目的 評價孟魯司特聯(lián)合丙酸氟替卡松對變應(yīng)性鼻炎患兒的臨床療效及免疫調(diào)節(jié)作用。方法 收集2014年1月－2016年12月惠州市中心人民醫(yī)院第一分院收治的變應(yīng)性鼻炎患兒140例，使用數(shù)字法隨機分為丙酸氟替卡松單藥治療對照組和孟魯司特聯(lián)合丙酸氟替卡松治療觀察組，每組70人。ELISA法檢測免疫球蛋白IgE、白介素（IL）-17、IL-10因子表達。比較兩組的臨床療效和臨床不良反應(yīng)。結(jié)果 治療前兩組癥狀體征評分無顯著差異，治療后均較治療前有顯著降低（P<0.01），且觀察組評分降低作用顯著優(yōu)于對照組（P<0.05）；對照組臨床有效率為80.0%，顯著低于觀察組的94.3%（P<0.05）；治療前兩組IgE、IL-17和IL-10表達無顯著差異，治療后兩組IgE和IL-17表達顯著降低、IL-10表達顯著升高（P<0.01），且觀察組對IgE和IL-17的減低作用以及對IL-10的升高作用優(yōu)于對照組（P<0.05）。IgE表達與IL-17呈顯著正相關(guān)（r=0.392，P<0.05），與IL-10呈顯著負相關(guān)（r=-0.364，P<0.05）。觀察組不良反應(yīng)發(fā)生率為14.3%，對照組的為11.4%，治療期間兩組臨床不良反應(yīng)發(fā)生率無顯著差異。結(jié)論 孟魯司特鈉聯(lián)合丙酸氟替卡松治療小兒變應(yīng)性鼻炎臨床療效顯著，使用安全，調(diào)節(jié)IL-17/IL-10因子失衡可能是其起效的作用機制。

Objective To observe the immunomodulatory effects of montelukast and flixonase on children with allergic rhinitis and to explore its clinical efficacy. Methods A total of 140 cases of allergic rhinitis children were sellected, who were randomly divided into two groups:flixonase control group (n=70) and montelukast and flixonase observation group (n=70). The expression of IgE, IL-17, and IL-10 was determined by ELISA analysis. The clinical effect and adverse reactions were compared. Results Before treatment, there was no significant difference of symptom and sign scores between two groups. After treatment, the symptom and sign scores were significantly decreased in the two groups (P<0.01). But the decreasing of symptom and sign scores was better in observation group than in control group (P<0.05). The clinic effective rate of control group was 80.0%, which was lower than 94.3% in observation group (P<0.05). Before treatment, there was no significant difference of IgE, IL-17, and IL-10 expression between two groups. After treatment, the expression of IgE and IL-17 in two groups was significantly decreased (P<0.01), and IL-10 was significantly increased (P<0.01). But the moderating effect of IgE, IL-17, and IL-10 was better in observation group than in control group (P<0.05). IgE expression was positively correlated with IL-17 (r=0.392, P<0.05), and negatively correlated with IL-10 (r=-0.364, P<0.05). The rate of adverse reactions was 14.3% in observation group and 11.4% in control group. There was no significant difference between the two groups (P<0.05). Conclusion Montelukast and flixonase showed effectively clinical efficacy and safty to treat children with allergic rhinitis, and the regulation of IL-17/IL-10 imbalance may be the mechanism of its effect.