Clinical Efficacy Of Montelukast For The Treatment Of Bronchiolitis In Infants And It's Influence On Leukotrienes Level

Objective: Bronchiolitis is common in infants whose age are under 2years old with lower respiratory tract infection.For the first attack,polypnea,wheeze and three depression present as the main clinical features.About 30%-48% infants with Bronchiolitis will develop into the asthma,the incidence is significantly higher than normal children.It will seriously influence the children's daily physical and mental health.Leukotriene(leukotrienes,LTs)is one of the most important mediators of inflammation,first it is compounded into synthetic leukotriene A4(leukotriene A4,LTA4),then leukotriene B4(LTB4),leukotriene C4(LTC4),leukotriene D4(LTD4)and leukotriene E4(LTE4)in our body.These inflammatory mediators can be combined with the leukotriene receptor which was found in human airway,and cause bronchoconstriction,mucus secretion,increased vascular permeability,eosinophil gathering,increased airway remodeling and airway hyperresponsiveness,even small airway obstruction and wheezing.As a common clinical used Leukotriene receptor antagonists(Leukotriene receptor antagonist,LTRAs),Montelukast will effectively suppress LTs with the receptor and physiological effects.This study intends to observe the treatment effect of montelukast on levels of serum LTB4 and urinary LTE4 in infants with bronchiolitis,and to explore its clinical significance.Methods: This sdudy adopts randomized controlled method.The seventy-five diagnosed with Bronchiolitis infants with age from 6 months to 12 months between June 2014 and December 2014 in Second People's Hospital of Anhui province were randomly assigned into two groups.One with thirty-eight cases is the montelukast treatment group and another thirty-seven cases is the control group.All of the children were given routine medical treatment.The infants in the montelukast treatment group were additionally given montelukast daily(4mg once a day,for 7 days).The serum LTB4 and urinary LTE4 levels were measured using ELISA before and after treatment.The relationship between serum LTB4 and urinary LTE4 levels was analyzed by Peason correlation analysis.Results: The general information: The differences about gender,age,the course of the disease prior to admission of the two groups are not statistically significant(P >0.05).Comparison serum LTB4 and level of urinary LTE4 before and after the treatment in the two groups : Before treatment,the serum LTB4 and urinary LTE4 levels of infants in the two groups,no significant difference(P > 0.05);After treatment,the serum LTB4 and urinary LTE4 levels in the montelukast treatment and control groups were significantly reduced compared with before treatment(p <0.05).The montelukast treatment group showed significantly lower serum LTB4 and urinary LTE4 levels than the control group(p <0.05).Comparison of the Clinical symptoms remission time and the length of hospital stay in the two groups: The remission time of cough,wheezing,lung wheezes and the length of hospital stay in the montelukast treatment group were significantly shorter compared with the control group(p < 0.05).Serum LTB4 and urinary LTE4 correlation analysis:There was a positive correlation between serum LTB4 and urinary LTE4 levels(r =0.723,p <0.05).Conclusions: Montelukast has a reliable clinical curative efficacy for bronchioliti in infants,possibly by decreasing serum LTB4 and urinary LTE4 levels.There was a positive correlation between serum LTB4 and urinary LTE4 levels,urine specimen conveniently,therefore,the determination of urinary LTE4 in clinical understanding of LTs levels in infants with capillary bronchitis,and to evaluate the effect of LTRAs has certain clinical significance.