摘要目的 探讨应用储雾罐经口鼻吸入糖皮质激素联合口服孟鲁司特钠阻断气道变态反应性炎症向纵深发展,防止变应性鼻炎(AR)向咳嗽变异型哮喘(CVA)、支气管哮喘(BA)转化的效果.方法 232例AR患儿被随机分为对照组114例,观察组118例.对照组予口服氯雷他定片,体重＜30 kg,每次5 mg,每日1次,体重≥30 kg,每次10 mg,每日1次.观察组在对照组治疗基础上,吸入丙酸氟替卡松定量气雾剂,每次1揿(125μg),每日2次,症状控制后减为每日1次,采用带有活瓣的储雾罐辅助吸入,若患儿能够配合,嘱闭口呼吸1分钟.同时口服孟鲁司特钠,1～5岁用4 mg,6～ 14岁用5 mg,每天1次.两组疗程均为3个月.疗程结束后,每月至少随访1次,随访时间3年.若症状未愈或复发,继续以上治疗3个月.治疗后半年、1年、2年、3年比较两组AR未愈或复发以及CVA和BA发生率.若患儿诊断为BA则按有关治疗常规进行治疗.若符合CVA诊断标准,再将患儿随机分成两组,观察组按上述治疗方案继续半年治疗,对照组仅予祛痰、止咳、抗感染等治疗.症状未控制时每1～2周随访1次,症状控制后每月随访1次,随访时间3年.治疗后半年、1年、2年、3年比较两组CVA未愈或复发以及BA发生率.结果 治疗后半年、1年、2年、3年AR未愈或复发率在对照组和观察组分别为52％、60％、71％、80％和14.15％、16.38％、18.87％、25.47％,CVA发生率在对照组和观察组分别为40％、48％、57％、71％和15.09％、16.98％、20.75％、23.73％,BA发生率在对照组和观察组分别为30％、39％、47％、53％和11.32％、13.21％、16.04％、18.87％,对照组均明显高于观察组(P≤0.001);CVA未愈或复发率在对照组和观察组分别为45％、55％、62.5％、75％和17.5％、25％、30％、37.5％,转化为BA在对照组和观察组分别是35％、45％、60％、70％和10％、12.5％、15％、17.5％,对照组均明显高于观察组(P＜0.01).且随着随访时间延长,上述各项发生率对照组比观察组增加更为明显.结论通过应用储雾罐经口鼻吸入糖皮质激素联合口服孟鲁司特钠,可防止AR及CVA反复,且可防止AR向CVA和BA转化,阻断气道变态反应性炎症向纵深发展.

abstractsObjective To investigate the effect on preventing exacerbation of airway allergy inflammation by inhaled corticosteroid with a spacer through nose and mouth combined with oral montelukast,in order to prevent transformation from allergic rhinitis (AR) to cough variant asthma (CVA) and bronchial asthma (BA).Methods 232 cases of AR were randomly divided into control group (114 cases) and observation group (118 cases).Control group was treated by oral loratadine (Wt ＜ 30 kg,5 mg once daily; Wt ≥ 30 kg,10mg once daily).Observation group was administered by inhaled fluticasone propionate with 125 μ g twice daily and oral montelukast (1-5 yrs,4 mg once daily; 6-14 yrs,5 mg once daily) on basis of control group.When patients' symptoms were controlled,dose of fluticasone propionate was reduced to once daily.Fluticasone was inhaled with a spacer,patients were required to close their mouth and to breathe for 1 minute through their nose if they were able to cooperate.Course of treatment was 3 months in both groups.After treatment,patients were followed up at least once a month for 3 years.If patients' symptoms weren' t controlled or didn' t recur,treatment above would be continued for another 3 months.The unhealed and recurrent rates of AR,incidence of CVA and BA were compared between two groups half a year,1 year,2 years and 3years after treatment.If patients were diagnosed with BA,they would be treated by routine therapy of BA.If patients corresponded to diagnostic criteria of CVA.they would be randomly divided into control group and observation group again.Observation group would continue to he treated by above-mentioned therapy for half a year,while control group was treated by antitussives,expectorants and antibiotics.Patients were followed up every 1-2 weeks when their symptoms weren't controlled,then they were followed up once a month when their symptoms were controlled.Follow-up lasted for 3 years.The unhealed and recurrent rates of CVA,incidence of BA were compared between two groups half a year,1 year,2 years and 3 years after treatment.Results Half a year,1 year,2 years and 3 years after treatment,the unhealed and recurrent rates of AR in control group and observation group were 52％,60％,71％,80％ and 14.15％,16.38％,18.87％,25.47％respectively (P ＜ 0.001),the incidences of CVA in control group and observation group were 40％,48％,57％,71％ and 15.09％,16.98％,20.75％,23.73％ respectively (P ＜ 0.001),the incidences of BA in control group and observation group were 30％,39％,47％,53％ and 11.32％,13.21％,16.04％,18.87％ respectively (P ≤ 0.001).In patients with CVA,the unhealed and recurrent rates in control group and observation group were 45％,55％,62.5％,75％ and 17.5％,25％,30％,37.5％ respectively (P ＜ 0.01),incidences of BA in control group and observation group were 35％,45％,60％,70％ and 10％,12.5％,15％,17.5％ respectively (P ＜ 0.01).As the time of follow-up extended,above-mentioned rates in control group had increased more obviously than those in observation group.Conclusions Repetitions of AR and CVA were prevented,and transformation from AR to CVA and BA was also prevented by inhaled corticosteroid combined with oral montelukast,which could stop airway allergy inflammation from worsening.