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白三烯受体拮抗药联合鼻喷激素治疗不同程度腺样体肥大合并变应性鼻炎患儿的临床观察
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| 篇名： | 白三烯受体拮抗药联合鼻喷激素治疗不同程度腺样体肥大合并变应性鼻炎患儿的临床观察 |
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| 摘要： | 目的：探讨白三烯受体拮抗药联合糖皮质激素鼻喷雾剂（以下简称“鼻喷激素”）治疗不同程度腺样体肥大（AH）合并变应性鼻炎（AR）患儿的临床疗效及安全性。方法：240例合并AR的AH患儿按随机数字表法分为对照组、鼻喷激素组和联合用药组，各80例。对照组患儿每天早晚各使用1次鼻喷生理性海水，左右鼻孔各3喷；鼻喷激素组患儿给予糠酸莫米松鼻喷雾剂，每天左右鼻孔各1揿；联合用药组患儿在此基础上加用白三烯受体拮抗药孟鲁司特钠咀嚼片，＜5岁患儿予以4 mg，≥5岁患儿予以5 mg，qd，睡前嚼服。3组患儿疗程均为12周。比较3组患儿治疗后鼻塞、打鼾、张口呼吸等临床症状评分和腺样体厚度（A）/鼻咽腔宽度（N）比值的改变，及不良反应发生情况；同时根据AH程度将各组各分为两个亚组（中、重度）进行疗效评价。结果：本研究共脱落患儿21例，其中对照组、鼻喷激素组与联合用药组分别脱落11、6和4例。治疗后，联合用药组与鼻喷激素组各亚组患儿的临床症状评分和A/N均较对照组更低，差异均有统计学意义（P＜0.05）；联合用药组与鼻喷激素组中AR合并中度AH亚组患儿的临床症状评分和A/N比较，差异均无统计学意义（P＞0.05）；联合用药组中AR合并重度AH亚组患儿的临床症状评分和A/N较鼻喷激素组更低，差异均有统计学意义（P＜0.05）。3组患儿均未见明显不良反应发生。结论：单用鼻喷激素及鼻喷激素联合白三烯受体拮抗药均能不同程度地改善合并AR的AH患儿的临床症状，并缩小腺样体体积。建议中度AH合并AR的患儿可首先应用鼻喷激素治疗，而重度AH合并AR的患儿需联合应用白三烯受体拮抗药治疗。 |
| ABSTRACT： | OBJECTIVE： To explore the clinical efficacy and safety of Leukotriene receptor antagonist combined with Glucocorticoid nasal spray （called “intranasal steroid” for short） in the treatment of different degree of adenoidal hypertrophy （AH） complicated with allergic rhinitis （AR）. METHODS： 240 AR children with AH were randomly divided into control group， intranasal steroid group and drug combination group， with 80 cases in each group. Control group was given physiological seawater， 3 presses each nostrile， in the morning and evening. The intranasal steroid group received Momestasone furoate nasal spray， one press each nostrile， qd. Drug combination group was additionally given leukotriene receptor antagonist Montelukast sodium chewable tablet， 4 mg for under 5 year-old and 5 mg for 5-year-old or above， qd， at bedtime. Treatment course of 3 groups lasted for 12 weeks. The change of clinical symptoms and signs （such as nasal obstruction， snore， mouth breathing， etc） and adenoid/pharyngeal ratio（A/N ratio）were compared among 3 groups after treatment as well as the occurrence of ADR. Each group was divided into two sub-groups （medium and severe） according to the severity of AH so as to evaluate therapeutic efficacy. RESULTS： 21 children withdrew from the study， including 11 cases in control group， 6 in intranasal steroid group and 4 in drug combination group. After treatment， clinical symptom score and A/N in subgroups of drug combination group and intranasal steroid group were all lower than those of control group， with statistical significance （P＜0.05）. There was no statistical significance in clinical symptom score and A/N between drug combination group and AR complicated with medium AH subgroup from intranasal steroid group （P＞0.05）. Clinical symptom score and A/N of AR complicated with severe AH subgroup from drug combination group were lower than intranasal steroid group， with statistical significance （P＜0.05）. No obvious ADR occurred in 3 groups. CONCLUSIONS： Intranasal steroid alone and intranasal steroid combined with leukotriene receptor antagonist can improve clinical symptom of AR patients with AH，and reduce adenoid volume. It is suggested to use intranasal steroid firstly for medium AH complicated with AR， and additionally use Leukotriene receptor antagonist for severe AH complicated with AR. |
| 期刊： | 2016年第27卷第29期 |
| 作者： | 高黎，徐洁 |
| AUTHORS： | GAO Li，XU Jie |
| 关键字： | 腺样体肥大；变应性鼻炎；白三烯受体拮抗药；糖皮质激素鼻喷雾剂；儿童 |
| KEYWORDS： | Adenoidal hypertrophy； Allergic rhinitis； Leukotriene receptor antagonist； Glucocorticoid nasal spray； Children |
| 阅读数： | 479 次 |
| 本月下载数： | 3 次 |
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