孟鲁司特联合酮替酚对咳嗽变异性哮喘血清金属蛋白酶―29水平影响及疗效观察.doc

孟鲁司特联合酮替酚对咳嗽变异性哮喘血清金属蛋白酶―29水平影响及疗效观察 　　[摘要] 目的 探讨孟鲁司特联合酮替酚对咳嗽变异性哮喘（CVA）患者金属蛋白酶（MMP）-2、9水平的影响及疗效观察。 方法 将90例CVA患者随机分为观察组和对照组。两组予以舒喘灵气雾剂治疗，咳嗽消失后停药。观察组加用孟鲁司特咀嚼片（10 mg/次，1次/d，口服）联合酮替酚片（1 mg/次，2次/d，口服）治疗，对照组予以单纯孟鲁司特咀嚼片治疗，剂量与用法同观察组，两组疗程8周。 结果 治疗8周后，两组血清MMP-2和MMP-9均明显下降（P0.05）。随访1年，观察组复发率低于对照组（χ2=6.33，P0.05）。 结论 孟鲁司特联合酮替酚治疗CVA的效果及安全性均较好，且能降低复发率，作用可能与降低血清MMP-2和MMP-9水平密切相关。 　　[关键词] 咳嗽变异性哮喘；孟鲁司特；酮替酚；金属蛋白酶-2；金属蛋白酶-9；复发 　　[中图分类号] R725.6 [文献标识码] B [文章编号] 1673-9701（2015）04-0070-03 　　[Abstract] Objective To discuss curative effect and influence on plasma of MMP-2 and MMP-9 levels of Montelukast combined with ketotifen on cough variant asthma （CVA）. Methods A total of 90 cases of patients with CVA were divided into observation group and control group by numeration table at random. The patients in two groups were given Salbutamol Aerosol treatment until the disappearing of cough. The patients in observation group were additionally given Montelukast Dulcets（10 mg per time， once a day， through the mouth） combined with ketotifen tablets （1 mg per time， twice a day， through the mouth）， while the patients in control group were given the pure Montelukast Dulcets with the same dose and method as those in observation group， for 8 weeks as the course of treatment. Results After 8 weeks’treatment， the plasma MMP-2 and MMP-9 levels descended significantly（P0.05）. According to the one-year following-up after the withdrawal of drugs， reoccurrence rate of patients in observation group was much lower than that in control group（χ2=6.33，P0.05）. Conclusion Montelukast combined with Ketotifen has favorable clinical curative effect on CVA with high security，and can reduce the reoccurrence rate. May its mechanism relates to down-regulating MMP-2 and MMP-9. 　　[Key words] Cough variant asthma；Montelukast；Ketotifen；MMP-2；MMP-9；Reoccurrence 　　咳嗽变异性哮喘（cough variant asthma， CVA）是一种隐匿型哮喘，以慢性顽固性干嗽为主要表现，易误诊，部分患者可发展为典型哮喘[1]。研究证实CVA病理机制与典型哮喘基本相似，近年来研究已证实，慢性气道炎症与气道重构在其中起极其重要的作用，基质金属蛋白酶（MMPs）是引起哮喘患者气道慢性炎症与气道重构