenic bacteria except mumps virus and coxsackievirus. The levels of IFN-γ and IL-4 in children with bronchiolitis except for Bordetella pertussis, mumps virus and Coxsackievirus in 2 groups were significantly different (Pa0.05). There were 5 cases of asthma in RSV group and 13 cases of asthma in non-RSV group. There was no significant difference in the incidence of asthma between the two groups (χ2 = 2.71, P> 0.05). Conclusion Montelukast can relieve the clinical symptoms of bronchiolitis after non-RSV infection, improve the BHR induced by it, and reduce the incidence of asthma after bronchiolitis. The changes of cytokines in children with bronchiolitis after non-RSV infection are similar to those of RSV The same after infection; pathogen species on the efficacy of montelukast little effect.