• TAP CHl NGHIEN CCJU Y HQC
HIEU QUA CflA KHANG LEUKOTRIENE VA KHANG HISTAMINE H1 TRONG DIEU TRI MAY DAY MAN TINH
VQ Thj Thcm^ Hoang Thj Lam^
* Hgc viin Y hgc cd tmyen Tui Tinh; ^Trw&ng Dg/ hgc Y Hi N0i Nghien cwu nhim xic dinh hipu qua phoi hgp Montelukast (khing Leukotriene) vi Cetinzine (khing histamine HI) trong diiu tn may day mgn tinh. Diy li thCr nghiim lim sing ngiu nhiin cd ddi chwng dwgc Sen hanh vai 2 nhdm bpnh nhan may day m^n tinh kham t^i tmng tim Di img - Mien dich lim sing, binh vi$n B$eh Mai vi khoa Kham b$nh. bpnh vi$n Da lieu Trung wang. Nhdm 1 (31 bpnh nhin) dung 1 viin Singuiaire lOmg vio bu6i tdi vi 1 viin Cetinzine (Xyzal 5mg) vio buoi sing. Nhdm 2 (31 bpnh nhin) dung 1 viin Xyzal 5mg vao buoi sang. Kit qua nghien cuv cho thiy. nhdm 1 kiim soil triiu chwng b$nh (so Iwgng.
irich thwdc san phu. muc dd ngira va tan suit xuit hipn miy day) hieu qua han so vol nhom 2. Swkhac biet cd y nghTa thing ke, p < 0.001 sau 8 tuin dieu tri. Ty le khoi bpnh (khdng tripu chung) cua nhdm 1 (90,3%) cao han cd y nghTa so vdi nhdm 2 (41,9%). p < 0.001 Nhw viy, diiu In phdi hpp giOs Xyzal (Levoceritizine) va Singuiaire (Montelukast) dpt hieu gua va cd dp an toan cao
Tir khda: may day man, montelukast, singuiaire, cetirizlne, xyzal
I. DAT
V A NBt
Mdy day la bgnh pho b i l n , khoang 15 - 23% s l dan da tfl'ng cd b i l u hidn mdy day trong cuflc ddi cfla ho, 0 Viet Nam, theo nghidn cfl'u cua Nguydn Ndng An, ty Id may day trong cdng d i n g Id 11,68% [1], May day vdi ddc tryng Id ngda vd san phu keo ddi dydi 24 gid, do n h i l u nguyen nhan gdy ra.
Vide xac dinh nguydn nhdn t h y c s y rat khfl khan vl h l u h i t bdnh nhdn d i n vien Id may day man tinh vd cfl tdi 80% trydng hop ndy khong xdc djnh d u p e nguydn nhdn [1], Logi bo nguyen nhdn kich thich la p h y a n g phap d i l u tri hu'u higu nhat Khi d i l u ndy id khflng the thi thuoc khang histamin dan t h u i n hodc k i t hap vdi khdng leukotriene, corticoid. Id cac bidn phdp d u a c cdc bdc s? uu tidn lua chpn
Bia ch! lien h$ Hoang Thi Lam. 8$ mon Di iing. trudng DaihQcYHaN^i
Email [email protected] Ngay nhan. 30/1/2015 Ngdy (Juvc chap thu$n 31/5/2015
Mdy day man tinh gdy nen do cac chat trung gian hda hoc d y a c giai phflng tfl' t l bdo mast vd bach c l u di k i l m bdi phan fl'ng mien dich hay khflng do m i l n dieh Histamine Id chdt trung gian hoa hoc quan trong nhat gdy t i n thu'ong mdy day vd thude khang histamine H I khflng an thdn id thuflc dieu tn ddu tay [2]
T h y c te, n h i l u tru'dng hpp khdng histamine dan thuan khflng k i l m sodt d y p c bgnh Bdi vi, ngodi histamine, ed rdt nhieu chat trung gian hfla hpc khac nhu leukotriene, prostaglandine, ,cung dong vai trd quan trong trong bdnh sinh cua may day [3] Cdc nghien cdu invivo va invitro da chimg minh leukotriene dflng vai trfl r i t quan trong trong phan iJng vidm cfla da, Trong thyc nghigm, tiem leukotriene trong da dd tao ra san phfl, eung e l p them bdng chfl'ng rdng nfl cfl t h l tham gia vao s y hinh thdnh cua mdy day [4]
