孟鲁司特联合糠酸莫米松治疗腺样体肥大合并变应性鼻炎患儿的临床研究
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摘要
目的探讨白三烯受体拮抗剂孟鲁司特联合鼻用糖皮质激素对腺样体肥大合并变应性鼻炎患儿的治疗效果。方法方便选择2017年1—9月于门诊就诊的腺样体肥大并伴有变应性鼻炎的患儿60例,随机分为两组,每组30例,对照组仅接受糖皮质激素类药物糠酸莫米松鼻喷剂治疗,实验组在对照组基础上每晚口服白三烯受体拮抗剂孟鲁司特钠。记录两组患儿治疗前及治疗2月后打鼾症状评分、鼻炎症状评分及腺样体大小。结果联合用药组与单用激素组在治疗前的临床评分差异无统计学意义(t=0.41,0.78;P>0.05);在治疗2个月后,联合用药组,单用激素组的临床评分均优于治疗前,差异有统计学意义(t睡眠=10.25,12.53;t鼻炎=20.04,18.29;P<0.05);治疗2个月后两组的睡眠打鼾症状评分差异无统计学意义(t=1.78,P>0.05),联合用药组鼻炎症状评分优于单用激素组(t=5.61,P<0.05)。治疗前,联合用药组腺样体中度肥大患儿23例,重度肥大7例;单用激素组中度肥大24例,重度肥大6例,组间差异无统计学意义。治疗后,联合用药组腺样体肥大好转26例,好转率86.67%;单用激素组好转21例,好转率70.00%,但两组间差异无统计学意义(χ~2=2.455,P>0.05)。结论白三烯受体拮抗剂孟鲁司特联合糖皮质激素类药物可有效缩小腺样体肥大合并变应性鼻炎患儿腺样体体积,降低变态反应程度,改善患儿睡眠质量及鼻炎状况。可作为非手术干预治疗腺样体肥大伴变应性鼻炎的有效方法。
Objective To investigate the therapeutic effect of leukotriene receptor antagonist montelukast combined with nasal glucocorticoid on children with adenoid hypertrophy and allergic rhinitis. Methods 60 children with adenoid hypertrophy and allergic rhinitis who were treated in the outpatient clinic from January to September 2017 were convenient selected and randomly divided into two groups, 30 in each group. The control group only received glucocorticoids corticosteroids with mometasone furoate nasal spray. The experimental group received oral leukotriene receptor antagonist montelukast sodium every night on the basis of the control group. The snoring symptom score, rhinitis symptom score and adenoid size were recorded before treatment and after 2 months of treatment. Results There was no significant difference in the clinical scores between the combination group and the hormone group before treatment(t=0.41,0.78,P>0.05). After 2 months of treatment,the combination group and the hormone group were better than that before the treatment, the difference was statistically significant(tsleep= 10.25, 12.53; trhinitis= 20.04, 18.29; P<0.05); there was no significant difference in sleep snoring score between the two groups after 2 months of treatment(t=1.78, P>0.05), the combined symptom group was better than the hormone group alone(t=5.61, P<0.05). Before treatment, 23 patients with moderate adenoid hypertrophy and 7 patients with severe hypertrophy in the combination group; 24 patients with moderate hypertrophy and 6 patients with severe hypertrophy in the hormone group alone, the difference between the groups was not statistically significant. After treatment, 26 cases of adenoid hypertrophy improved in the combination group, the improvement rate was 86.67%; 21 cases were improved in the hormone group alone, and the improvement rate was 70.00%, but the difference between the two groups was not statistically significant(χ~2=2.455, P>0.05). Conclusion The leukotriene receptor antagonist montelukast combined with glucocorticoids can effectively reduce adenoid volume in children with adenoidal hypertrophy and allergic rhinitis, reduce the degree of allergic reaction, and improve the sleep quality and rhinitis status of children. It can be used as an effective method for nonsurgical intervention for adenoid hypertrophy with allergic rhinitis.
Objective To investigate the therapeutic effect of leukotriene receptor antagonist montelukast combined with nasal glucocorticoid on children with adenoid hypertrophy and allergic rhinitis. Methods 60 children with adenoid hypertrophy and allergic rhinitis who were treated in the outpatient clinic from January to September 2017 were convenient selected and randomly divided into two groups, 30 in each group. The control group only received glucocorticoids corticosteroids with mometasone furoate nasal spray. The experimental group received oral leukotriene receptor antagonist montelukast sodium every night on the basis of the control group. The snoring symptom score, rhinitis symptom score and adenoid size were recorded before treatment and after 2 months of treatment. Results There was no significant difference in the clinical scores between the combination group and the hormone group before treatment(t=0.41,0.78,P>0.05). After 2 months of treatment,the combination group and the hormone group were better than that before the treatment, the difference was statistically significant(tsleep= 10.25, 12.53; trhinitis= 20.04, 18.29; P<0.05); there was no significant difference in sleep snoring score between the two groups after 2 months of treatment(t=1.78, P>0.05), the combined symptom group was better than the hormone group alone(t=5.61, P<0.05). Before treatment, 23 patients with moderate adenoid hypertrophy and 7 patients with severe hypertrophy in the combination group; 24 patients with moderate hypertrophy and 6 patients with severe hypertrophy in the hormone group alone, the difference between the groups was not statistically significant. After treatment, 26 cases of adenoid hypertrophy improved in the combination group, the improvement rate was 86.67%; 21 cases were improved in the hormone group alone, and the improvement rate was 70.00%, but the difference between the two groups was not statistically significant(χ~2=2.455, P>0.05). Conclusion The leukotriene receptor antagonist montelukast combined with glucocorticoids can effectively reduce adenoid volume in children with adenoidal hypertrophy and allergic rhinitis, reduce the degree of allergic reaction, and improve the sleep quality and rhinitis status of children. It can be used as an effective method for nonsurgical intervention for adenoid hypertrophy with allergic rhinitis.
