Page 87 - 202007

孟鲁司特钠治疗儿童百日咳的临床观察 Δ

刘 铮（重庆医科大学附属儿童医院呼吸中心/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临
＊
床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室，重庆 400014）

中图分类号 R272 文献标志码 A 文章编号 1001-0408（2020）07-0845-05
DOI 10.6039/j.issn.1001-0408.2020.07.16

摘 要 目的：研究在常规治疗基础上加用孟鲁司特钠治疗儿童百日咳的效果。方法：选取我院2017年1月－2018年7月收治的
160例6个月～6岁的百日咳患儿，采用区组随机分组法分为对照组和观察组，各80例。对照组患儿给予抗菌药物等常规治疗；观
察组患儿在对照组治疗基础上口服孟鲁司特钠颗粒或咀嚼片（年龄＜2岁者给予颗粒剂，温水冲服；年龄≥2岁者给予咀嚼片），4
mg/d，每晚给药1次。两组患儿的疗程均为2周。比较两组患儿的临床症状、疗效、不良反应发生情况等临床指标以及肺功能[达
峰容积比（VPEF/VE）、达峰时间比（TPTEF/TE）或第1秒用力呼气量（FEV1）、用力肺活量（FVC）和第1秒用力呼气量占用力肺活
+
+
+
+
量百分率（FEV1/FVC）]、T 淋巴细胞亚群（CD4 、CD8 和 CD4 /CD8 ）水平、免疫球蛋白（IgE、IgG、IgA）水平、血清白三烯（LTB4、
LTC4、LTD4）水平等实验室指标的变化。结果：观察组患儿的总有效率（95.00％）较对照组（80.00％）显著升高（P＜0.05），痉挛样
咳嗽时间、鸡鸣样回声时间、咳嗽导致面色青紫时间、咳嗽导致呕吐时间、闻及肺部啰音时间及住院时间较对照组均显著缩短（P＜
0.05），且观察组患儿出院后新发呼吸道感染率较对照组显著更低（P＜0.05），但两组患者治疗后的药品不良反应发生率差异无统
计学意义（P＞0.05）。观察组患者肺功能指标 VPEF/VE、TPTEF/TE 或 FEV1、FVC、FEV1/FVC 水平和外周血 CD4 、CD4 /CD8 水
+
+
+
+
平以及血清 IgG、IgA 水平较对照组均显著升高，而外周血 CD8 水平以及血清 IgE、LTB4、LTC4、LTD4 水平较对照组均显著降低
（P＜0.05）。结论：在常规治疗百日咳的基础上加用孟鲁司特钠，可改善患儿的临床症状、提高患儿肺功能，并且可调节患儿免疫
及抑制其气道白三烯类炎症介质的释放，有一定的临床应用价值。
关键词 百日咳；孟鲁司特钠；儿童；肺功能；临床症状；炎症介质；免疫功能；白三烯
Clinical Observation of Montelukast Sodium in the Treatment of Pertussis in Children
LIU Zheng（Dept. of Respiratory Medicine，Children’s Hospital of Chongqing Medical University/ Ministry of
Education Key Laboratory of Child Developmental and Disorders/National Clinical Research Center for Child
Health and Disorders/China International Science and Technology Cooperation Base for Child Development and
Critical Disorders/Chongqing Key Laboratory of Pediatrics，Chongqing 400014，China）

ABSTRACT OBJECTIVE：To study the effects of montelukast sodium in the treatment of pertussis in children. METHODS：A
total of 160 children aged 6 months-6 years with pertussis admitted to our hospital from Jan. 2017 to Jul. 2018 were randomly
divided into control group and observation group，with 80 cases in each group. Control group received routine treatment such as
antibiotics. Observation group was additionally given Montelukast sodium granule or chewable tablets orally（granule for age below
2 years old，taking with warm water；chewable tablets for age more than 2 years old），4 mg/d，once a night. Treatment course of 2
groups lasted for 2 weeks. The changes of clinical indexes as clinical symptoms，clinical efficacy，the occurrence of ADR，and lab
+
+
indexes as lung function [VPEF/VE，TPTEF/TE，FEV1，FVC，FEV1/FVC]，T lymphocyte subsets（CD4 ，CD8 and CD4 /CD8 ）
+
+
level，immunoglobulin（IgE，IgG，IgA）level，serum leukotriene（LTB4，LTC4，LTD4）level were compared between 2 groups.
RESULTS：Compared with control group（80.00％），total effective rate rate of observation group（95.00％）was significantly
increased（P＜0.05）；the cough time of spasm，the echo time of cockcrow，the blue and purple time of face caused by cough，the
time of vomit caused by cough，the time of lung rale and the time of hospitalization were significantly shorter（P＜0.05）；new
respiratory tract infection incidence of observation group was lower than that of control group （P＜0.05）；but there was no
significant difference in the incidence of ADR between 2 groups after treatment（P＞0.05）. The levels of VPEF/VE，TPTEF/TE or
+
FEV1，FVC，FEV1/FVC，the levels of peripheral CD4 and CD4 /CD8 ，serum levels of IgG and IgA in observation group were
+
+
+
significantly increased，compared with control group；the level of peripheral CD8 and the serum levels of IgE，LTB4，LTC4 and
LTD4 were significantly decreased，compared with control group （P＜0.05）. CONCLUSIONS：The addition of montelukast
sodium to the routine treatment of pertussis can improve clinical symptoms and lung function of children，regulate immune function
of children and inhibit the release of airway leukotrienes，which has certain clinical application value.
KEYWORDS Pertussis； Montelukast sodium； Children；
Δ 基金项目：重庆市技术创新与应用示范（社会民生类）一般项目
（No.cstc2018jscx-msybX0021） Lung function； Clinical symptom； Inflammatory medium；
＊主治医师，硕士。研究方向：儿童呼吸道感染性疾病与变态反 Immune function；Leukotriene
应性疾病的诊治。E-mail：524402@163.com

中国药房 2020年第31卷第7期 China Pharmacy 2020 Vol. 31 No. 7 ·845 ·