Hydng d i n dieu tri cua EAACI/GA2LEN/
EDF/WAO (ede nhd da l i l u vd di fl'ng Chdu Au) vdo ndm 2012 vd Vidn hdn ldm Da l i l u chdu A (AADV) phoi hpp vdi lien dodn cdc hdi
TCNCYH 94 (2)-2015
H A P CHl NGHIEN cO'U Y HQC • da l i l u Chdu A ndm 2010 dd sfl' dung t h u l c khdng leukotriene k i t hpp cflng thuoc khdng _ histamine H I khflng an t h i n trong d i l u trj mdy day mgn tinh [5, 7] Thuoc khdng leukotriene dd chfl'ng minh d u a c hidu qua trong d i l u trj bdnh mdy day man tinh tfl' rat n h i l u nghidn cu'u trdn t h l gidi [8, 10] cfln d Vidt Nam chya cfl nghien cdu vd van d l ndy. VI v$y, chflng tfli t i l n hdnh nghidn cfl'u ndy vdi myc tidu Ddnh gid hieu qua eua thuoc Montelukast trong d i l u tn bdnh mdy day mgn tinh,
II. 06l TU'aNG VA PHU'ONG PHAP
1. D d i t u ^ n g
Ld cdc b§nh nhdn d u p c chan dodn mdy day mgn d i n khdm vd d i l u tn tai Khoa khdm bgnh, bdnh vidn Da l i l u Trung uang va Trung tdm Di fl'ng - Midn dich Idm sdng, bgnh vien Bach Mai.
* Tieu chuan chgn benh nhan: Ld bdnh nhdn tO' 18 t u l i trd Idn, d i n g y tham gia nghidn cdu.
* Tieu chuan /o?/ trif: Phy nO- cd thai, eho con bu, ngydi cfl t i n thuang gan ho^c dang cfl b0nh nfli khoa n§ng khdc NhO'ng bdnh nhdn r l i logn tdm than, sa sflt tri tud ho§e khflng tudn thu d i l u trj d i y dfl cflng bi loai khoi nghidn cfl'u.
2. Vat ligu nghidn ci^u
- Montelukast: bidt d u a c Id Singular lOmg dang vidn ndn, nhd san x u l t Merck & Co Ltd, Hoa Ky,
- Levocetirizine. Bi^t d y a c Id Xyzal® 5mg, dgng vidn ndn, nhd sanxuat UCB Phamia, thupc Glaxo Smith Kline.
3. Th&i gian: tit thdng 3 den thdng 8/2014.
4. Phu'O'ng phdp
4.1. Thiet ke nghien ciru: Phuang phap nghien cdu thfl- nghidm Idm sdng ngdu nhidn cd d l l chfl'ng,
4.2. Cd' mau
C d mdu d u p c tfnh theo cdng thfl'c nghidn cO'U thfl' nghigm Idm sdng cfla To chfl'c Y t l T h l gidi'
[Zi-a;2 V w r ^ ^ 2 > l * ^ - P l > ^ P 2 ( ^ " P 2 ' ( P i - P z ) '
hi: c d mdu nhdm 1 (dypc didu tn bdng levocetirizine vd montelukast).
ni. c d mdu nhdm 2 ( d y p c d i l u tn bdng levceetirizine),
Zi-j^a: h0 s l tin cdy 95% (= 1,96), Zp, lyc mdu 80% (= 1,645); pi, ty 1^ bdnh nhdn nhdm 1 dat ket qua t i t : y d c luang 85%, p2 ty le bdnh nhdn nhflm 2 dgt k i t qua tflt: y d e lu'ong 4 5 % ; p = (pi + pz)/2.
K i t qua tinh todn e d mdu cho mfli nhflm m = n2 = 31 .Tong so bdnh nhdn cfla hai nhflm Id 62.
4.3. Cac bw&c tien hanh nghien cuu Cdc bdnh nhdn d u p e lya chon ngdu nhien vdo hai nhflm. Bdnh nhdn so le vdo nhflm 1, bgnh nhdn so chdn vdo nhdm 2 So hdu duac thu th$p theo bdnh dn nghidn cfl'u mdu.
T i l n hdnh d i l u tn: nhflm 1, uong Xyzal 5mg X 1 vidn/ngdy vdo b u l l sdng vd Singulair lOmg X 1 vidn/ngdy vdo b u l l toi. Nhdm 2:
u l n g xyzal 5mg x 1 vien/ngdy vdo b u l l sdng Ca 2 nhflm b$nh nhdn deu d y p c d i l u tri trong 8 tuan.
