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目的:探讨孟鲁司特对儿童过敏性紫癜Toll样受体表达的影响及临床疗效。方法:将86例过敏性紫癜(HSP)患儿,按照随机数字法分为治疗组和对照组各43例。对照组采用常规综合治疗,治疗组在对照组治疗基础上加用孟鲁司特,2~6岁4 mg/d,>6岁~14岁5 mg/d,每日一次,睡前服用。比较两组患儿的临床疗效并观察皮疹消退、腹痛缓解及关节肿痛缓解时间;实时荧光定量PCR技术检测外周血单核细胞中TLR2、TLR5及TLR9 mRNA的基因相对表达量,ELISA检测患者血清中IL-6和IL-8浓度。结果:(1)治疗组总有效率97.7%,明显高于对照组的81.4%(P<0.05),治疗组患儿的皮疹消退、腹痛缓解及关节肿痛缓解时间均显著短于对照组(P<0.05);(2)治疗组和对照组治疗后与治疗前比较,外周血单核细胞TLR2、TLR5及TLR9mRNA相对表达量均显著降低(P<0.05),且治疗后观察组外周血单核细胞TLR2、TLR5及TLR9 mRNA相对表达量均明显低于对照组(P<0.05);(3)两组过敏性紫癜患儿治疗后血清中IL-6和IL-8的表达均明显低于治疗前(P<0.05),且治疗后观察组血清中IL-6和IL-8的表达明显低于对照组(P<0.05)。结论:孟鲁司特治疗儿童HSP临床疗效显著,TLR2、TLR5及TLR9活化可能参与了HSP的免疫发病机制,孟鲁司特能影响Toll样受体(TLR2、TLR5及TLR9)以及IL-6和IL-8的蛋白表达,对儿童HSP的治疗发挥积极作用。
Objective: To investigate the effect of montelukast on Toll-like receptor expression in children with Henoch-Schonlein purpura and its clinical efficacy. Methods: 86 children with Henoch-Schonlein purpura (HSP) were divided into treatment group and control group according to random number method, 43 cases each. Patients in the control group were treated with montelukast, 4 mg / d at 2 to 6 years and 5 mg / d at> 6 to 14 years old on the basis of the control group, once a day and at bedtime. The curative effect of the two groups was compared and the eradication of the rash, the relief of abdominal pain and the time of relieving joint pain were observed. The relative expression of TLR2, TLR5 and TLR9 mRNA in peripheral blood mononuclear cells were detected by real-time fluorescence quantitative PCR. In IL-6 and IL-8 concentrations. Results: (1) The total effective rate in the treatment group was 97.7%, which was significantly higher than that in the control group (81.4%, P <0.05). The treatment group had subsided rash, relieve abdominal pain and joint pain relief time significantly shorter than the control group P <0.05). (2) The relative expression levels of TLR2, TLR5 and TLR9mRNA in peripheral blood mononuclear cells in treatment group and control group after treatment were significantly lower than those before treatment (P <0.05) The relative expression levels of TLR2, TLR5 and TLR9 mRNA in nucleus were significantly lower than those in control group (P <0.05). (3) The levels of IL-6 and IL-8 in serum of children with Henoch-Schonlein purpura were significantly lower than those of control Before treatment (P <0.05), the levels of IL-6 and IL-8 in serum of the observation group were significantly lower than those of the control group after treatment (P <0.05). Conclusion: The therapeutic effect of montelukast on children’s HSP is significant. The activation of TLR2, TLR5 and TLR9 may be involved in the pathogenesis of HSP. Montelukast can affect the expression of TLR2, TLR5 and TLR9 and IL-6 and IL-8 protein expression, play an active role in the treatment of children with HSP.