目的探讨不同白三烯（LT）水平的咳嗽变异性哮喘（CVA）患儿接受白三烯受体拮抗剂（LTRA）治疗后体内LT水平变化与临床疗效的关系。方法以本地300例同年龄儿童所测定的尿LTE4值（25.17±14.26）ng/L作为基础对照，将使用LTRA孟鲁司特治疗的67例CVA患儿按LTE4水平是否高于基础对照水平的2SD，分成LTRA-高（H）组25例和LTRA-低（L）组42例，治疗1个月后观察尿LTE4水平变化和临床疗效；采用相同方法将使用吸入糖皮质激素（ICS）氟替卡松治疗的60例患儿分成ICS-H组20例和ICS-L组40例进行对照。结果所有CVA患儿尿LTE4水平与基础对照相比均有统计学差异（均P＜0.05）；在接受2种不同方法治疗1个月后，LTRA-H组、LTRA-L组和ICS-H组患儿尿LTE4水平均有明显下降（均P＜0.05），但ICS-L组无明显变化（P＞0.05）。LTRA组与ICS组总体疗效相当（P＞0.05）；LTRA-H组疗效优于LTRA-L组（P＜0.05），LTRA-L组与ICS-H组、ICS-L组疗效均无统计学差异（均P＞0.05）。结论 CVA患儿采用LTRA和ICS治疗总体疗效相当；体内LT水平与LTRA临床疗效密切相关，LT水平高者疗效优于低者；尿LTE4检测可以作为临床选用LTRA的指标。% Objective To explore the changes of leukotriene levels in vivo and clinical efficacy after accetping the treat-ment of leukotriene receptor antagonist (LTRA) in the cough variant asthma (CVA) children who have different levels of leukotriene. Methods Put urinary leukotriene E4 (LTE4)(25.17±14.26)ng/L as the basis for the control, the value of the basis for the control comes from 300 local children in the same age. Put +2SD as a standard, 67 cases of CVA who received the treatment of LTRA-montelukast, were divided into high LTRA group(LTRA-H) 25 cases and low LTRA group(LTRA-L) 42cases. Observed the the change of urinary LTE4 levels and clinical efficacy after a month. Grouped with the same method, 60 cases of CVA who received the treatment of inhaled corticosteroids (ICS)-fluticasone, were divided into high-ICS group (ICS-H) 20 cases and low-ICS group (ICS-L) 40 cases. Results There have significant difference in urinary LTE4 between CVA children and the basis for the control (P<0.05);After a month, the urinary LTE4 levels in the LTRA-H、LTRA-L、ICS-H were significantly reduced after accepting the two different treatment (P<0.05), But the ICS-L did not change significantly (P>0.05);The overal efficacy of the LTRA and the ICS group have no difference (P>0.05). Efficacy of LTRA-H is better than LTRA-L (P<0.05), but there have no difference between LTRA-L、ICS-H and ICS-L (P>0.05). Conclusion The overall efficacy is quite after the CVA were treated with LTRA and ICS. Leukotriene levels in vivo and the LTRA clinical efficacy are closely related. Leukotriene levels as high as more effective than the low level of . The urinary LTE4 can be used as a predictor of the clinical selection of LTRA.
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