【摘要】 目的探讨布地奈德/福莫特罗和白三烯受体拮抗剂(孟鲁司特)分别对咳嗽变异性哮喘(CVA)患者的疗效,为目前CVA的治疗提供更合理、更个体化的治疗方案。方法选取2012年3月至2013年7月在东莞康华医院呼吸内科门诊初次确诊为CVA且符合入组标准的69例患者为研究对象,采用随机数字表法将69例CVA患者分为A组35例(布地奈德/福莫特罗组,给予160/4.5μg/吸,1吸/次,2次/d),B组34例(孟鲁司特组,10 mg/次,口服,1次/d)。治疗1月后进行疗效评价,治疗显效的患者维持原方案治疗至疗程满3个月;治疗效果欠佳的患者改为两药的联合治疗,总疗程3个月,治疗结束后随访6个月。用SPSS 17.0软件对数据进行t检验、χ2检验和秩和检验。结果 A组咳嗽症状完全缓解比例(85.2%)高于B组(54.2%),差异有统计学意义(P<0.05);两组痰嗜酸性粒细胞(EOS)百分比均明显下降:A组由2.63%±1.79%下降至0.59%±0.72%,B组由2.56%±1.84%下降至0.67%±0.76%,差异均有统计学意义(P<0.01);A组PD20-FEV1(第1秒用力呼气量较基础值下降20%时吸入组胺的累积量)治疗后[(5.03±2.94)μmol]较治疗前[(3.37±3.01)μmol]明显升高,差异有统计学意义(P<0.05),而B组无明显变化[分别为(2.83±2.93)、(3.03±2.98)μmol];A组支气管激发试验阴转率为18.5%,B组为8.3%。随访6个月A组复发率为25.9%,B组为33.3%,差异无统计学意义(P>0.05)。联合治疗的有效率为84.6%,支气管激发试验阴转率为18.2%,随访6个月复发率为15.4%。结论 CVA患者给予2种药物3个月的疗程均能有效地改善咳嗽症状,布地奈德/福莫特罗镇咳及降低气道高反应性的作用优于白三烯受体拮抗剂,部分患者需要两药联合治疗才能获得更好的疗效。更多还原

【Abstract】 Objective To explore the effectiveness of budesonide/formoterol and montelukast for treating cough variant asthma(CVA), and to provide the reasonable and individualized therapy protocol for CVA. Methods Sixty-nine patients with newly diagnosed CVA during March of 2012 to July of 2013 in Kanghua hospital served as the subjects, the subjects were randomly divided into A group(35 cases) with budesonide/formoterol(160/4.5 μg, bid) and B group(34 cases) with oral montelukast(10mg, qd). After treatment for one month, the efficacy of two groups was assessed. The patients with good response continued to use the same therapy protocol for 2 months. The patients with worse response would use the combination of two medications for 2months. Total course was 3 months. All patients were followed up for 6 months after treatment. Results The rate(85.2%) of complete remission of cough in A group was higher than that(54.2%) in B group(P<0.05). The rates(2.63%±1.79% and 2.56%±1.84%) of sputum eosinophil(EOS) significantly reduced to 0.59% ±0.72% and 0.67%±0.76%(P<0.01). The PD20-FEV1(3.37±3.01 μmol) in A group significantly enhanced to(5.03±2.94) μmol(P<0.05). But the PD20-FEV1 in B group did not significantly improve(P>0.05). The negative conversion rates of bronchial provocation test(BPT) in A and B groups were 18.5%and 8.3%, respectively. The relapse rates after following-up for 6 months in A and B groups were 25.9% and 33.3%, respectively.There were no significant differences between two groups(P>0.05). The efficacy rate, negative conversion rate and relapse rates after following-up for 6 months for combinative therapy were 84.6%, 18.2% and 15.4%, respectively. Conclusion In patients with CVA, three months of treatment with budesonide/formoterol or montelukast could effectively reduce cough symptoms; but the antitussive effect and in decreasing airway hyper-responsiveness effect in A group are better than those in B group. The combinative therapy has better efficacy for some patients.更多还原