The Influence Of Montelukast On Peripheral Blood Th17/Treg Balance And Their Related Cytokines Of Children With Bronchiolitis Infected With RSV

Objectives:To investigate the influence of Montelukast on peripheral blood Th17/Treg balance and their related cytokines of children with bronchiolitis infected with respiratory syncytial virus ( RSV), further discuss the immunologic mechanism of Montelukast on bronchiolitis,and observe its curative effect.Methods:Sixty cases children with RSV bronchiolitis was selected ,which were admitted to the Affiliated Hospital of Binzhou Medical College pediatric comprehensive ward,from October 2014 to February 2015. After the incoming of the hospital,we detected the serum specific RSV antibodies IgM by solid-phase enzyme-linked immunosorbent assay,two positive results were selected.The diagnosis of RSV bronchiolitis should be carried out in strict accordance with the diagnostic criteria of "Zhu Futang Practical Pediatrics",which is the seventh edition. There were 30 male and 30 female patients,aged 2～24 months,before the incoming of the hospital, the course of the disease were less than 5 days, and have not been treated by the formal system progression. According to whether or not applicating of Montelukast therapy, the chosen children which meet the conditions were divided into two groups: one is the experimental group, a total of 30 cases, which 14 cases were male, 16 cases were female.The other one is the control group, there were 30 cases, male 16 cases, female 14 cases.Two groups of children showed acute onset,coughing, wheezing, shortness of breath, the three concave sign positive or weakly positive, unilateral or bilateral lungs can smell dry and wet rales sound, chest X-ray examination showed lung markings increased or patchy high density shadow.A total of 30 children in the same period were selected as the normal control group.There was no significant difference in the age and sex between the three groups(P > 0.05).The children in the experimental group and the control groups were given anti-virus,inhalation of Budisonide and other surporting symptomatic. treatment until the symptoms disappeared. The children in the experimental group were additionally given 4mg Montelukast dulcets orally once at bed-time for 3 months.The changes of serum IL-17、TGF-β and their related cytokines levels of children in the two groups were observed before and after 7 days,medical treatment,and the gasping reoccurrence rate was followed up and observed at the time of half-a-year after 3 months medical treatment.We chose flow cytometry to determinate the percentage of Th17 and Treg cells among the peripheral blood before and after treatment. We measured the related cytokines IL-17 and TGF-content by ELISA among the peripheral blood before and after treatment.Result:Before the treatment of Montelukast, the rate of Th17 cells in the peripheral blood of the experimental group and the control group were obviously superior to the normal group(P < 0.05), while the rate of Treg cells was distinctly decreased compared with the normal group(P < 0.05). And the rate of Th17 and Treg cells in the peripheral blood between the children of the experimental group had no statistic significance (P > 0.05). The rate of Th17 and Treg cell in the peripheral blood between the children of the control group also had no significant difference(P > 0.05). The level of IL-17 in the peripheral blood of the experimental group and the control group was significantly higher than that of the normal control group (P < 0.05), whereas the level of TGF- β was significantly lower than that of the normal control group (P < 0.05).The levels of IL-17 and TGF-β in the peripheral blood between the children of the experimental group had no statistic significance (P > 0.05),and the levels of IL-17 and TGF-β in the peripheral blood between the children of the control group also had no significant difference (P >0.05).After the treatment of the Montelukast for 7 days,the rate of Th17 cells in the peripheral blood of the experimental group and the control group was decreased,while the rate of Treg cells was increased. The difference of the rate of Th17 and Treg cells in the peripheral blood of the experimental group before and after treatment had statistic significance (P < 0.05), while the difference of the rate of Th17 and Treg cells in the peripheral blood of the control group before and after treatment had no statistical difference (P > 0.05). The level of IL-17 in peripheral blood of the experimental group and the control group was decreased after treatment, whereas the level of TGF-β was increased.The difference of the levels of IL-17 and TGF-β in the peripheral blood of the experimental group before and after treatment had statistic significance (P <0.05), while the difference of the levels of IL-17 and TGF-β in the peripheral blood of the control group before and after treatment had no statistical difference (P > 0.05).Followe up and observe the recurrence rate of wheezing at the time of half-a-year after 3 months medical treatment Within the half year after the treatment, there are five cases occurred wheezing once in the experimental group,the recurrence rate was 16.7%; while there are six cases occurred wheezing once and one cases occurred wheezing tiwce in the control group, the recurrence rate was 23.3%; among the two groups, the difference was not statistically significant(P>0.05).Conclusion:Montelukast can decrease the expression of Th17 cells of children with RSV bronchiolitis,and at the same time,increase the expression of Treg cells,make the losing balance of Th17 / Treg expression at the disease state restored to a state of equilibrium from newly, thereby relieving wheezing, shortness of breath and other symptoms, in order to achieve a faster cure of the children with RSV bronchiolitis.