TCNCYH 94 (2) - 2015
• TAP CHi NGHlfeN cO'U Y HQC ' Thep ddi vd ddnh gid gom 3 lan:
+ Ldn khdm 1 (trudc d i l u trj): khdm Idm sdng, danh gia chi so hogt dflng mdy day. tan s u i t x u l t hien t i n thuang, xet nghidm,
+ Lan kham 2 (sau 4 tuan d i l u tri) khdm ldm sang, ddnh gid chi so hoat dflng mdy day, tan s u i t x u l t hign ton t h y a n g , tdc dyng phu eua t h u l c n l u cfl.
+ Ldn khdm 3 (sau 8 tuan d i l u trj) Kham lam sdng. ddnh gid chi so hoat dflng mdy day, tan s u i t x u l t hidn ton thuang, c h i t luang cuflc sflng, xet nghiem c a ban, tdc dung phu cua thuoc
* Khdm vd ddnh gia theo eae tidu cht nhu' sau' Cac tndu chfl'ng lam sdng d u a c ddnh gid theo ehi s l hoat dflng cfla mdy day UAS [2]
Ddnh gid tdc dung phu' Khdm, theo doi vd ghi chdp cdc tdc dyng phy cfla thuoc montelukast nhy:1) Dau ddu, chdng mat, lo du, rfli loan gidc ngfl, tram cam. 2) Dau bung, tieu chay. 3) Vidm hpng. vidm thanh quan, viem dudng ho hap trdn, phdt ban. 4) R l i loan chdc ndng gan tdng men gan.
Bang 1 . So s a n h dac diem benh
5. Xu> ly s d lieu
Theo chuang trinh SPSS 21,0 Cdc test t h i n g kd: ^ hodc Fisherexaet test cho cdc b i l n dmh tinh, p < 0.05 duae coi Id efl y nghTa thong kd-
6. Dao dfl'c t r o n g nghien cfl'u T i t ca bgnh nhdn tham gia nghidn cuu d y p c giai thich rfl v l muc dich, ydu eau cfla nghidn c d u vd t y nguyen dong y tham gia.
Cdc thdng tin ca nhdn cfla benh nhdn dupe giu' kin. Tru'dng hop bdnh nhdn tu- choi. khflng tham gia vdo nghien ciJu vdn du'ae khdm, t y vdn vd d i l u tri chu ddo Trong thdi gian nghidn cfl'u, bdnh nhdn t h y d n g xuydn trao doi thflng tin vdi ngudi nghidn cfl'u v l tndu chfl'ng vd tdc dung phu neu cfl. Tat ca ede so lidu chi d y p c sfl' dyng vdi muc dich nghidn cfl'u khoa hoc,
III. K^T QUA
1. T r u w ; dieu t n
cua hai n h d m t n p d c didu trj
Tuoi
Giffi tinh
Thdi gian mic
IWLKC do b$nh b^nh
< 4 0
> 4 0 Nam N i j
< 1 nSm
> 1 n i m Nhe - trung Ning
binh
Nhom i (%) 61,3 38,7 32,3 67,7 48,4 51,6 29 71
N l i o m II (%) 74,2 25,8 32,3 67,7 38,7 61,3 32,3 67,7
P
>0.05
>0,05
>0,05
>0,05
Theo l<et qua bang 1, t r y d c di4u tn ca hai nhfim deu tuong a6ng ve mat tuoi, gioi, then gian mac bgnh cung nhu- mi>c do cua benti.
TCNCYH 94 (2) - 2015
TAP CHl N G H I S N C O - U Y H Q C •
2. Kdt qua didu trj t i n thu'O'ng da
Bang 2. Kdt qua didu trj cac t 6 n t h u v n g da cua hai n h d m nghien CIFU
Lam
San phu
thirdc san phil
Ngija sang
KhSng Rai r^c ToSn than
KhSng
< 3mm
£ 3 m m Khong It Nhieu
Nhom 1 n (%) 2 (6,5) 19(61,3) 10(32,3) 3(9,7) 25 (80,7)
3 (9,7) 2 (6,5) 14 (45,2) 15(48,4)
Sau 4 t u i n Nh6m 11 n (%) 3 (9,7) 15(41,9) 15(48,4) 2 (6,5) 18(58,1) 11 (35,5) 2 (6,5) 12 (38,7) 17(64,9)
P
> 0 , 0 5
>0,05
> 0 , 0 5 N h o m l
n (%) 28 (90,3)
3 (9,7) 0 29 (93,6)
2 (6,5) 0 23 (90,3)
2 (6,5) 1 (3,2)
Sau 8 t u d n N h o m II
n (%) 13(41,9) , 17(54,8)
1 (3,2) 13(41,9) 17(54,9) 1 (3,2) 13(41,9) 15(48,4) 3 (9,7)
P
<0,0S
<0,06
<0,05
Sau 4 tuan d i l u tn nhflm I cfl s l lu'ong bdnh nhdn dat hidu qua t i t han so vdi nhdm II, tuy nhidn s y khac bidt nay khdng cfl y nghTa t h i n g kd D i l u tn t i l p thdm 4 tuan nu'a. s u khdc biet ndy dd cfl y nghta t h i n g kd vdi p < 0,05 vdi t i t ca eae dde d i l m t i n thuang da nhy s i n phfl, kieh thydc san phfl, ngda.
