| Objective: 1 To determine the levels of CysLTs (cysteinyl leukotrienes) and MCP-4 (monocyte chemoattractant protein-4) in serum in bronchiolitis and their relationships with the severity of the disease. 2 To discuss the relationships between second-hand smoking, personal or family atopic history and clinical score, serum levels of CysLTs and MCP-4. 3 To evaluate the clinical efficacy of montelukast on bronchiolitis by comparing the alterations in serum MCP-4 levels, clinical scores and disappearing time of wheezing and wet rale before and after the treatment with or without Montelukast.Methods: 80 children aged 3-24 months old with bronchiolitis were chosen randomly as objects, which were treated in out-patient clinic or hospitalized. Information including age, sex, personal or family atopic history, exposure to second-hand smoking, disease course, treatment outside the hospital were collected. Clinical score was measured by respiratory rate, heart rate, dyspnea performance and the nature of wheezing, which reflects the severity of the disease. Then children were divided into treatment (n=40) and control (n=40) group randomly. The patients in control group were treated with conventional therapy, and the treatment group with oral montelukast (6-24 months old, 4mg/d; 3-5 months old, 3mg/d, both taken at night for 2-3weeks till the children were fully recovered ) in addition to the conventional therapy. Blood samples were taken at the time when children were hospitalized or in the next morning. Sera were collected and preserved after centrifuge for CysLTs and MCP-4 measurement by ELISA. Blood samples were taken after 7 days of treatment for MCP-4 measurement and the clinical scores were calculated again. The time that the wheezing and wet rale disappearing was also observed. Serum levels of CysLTs and MCP-4 from 25 healthy children at the same age were measured as normal standards. Statistical analyses were performed by SPSS13.0 after data were collected. Data with normal distribution were expressed as mean±SD and non-normal distribution data as median (quartile range). p value >0.1 was not considered statistically different in the analyses of comparability between the treatment and control group, and p value <0.05 was considered statistically different in other analyses.Results : The levels of CysLTs (57.41±18.00 vs 22.58±12.46ng/ml, t=5.929, p<0.001) and MCP-4 (106.22 ±19.57 vs.82.46±18.26pg/ml, t=4.882, p<0.001) in serum were both significantly higher than the healthy children at the same age. The clinical score at the time when the children were hospitalized was 8.46±3.50, which significantly correlated with the serum CysLTs(r=0.661, p<0.001)and MCP-4(r=0.819,p<0.001)levels.For risk factors analyses, only those children whose courses were less than five days and treated only with oral drugs (except glucocorticoid and antiallergic medicines) were chosen. Compared with the children without second- hand smoking history, the concentrations of CysLTs (64.22±18.78 vs.53.10±16.25ng/ml, t=2.806, p<0.01) and MCP-4(112.99±21.76vs.101.95±16.92pg/ml, t′=2.404, p< 0.05) in serum, and clinical score(9.61±3.69vs.7.73±3.20, t=2.408, p<0.05) were significantly increased in the children with this history. Compared with the children without personal atopic history, children with this history had significantly higher levels of CysLTs (66.96±14.61vs. 47.37±15.72ng/ml, t=5.775, p<0.001)and MCP-4 ( 113.20±19.01vs.98.89±17.56pg/ml, t=3.492, p<0.01) in serum, and clinical score (9.63±3.30vs.7.23±3.31, t=3.25, p<0.01). The level of serum CysLTs (63.59±16.26vs. 53.69±18.13 ng/ml, t=2.445, p<0.05) was significantly higher in the children with family atopic history compared with those without this history, whereas there were no significant differences in the serum MCP-4 level (105.49±15.51vs. 106.66±21.79 pg/ml, t=-0.258, p>0.05) and the clinical score (8.70±2.69 vs. 8.32±3.93, t′=0.512, p>0.05).There were no significant differences in the age, sex, personal or family atopic history, the levels of serum CysLTs and MCP-4 and the clinical scores between the treatment and control group. The levels of MCP-4 were significantly reduced in both groups(treatment group: 105.08±20.28vs.83.96±15.09pg/ml,t=5.28,p<0.001; control group:107.37±19.02vs. 95.10±14.11pg/ml, t=3.28, p<0.01) after seven days treatment, the decrease in treatment group was more obvious than the control group(21.12±7.41pg/ml vs.12.27±7.51pg/ml, t=5.31, p<0.001); The clinical scores were reduced in both groups(treatment group:8.20±3.29vs. 3.90±2.47, t=6.61, p<0.001; control group:8.73±3.72vs. 5.70±2.74, t=4.14, p<0.001), the decrease in the treatment group was more than the control group(4.30±1.81 vs. 3.03±2.78, t′=2.42, p<0.05); The disappearing time of wheezing and wet rale in the treatment group(wheezing: 6.03±2.97d; wet rale: 8.90±3.24d) was shorter than the control group(wheezing: 7.60±2.87d; wet rale: 10.43±3.15d), the differences reached statistical significance (wheezing: t=-2.41, p<0.05; wet rale: t=-2.14, p<0.05).Conclusions: 1 The levels of serumal CysLTs and MCP-4 in the children with bronchiolitis can be used to evaluate the severity of disease. 2 Montelukast, a leukotriene receptor antagonist, is a effective medicine for bronchiolitis therapy. 3 Children with one of the three risk factors, second-hand smoking, personal or family atopic history, should take the medicine-montelukast earlier to achieve better therapeutic effect.
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