引文
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[3]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组、小儿学组,中华儿科杂志编辑委员会.儿童变应性鼻炎诊断和治疗指南(2010年,重庆)[J].中华耳鼻咽喉头颈外科杂志,2011(1):7-8.
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[5]Chohan A,Lal A,Chohan K,Chakravarti A,et al.System atic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children Int J Pediatr Otorhinolaryngol,2015,79(10):1599-1608.
[6]Shokouhi F,Meymaneh Jahromi A.Montelukast in Adenoid Hypertrophy:Its Effect on Size and Symptoms[J].Iran JOtorhinolaryngol,2015,27(83):443-448.
[7]Modrzynski M,Zawisza E.An analysis of the incidence of adenoid hypertrophy in allergic children[J].Int J Pediatr Otorhinolaryngol,2007,71(5):713-719.
[8]王丰,周成勇,张京红,等.儿童OSAHS和变应性鼻炎的关系探讨[J].临床耳鼻咽喉头颈外科杂志,2012,26(6):260-262.
[9]Dixon AE,Castro M,Gerald LB,et al.Effect of intranasal corticosteroids on allergic airway disease in asthma[J].JAllergy Clin Immunol Pract,2017,5(4):1125-1128.
[10]Cingi C,Muluk NB,Ipci K,et al.Antileukotrienes in upper airway inflammatory diseases[J].Curr Allergy Asthma Rep,2015,15(11):64.
[11]冯韶燕,樊韵平,李磊,等.白三烯受体拮抗剂联合鼻用激素治疗变应性鼻炎的系统评价[J].临床耳鼻咽喉头颈外科杂志,2015,29(3):207-211.
[12]Braido F,Arcadipane F,Marugo F,et al.Allergic rhinitis:current options and future perspectives[J].Curr Opin in Allergy&Clin Immunol,2014,14(2):168-176.
[13]陆忆,殷敏,程雷.白三烯受体拮抗剂孟鲁司特治疗变应性鼻炎的荟萃分析[J].中华耳鼻咽喉头颈外科杂志,2014(8):659-667.
[14]Goh BS,Ismail MI,Husain S.Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids:a randomised double-blind,placebo-controlled study[J].J Laryngol Otol,2014,128(3):242-248.
[2]Evcimik MF,Dogru M,Cirik AA,et al.Adenoid hypertrophy in children with allergic disease and influential factors[J].Int J Pediatr Otorhinolaryngol,2015,79(5):694-697.
[3]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组、小儿学组,中华儿科杂志编辑委员会.儿童变应性鼻炎诊断和治疗指南(2010年,重庆)[J].中华耳鼻咽喉头颈外科杂志,2011(1):7-8.
[4]Demain JG,Goetz DW.Pediatric adenoidal hypertrophy and nasal airway obstruction:reduction with aqueous nasal beclomethasone[J].Pediatrics,1995,95(3):355-364.
[5]Chohan A,Lal A,Chohan K,Chakravarti A,et al.System atic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children Int J Pediatr Otorhinolaryngol,2015,79(10):1599-1608.
[6]Shokouhi F,Meymaneh Jahromi A.Montelukast in Adenoid Hypertrophy:Its Effect on Size and Symptoms[J].Iran JOtorhinolaryngol,2015,27(83):443-448.
[7]Modrzynski M,Zawisza E.An analysis of the incidence of adenoid hypertrophy in allergic children[J].Int J Pediatr Otorhinolaryngol,2007,71(5):713-719.
[8]王丰,周成勇,张京红,等.儿童OSAHS和变应性鼻炎的关系探讨[J].临床耳鼻咽喉头颈外科杂志,2012,26(6):260-262.
[9]Dixon AE,Castro M,Gerald LB,et al.Effect of intranasal corticosteroids on allergic airway disease in asthma[J].JAllergy Clin Immunol Pract,2017,5(4):1125-1128.
[10]Cingi C,Muluk NB,Ipci K,et al.Antileukotrienes in upper airway inflammatory diseases[J].Curr Allergy Asthma Rep,2015,15(11):64.
[11]冯韶燕,樊韵平,李磊,等.白三烯受体拮抗剂联合鼻用激素治疗变应性鼻炎的系统评价[J].临床耳鼻咽喉头颈外科杂志,2015,29(3):207-211.
[12]Braido F,Arcadipane F,Marugo F,et al.Allergic rhinitis:current options and future perspectives[J].Curr Opin in Allergy&Clin Immunol,2014,14(2):168-176.
[13]陆忆,殷敏,程雷.白三烯受体拮抗剂孟鲁司特治疗变应性鼻炎的荟萃分析[J].中华耳鼻咽喉头颈外科杂志,2014(8):659-667.
[14]Goh BS,Ismail MI,Husain S.Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids:a randomised double-blind,placebo-controlled study[J].J Laryngol Otol,2014,128(3):242-248.