陈晓飒

[摘要] 目的 探讨孟鲁司特对呼吸道合胞病毒毛细支气管炎（RSV）患儿血清半胱氨酰白三烯（CysLTs）水平的影响及疗效。方法 选取84例RSV毛细支气管炎患儿，随机分为观察组和对照组。两组患儿均予以抗病毒、解痉平喘和止咳化痰等对症治疗。观察组患儿加用孟鲁司特咀嚼片2 mg，睡前口服，连用8周。 结果 治疗1周后，两组患儿血清CysLTs水平均较治疗前明显下降（P <0.05或P <0.01），且观察组患儿下降幅度明显高于对照组（P <0.05）； 观察组患儿临床总有效率明显高于对照组（χ2=4.46，P <0.05）；两组患儿均未发生明显药物不良反应；观察组患儿随访半年和1年内的喘息复发率均明显低于对照组（χ2 =4.54和5.59，P 均<0.05）。 结论 孟鲁司特治疗RSV毛细支气管炎疗效确切，安全性较好，并能减少喘息复发率，作用与其能降低血清CysLTs水平、减少白三烯的释放密切相关。

[关键词] 毛细支气管炎；呼吸道合胞病毒；孟鲁司特；半胱氨酰白三烯；喘息复发

[中图分类号] R725.6 [文献标识码] B [文章编号] 1673-9701（2014）17-0147-03

The effect of Montelukast on serum cysteinyl leukotrenes（CysLTs） of respiratory syncytial virus （RSV） bronchiolitis in children and curative effect

CHEN Xiaosa

Department of Paediatrics， Linan Peoples Hospital in Zhejiang Province， Linan 311300，China

[Abstract] Objective To discuss the effect of Montelukast on serum cysteinyl leukotrenes（CysLTs） of Respiratory Syncytial Virus（RSV） bronchiolitis in children. Methods A total of 84 cases of children with RSV bronchiolitis were selected and divided into observation group and control group at random. The children in two groups were given symptomatic treatment， such like anti-virus， spasmolysis and relieving asthma， relieving cough and reducing sputum and etc， which shall be stopped until the symptom disappeared. The children in observation group were additionally given 2 mg Montelukast Dulcet， and taken through the mouth at bedtime for 8 weeks. Results After 1 weeks medical treatment， the serum CysLTs levels of children in two groups declined obviously than before（P<0.05 or P<0.01）， and the declining rate in experimental group was much higher than that in control group （P<0.05）， and the total clinical efficiency of children in observation group was much higher than that in control group （χ2=4.46， P<0.05）. No obvious drug adverse reaction were appeared in children in two groups during the medical treatment. According to the following-up after the medical treatment， the gasping reoccurrence of children in observation group within half a year and one year were much lower than those in control group （χ2=4.54 & 5.59， P all<0.05）. Conclusion Montelukast has reliable curative effect on RVS bronchiolitis with high security， and can reduce the gasping reoccurrence rate， whose mechanism of action has close relationship with the descreaded of serum serum CysLTs levels and the reduction of the release of Leukotriene.

[Key words] Bronchiolitis； Respiratory syncytial virus （RSV）； Montelukast； Cysteinyl leukotrenes；Gasping reoccurrenceendprint

毛细支气管炎是儿科常见的下呼吸道炎症性疾病，好发于2岁以下婴幼儿，其中呼吸道合胞病毒（RSV）是其主要病原体[1]。毛细支气管炎治疗后大部分患儿愈合良好，部分日后可能出现反复喘息并发展成哮喘。因此，及时控制患儿症状、减少喘息复发是毛细支气管炎治疗的主要目的[2]。毛细支气管炎的发病机制较复杂，多种炎症细胞及其分泌的炎症介质参与其发病过程，其中半胱氨酰白三烯（CysLTs）是重要的炎性介质[3，4]。近年来应用白三烯受体阻滞剂治疗婴幼儿毛细支气管炎越来越受到关注，研究发现其具有预防喘息复发的作用[5，6]。本研究分析了孟鲁司特对RSV毛细支气管炎患儿血清CysLTs水平的影响及疗效观察，现报道如下。

1 资料与方法

1.1 临床资料

选取2010年1月～2012年8月在我院儿科就诊的RSV毛细支气管炎患儿84例。纳入标准：①符合《诸福棠实用儿科学》第7版中的标准；②血清RSV-IgM（+）；③首次喘息发作[7]。排除标准：①先天性心肺疾病、佝偻病及其他感染引起的喘息性疾病；……