孟鲁司特对哮喘患儿外周血Th1/Th2细胞功能平衡的调节作用

摘要

Objective To study the regulation function of selective cysteinyl leukotrienes (Cys LTs) receptor antagonist on Th1/Th2 cell function of peripheral blood in asthmatic children. Methods The clinical data of 200 children with bronchial asthma in our hospital were analyzed retrospectively from May 2008 to January 2012. They were divided into two groups according to the different treatment methods, and each had 100 cases. The basic therapy, such as oxygen uptake, antiasthmatic, anti -inflammation infection treatment was all used in both two groups. Montelukast Tablets of the selective Cys LTs receptor antagonist were given in observation group on basis of control by dosage of oral 4 mg/d and for 3 courses with 30 days in a course. Interleukin 4 (IL--4) and gamma-interferon (IFN-γ) levels before and after treatment were detected between two groups, and the results of two groups were statistically analyzed. Results IL-4, IFN-γ levels and TFN-γ/IL-4 ratio of asthmatic children were obviously changed after treatment of selective Cys LTs receptor antagonist, and it had significant difference contrasting to pre treatment (t = 3.05, 4.16, 3.26, all P ＜ 0.05). IFN-γ, IL-4 level and IFN-γ/IL-4 ratio increased significantly in the control group after treatment (t = 3.18, 3.47, 2.64, all P ＜ 0.05). IFN-γ, IL-4 levels and IFN-γ/IL-4 ratio had significant difference between two groups after treatment (t=2.89, 2.92, 3.02, all P ＜ 0.05). The clinical curative effect was analyzed after treatment for 6 months. The total effective rate was 93% in the observation group, whereas 73% in control group, it was statistically significant different (P ＜ 0.05). The disappearance time of cough, asthma and wheezing sound were significantly shorter than those of control group; these symptoms were improved better than those in control group, with significant difference (P ＜ 0.05). Conclusion Selective Cys LTs receptor antagonist can obviously increase IFN-γ and IL-4 level of asthmatic children,rnespecially to the former. It can promote maturity of Th cells meanwhile up-regulate the function of Th1, it also can improve function imbalance of Th1/Th2 in children with asthma.%目的 探讨选择性半胱氨酰白三烯(Cys LTs)受体拮抗剂对哮喘患儿外周血Th1/Th2细胞功能平衡的调节作用.方法 对我院2008年5月～2012年1月收治入院的支气管哮喘患儿200例的临床资料进行回顾性分析,根据治疗方法不同将200例患者分为两组,每组各100例,两组均采用吸氧、平喘、抗炎、抗感染等基础治疗,观察组在此基础上给予选择性Cys LTs受体拮抗剂孟鲁司特片4～5 mg/d,每天1次口服,30 d为1个疗程,共3个疗程.对两组患儿治疗前后进行白细胞介素4(IL-4)和γ-干扰素(IFN-γ)含量进行测定,并对两组结果进行统计学分析.结果 哮喘患儿经选择性Cys LTs受体拮抗剂治疗后,IFN-γ、IL-4水平及IFN-γ/IL-4比值均有明显变化,与治疗前比较差异均有统计学意义(t = 3.05、4.16、3.26,均P ＜ 0.05);而对照组治疗后IFN-γ、IL-4水平及IFN-γ/IL-4比值明显升高(t = 3.18、3.47、2.64,均P ＜ 0.05).两组治疗后IFN-γ、IL-4水平及IFN-γ/IL-4比值比较差异有统计学意义(t = 2.89、2.92、3.02,均P ＜ 0.05);两组治疗6个月后行临床疗效分析,观察组总有效率为93%,对照组总有效率为73%,两组临床疗效比较差异有统计学意义(P ＜ 0.05);观察组咳嗽消失时间、喘息消失时间、哮鸣音消失时间等改善情况均优于对照组,且差异有统计学意义(P ＜ 0.05).结论 选择性 Cys LTs受体拮抗剂可明显提高哮喘患儿IFN-γ和IL-4水平,尤以前者为著,在促进Th细胞成熟的同时上调Th1功能,改善哮喘患儿Th1/Th2功能失衡状态.