摘要
目的：研究丙酸氟替卡松(Flu)、孟鲁司特钠(Mon)、酮替芬(Ket)联合治疗小儿咳嗽变异性哮喘(CVA)的临床疗效。
方法：将2015年6月至2018年1月呼吸内科收治的280例CVA患儿随机分为Flu+Mon+Ket、Flu+Mon、Flu+Ket、Mon+Ket、Flu、Mon和Ket组，每组40例。每组患儿均给予相应药物治疗，每组疗程均为3个月。观察治疗2、3个月后患者咳嗽情况、咳嗽症状评分、肺功能及药物不良反应情况。随访患儿复发情况。
结果：经过治疗后，所有7组患儿咳嗽症状评分均呈下降趋势，1秒用力呼气量百分比(FEV1%)和预测呼气峰流量百分比(PEF%)均呈上升趋势。治疗2个月后，Flu +Mon+Ket组咳嗽症状评分明显低于其他组，FEV1%和PEF%明显高于其他组(P<0.05)。治疗2、3个月后，Ket组咳嗽症状评分明显高于其他组，FEV1%、PEF%明显低于其他组(P<0.05)。治疗3个月后，各组咳嗽症状评分、FEV1%、PEF%比较无显著性差异(P>0.05)。7组不良事件发生率均较低，7组间差异无统计学意义(P>0.05)。Ket组咳嗽复发率明显高于其他组(P<0.001)，而其他组咳嗽复发率无显著差异(P>0.0024)。
结论：对于CVA患儿来说，丙酸氟替卡松、孟鲁司特钠、酮替芬联合治疗2个月的临床效果优于两种药物联合治疗和单一药物治疗，并且是安全的。经过3个月的治疗，单用丙酸氟替卡松或单用孟鲁司特钠与药物联合治疗的效果相似。单用酮替芬临床疗效差，且停药后复发率高。
Clinical effect of fluticasone propionate, montelukast sodium and ketotifen in treatment of cough variant asthma in children.
Zhu XH, Tu JW, Dai JH.
Abstract
OBJECTIVE:To study the clinical effect of different combinations of fluticasone propionate (Flu), montelukast sodium (Mon) and ketotifen (Ket) in the treatment of children with cough variant asthma (CVA).
METHODS:A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with 40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was 3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence.
RESULTS:After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second (FEV1%) and percentage of predicted peak expiratory flow (PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups (P<0.05). After 2 and 3 months of treatment, the Ket group had a significantly higher cough symptom score and significantly lower FEV1% and PEF% than the other groups (P<0.05). After 3 months of treatment, there were no significant differences in cough symptom score, FEV1% and PEF% among the other groups (P>0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups (P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups (P<0.001), while there was no significant difference in this rate among the other groups (P>0.0024).
CONCLUSIONS:For children with CVA, a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination. Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.
目的：研究丙酸氟替卡松(Flu)、孟鲁司特钠(Mon)、酮替芬(Ket)联合治疗小儿咳嗽变异性哮喘(CVA)的临床疗效。
方法：将2015年6月至2018年1月呼吸内科收治的280例CVA患儿随机分为Flu+Mon+Ket、Flu+Mon、Flu+Ket、Mon+Ket、Flu、Mon和Ket组，每组40例。每组患儿均给予相应药物治疗，每组疗程均为3个月。观察治疗2、3个月后患者咳嗽情况、咳嗽症状评分、肺功能及药物不良反应情况。随访患儿复发情况。
结果：经过治疗后，所有7组患儿咳嗽症状评分均呈下降趋势，1秒用力呼气量百分比(FEV1%)和预测呼气峰流量百分比(PEF%)均呈上升趋势。治疗2个月后，Flu +Mon+Ket组咳嗽症状评分明显低于其他组，FEV1%和PEF%明显高于其他组(P<0.05)。治疗2、3个月后，Ket组咳嗽症状评分明显高于其他组，FEV1%、PEF%明显低于其他组(P<0.05)。治疗3个月后，各组咳嗽症状评分、FEV1%、PEF%比较无显著性差异(P>0.05)。7组不良事件发生率均较低，7组间差异无统计学意义(P>0.05)。Ket组咳嗽复发率明显高于其他组(P<0.001)，而其他组咳嗽复发率无显著差异(P>0.0024)。
结论：对于CVA患儿来说，丙酸氟替卡松、孟鲁司特钠、酮替芬联合治疗2个月的临床效果优于两种药物联合治疗和单一药物治疗，并且是安全的。经过3个月的治疗，单用丙酸氟替卡松或单用孟鲁司特钠与药物联合治疗的效果相似。单用酮替芬临床疗效差，且停药后复发率高。
(中日友好医院呼吸与危重症医学科 禹汶伯 摘译 林江涛 审校)
(Zhongguo Dang Dai Er Ke Za Zhi. 2019 Apr;21(4):393-398.)
(Zhongguo Dang Dai Er Ke Za Zhi. 2019 Apr;21(4):393-398.)
Clinical effect of fluticasone propionate, montelukast sodium and ketotifen in treatment of cough variant asthma in children.
Zhu XH, Tu JW, Dai JH.
Abstract
OBJECTIVE:To study the clinical effect of different combinations of fluticasone propionate (Flu), montelukast sodium (Mon) and ketotifen (Ket) in the treatment of children with cough variant asthma (CVA).
METHODS:A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with 40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was 3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence.
RESULTS:After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second (FEV1%) and percentage of predicted peak expiratory flow (PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups (P<0.05). After 2 and 3 months of treatment, the Ket group had a significantly higher cough symptom score and significantly lower FEV1% and PEF% than the other groups (P<0.05). After 3 months of treatment, there were no significant differences in cough symptom score, FEV1% and PEF% among the other groups (P>0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups (P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups (P<0.001), while there was no significant difference in this rate among the other groups (P>0.0024).
CONCLUSIONS:For children with CVA, a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination. Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.
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