维生素D联合孟鲁司特对咳嗽变异性哮喘患儿的临床疗效及对IL-17与Treg的影响分析

doi:10.3969/j.issn.1006-6233.2022.05.036

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摘要 目的:分析维生素D(vitamin D,VD)联合孟鲁司特对咳嗽变异性哮喘(cough variant asthma,CVA)患儿的临床疗效及对白介素-17(interleukin-17,IL-17)与调节性T细胞(regulatory T cells,Treg)的影响。方法:前瞻性选取2019年9月至2021年5月期间我院收治的244例CVA患儿为研究对象,采用随机数字表将患儿简单随机分为对照组(n=61)、孟鲁司特组(n=61)、VD组(n=61)与联合组(n=61),对照组患儿予常规治疗,另外三组患儿基础上分别给予孟鲁司特、VD及两者的联合治疗,持续12周。比较四组患儿的临床疗效及治疗前后的肺功能[包括1s用力呼气量(FEV1)、用力肺活量(FVC)、呼气峰流量(PEF)],以及血IL-17、CD₄⁺CD₂₅⁺Treg细胞水平。结果:联合组患儿咳嗽缓解时间、咳嗽消失时间均显著低于对照组、孟鲁司特组与VD组,差异有统计学意义(P<0.05)。四组治疗前的基线资料、FEV1、FVC、PEF、血IL-17、CD₄⁺CD₂₅⁺Treg细胞水平以及不良反应发生率比较无显著差异(P>0.05)。四组患者治疗后的FEV1、FVC、PEF、血CD₄⁺CD₂₅⁺Treg细胞水平较干预前均显著升高,血清IL-17水平较干预前均显著降低,差异有统计学意义(P<0.05),且联合组的应用效果较另外三组更佳突出(P<0.05)。析因方差分析表明孟鲁司特、VD干预后均有助于降低咳嗽缓解时间、咳嗽消失时间、IL-17,升高FEV1、FVC、PEF、CD₄⁺CD₂₅⁺Treg(P<0.05),且两者之间无交互作用(P>0.05)。结论:VD联合孟鲁司特能显著促进CVA患儿咳嗽症状的缓解,改善肺功能,临床疗效突出,可能与其纠正Th17/Treg失衡有关。

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	岳敬卫
	王燕
	张敏

关键词 ：咳嗽变异性哮喘, 维生素D, 孟鲁司特, 白介素-17, 调节性T细胞

Abstract：Objective: To analyze the clinical efficacy of vitamin D (VD) combined with montelukast in children with cough variant asthma (CVA) and its effect on interleukin-17 (IL-17) and regulatory T cells (Treg). Methods: Two hundred and forty-four children with CVA treated in our hospital from September 2019 to May 2021 were prospectively selected as the research objects and divided into control group (n = 61), montelukast group (n = 61), VD group (n = 61) and combined group (n = 61) through simple random method and random number table. Children in the control group were treated with routine treatment, and the other three groups were given montelukast, VD and their combination respectively for 12 weeks on the basis. The clinical efficacy and pulmonary function [including forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF)] and the levels of blood IL-17, CD₄⁺CD₂₅⁺Treg cells were compared among four groups. Results: The remission time and disappearance time of cough in combined group were significantly lower than those in control group, montelukast group and VD group (P<0.05). There were no significant differences in baseline data, FEV1, FVC, PEF, blood IL-17, CD₄⁺CD₂₅⁺ Treg cell levels and the incidence of adverse reactions among four groups before treatment (P>0.05). The levels of FEV1, FVC, PEF, blood CD₄⁺CD₂₅⁺Treg cells after treatment in four groups were significantly higher than those before the intervention, and the blood level of IL-17 was significantly lower than those before the intervention (P<0.05), and the application effect of the combined group was better than that of the other three groups (P<0.05). Analysis of factorial variance showed that montelukast and VD intervention were helpful to reduce cough remission time, cough disappearance time and IL-17, and increase FEV1, FVC, PEF and CD₄⁺CD₂₅⁺ Treg (P<0.05), and there was no interaction between them (P>0.05). Conclusion: VD combined with montelukast could significantly promote the remission of cough and improve lung function in children with CVA, which can be related to correcting Th17/Treg imbalance.

Key words： Cough variant asthma Vitamin D Montelukast Interleukin-17 Regulatory T cells

基金资助:陕西省社会发展科技攻关项目,(编号:2015SF214)

通讯作者: 张敏

引用本文:

岳敬卫, 王燕, 张敏. 维生素D联合孟鲁司特对咳嗽变异性哮喘患儿的临床疗效及对IL-17与Treg的影响分析[J]. 河北医学, 2022, 28(5): 873-876.
YUE Jingwei, WANG Yan, ZHANG Min. Clinical Efficacy of Vitamin D Combined with Montelukast in Children with Cough Variant Asthma and Its Effect on IL-17 and Treg. HeBei Med, 2022, 28(5): 873-876.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.05.036 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I5/873