The Study Of Clinic And Leukotriene Levels In Infant Early Wheezing Before And After Intervention

Objective:Wheezing is the most common clinical symptom in childhood. There is a tendency that infant wheezing could occur repeatedly after the first episode, and ultimately, about 22.1%-53.2% cases develop into asthma[1]. It has been confirmed that, the inflammatory mediator-Leukotrienes(LTs) participated in the development process of asthma. LTs's biological effect related to almost all aspects of the pathogenesis of asthma[2]. Leukotriene receptor antagonist plays an important role in the treatment of asthma, it can effectively alleviate symptoms and signs of asthma, reduce the relapse rate of asthma[3], and has become the first-line clinical medicine for the treatment of asthma. Clinically, we discovered that, when infant early wheezing(age less than 3 years old, wheezing attack less than or equal to 2 times) episodes acutely, treated with leukotriene receptor antagonist can receive a quite good clinical effect in a short time. It prompts us that, LTs may be participated in the process of infant early wheezing. To further confirm the function of LTs in infant early wheezing, provide the powerful clinical and experimental basis for the clinical medication, we detected the concentra- tion of LTE4 in serum and urine of 138 children with wheezing, and gave leukotriene receptor antagonist intervention to partial patients. Carried on clinical and experimental observation in the different time section, discussed around the changes of clinical effect and LTs levels in the serum and urine in infant early wheezing before and after the intervention. Method:1 Clinical observation method:We used the clinical compare method, divided 62 infant early wheezing patients into two groups on average: clinical observation group and clinical control group. In addition to normal treatment, we gave the leukotriene receptor antagonist to the clinical observation group, and didn't give it to the clinical control group. We recorded the signs of every patient after prescription, compared the changes of signs before and after prescription between two groups, observed the clinical effective ratio.2 Observation method of the leukotriene level in serum and urine:⑴There were 138 patients diagnosed with infant early wheezing. We collected serum and urine samples of them within 24 hours hospitalized, detected the concentration of LTE4 in serum and urine, observed the changes of leukotriene levels in serum and urine, and compared the result with those of the normal control group.⑵All the patients took the leukotriene receptor antagonist, 12 hours after medication, there were 38 patients provided serum samples, 77 patients provided urine samples; 72 hours after medication, there were 10 patients provided serum samples, 13 patients provided urine samples. We detected the concentration of LTE4 in serum and urine respectively, observed the changes of leukotriene levels in serum and urine in infant early wheezing in different time after prescription, compared the results with those of before medication and with those of the normal control group.⑶Normal control group: younger than 3 years, without family and personal allergy history, without helminth infection recently, without virus and other infection recently.3 Detection method of the LTE4 concentration in serum and urine: We uesd the ELISA method to detected the LTE4 concentration in serum and urine, the ELISA kit was bought from Rapid Bio Lab.4 Statistics method:The date was processed by statistical software SPSS 11.5.The clinical effective ratio was compared byχ2 test, and with signifincant level of 0.05. Because the date didn't follow the normal distribution ,we used the rank sum test, the LTE4 concentration is described by median (M) and quartiles (Q), and with signifincant level of 0.05.Result:1 The leukotriene level in serum and urine of infant early wheezing before intervention.⑴The LTE4 concentration in serum of infant early wheezing group was 132.63, 43.81pg/ml, the LTE4 concentration in serum of control group was 24.35, 15.38pg/ml , compared the result , the LTE4 concentration in serum of infant early wheezing group was significantly higher than that of the control group, P<0.01, the discrepancy was significant in statistics.⑵The LTE4 concentration in serum of bronchiolitis patients was 70.64, 35.96 pg/ml, the LTE4 concentration in serum of asthmatic bronchitis patients was 464.20, 75.69 pg/ml. The LTE4 concentration in serum of asthmatic bronchitis patients was higher than that of bronchiolitis patients. Compared the two groups, P<0.01, the discrepancy was significant in statistics.⑶The LTE4 concentration in urine before intervention in infant early wheezing group was 7.84, 1.40 pg/ml, the LTE4 concentration in urine in control group was 5.04, 1.96 pg/ml. Compared the two groups, P<0.05, the discrepancy was significant in statistics.2 The compare of clinical effective ratio in infant early wheezing before and after intervention.⑴The clinical effective ratio after medication for 12 hours in clinical observation group was 77.4%, the clinical effective ratio in clinical control group was 45.2% at the same time. Compared the two groups, P<0.05, the discrepancy was significant in statistics.⑵The clinical effective ratio after medication for 72 hours in clinical observation group was 95.7%, the clinical effective ratio in clinical control group was 68.0% at the same time. Compared the two groups, P<0.05, the discrepancy was significant in statistics.3 The leukotriene levels in serum and urine of infant early wheezing before and after intervention ⑴The LTE4 concentration in serum in infant early wheezing group after intervention for 12 hours was 248.65, 28.43 pg/ml ,compared with the LTE4 concentration in serum before intervention (475.62, 74.96 pg/ml), P< 0.01, there was a significant discrepancy between them.⑵The LTE4 concentration in serum in infant early wheezing group after intervention for 72 hours was 94.84, 20.68 pg/ml ,compared with the LTE4 concentration in serum before intervention (405.17, 106.29 pg/ml), P<0.05, there was a significant discrepancy between them.⑶The LTE4 concentration in urine in infant early wheezing group after intervention for 12 hours was 7.84, 1.4 pg/ml, compared with the LTE4 concentration in urine before intervention (7.00, 1.68 pg/ml), P> 0.05, there wasn't a statistical discrepancy between them.⑷The LTE4 concentration in urine in infant early wheezing group after intervention for 72 hours was 3.92,0.00 pg/ml, compared with the LTE4 concentration in urine before intervention (1.96, 0.00 pg/ml), P>0.05, there wasn't a statistical discrepancy between them.Conclusions:1 The LTE4 concentration of infant early wheezing increased both in serum and urine. The LTE4 concentration in serum of second time wheezing group (asthmatic bronchitis group)was much higher than that of first time wheezing group (bronchiolitis group). It reveals that leukotriene partici- pated in the process of infant early wheezing. Wheezing times increased, the increasing extent of serum levels of LTE4 would be higher.2 We compared the clinical signs of patients with infant early wheezing before and after medicine intervention, effective ratio of clinical observa- tion group is much higher than that of clinical control group. Intervened after 12 hours and 72 hours , the clinical effect were all obvious. It reveals that, the treatment of leukotriene receptor antagonist in acute exacerbation of infant early wheezing is effective. It provided the clinical basis for the use of leukotriene receptor antagonist in acute exacerbation of infant early wheezing.3 After being intervened by the leukotriene receptor antagonist, the LTE4 concentration in serum decreased significantly after 12 hours and 72 hours. It revealed that leukotriene receptor antagonist can decrease the serum LTE4 concentration in infant early wheezing in a short time(≤3days), and match the clinical observation effect after intervention. It provides the experimental basis for the use of leukotriene receptor antagonist in acute exacerbation of infant early wheezing. After being intervened by the leukotriene receptor antagonist for 12 and 72 hours, the urinary LTE4 concentration didn't change significantly. It reaveled that, being intervened by leukotriene receptor antagonist for a short time (≤3days) didn't influence the urinary LTE4 significantly.