3. Tdn sudt xudt hien may day
Bang 3. Kdt qua thay d l i v d tdn sudt xudt hien may day cua 2 n h d m Sau 4 tudn Sau 8 tudn T i n \ " " " " N h o m l Nhdm 11 N h o m l Nhdm 11
suSt \ . n (%) n (%) P n (%) n (%) ^ Khdng xuat hien
Hang tuSn Hang ngay
2 (6,5) 29 (93,6)
0(0)
2 (6,5) • 28 (90,3) 1 (3,2)
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
28 (90,3) 3 (9,7)
0 ( 0 )
13(41,9) 17(54,8) 1 (3.2)
<0,01
<0,01
<0,01
Sau 4 tuan dieu tn, a nhom 1 khdng cdn benh nhan nao bi xuat hi^n may day hang ngay c6n ff nhdm 2 v i n cdn 1 bdnh nhan noi mdy day, Tuy nhiSn, s y l<hac biet nay l<hdng cd y nghTa thdng l<e vd'i p > 0,05. Khi tiep tuc dieu tri thdm 4 t u i n nCra, ty le b$nh nhdn i<h6ng xuat hidn mdy day a nhdm 1 la 90,3% cao han nhdm 2 (41,9%). S y l<hac biSt ndy cd y nghTa thong ki, p < 0,01.
• T « P CHi N G H l i N CCPU Y HQC 4, Hi^u qua didu trj cua 2 nhdm
l O O . O " . 8 0 0 " . 5 0 . 0 " , 4 0 . 0 ' V 2 0 . 0 " , 0 . 0 " t
6 . S " „
^ ^
Tryd'c didu tri
9 0 . 3 " , .
Sau dieu tri
G S", i ^ H T r y d c dieu tri
4 1 . 9 %
Sau didu th Nhflm 1 Nhdm 2 B i l u dd 1 . Hieu qua d i l u trj ( h i t trieu chfl'ng) cfla hai nhdm
Sau 8 tuan d i l u tri, ty Id bdnh nhan h i t tridu chfl'ng Id 90,3% d nhom 1 vd 41,9% d nhflm 2, Sy khdc bi§t v l miJc dd h i t trigu chfl'ng cua hal nhflm cfl y nghta thong kd, p < 0,05
5. Tdc dung khong mong mudn
Bang 4. Tac dung khdng mong mudn cua thudc Tac dung phu
Dau ddu, chdng mat.
Dau bung, tieu chay Rdi Idan giac ngu
Vidm hong, thanh quan, d y d n g hd hap trdn Khac
Nhdm 1 n (%) 1 (3,1%) 1 (3,1%) 0 (0%) 0 (0%) 0 (0%)
Nhdm II n(%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Trong nhdm 1 cfl 1 bdnh nhan bj dau dau chflng mgt vd 1 benh nhdn bj dau bung tidu chay khi d i l u tn d y p e 4 tudn. Sau dd t i l p tuc d i l u tri vd 4 t u i n sau do benh nhdn khdng efl trigu chfl'ng nhu trdn. Nhdm 2 khflng cd bdnh nhan ndo co cdc tridu chfl'ng ndu tren.
IV. BAN LUAN
T r y d c d i l u tri, hai nhflm bgnh nhdn t u o n g d i n g v l gidi tinh, ve tuoi, thdi gian mdc bdnh cung n h u mfl'c dd ndng cua bdnh.
Nhu v$y, se giam t h i l u d u p c t l i da sai s l trong qud trinh t i l n hdnh nghidn ciru vd phdn tich dO- lidu.
K i t qua d i l u trj ton t h u a n g da. theo ddi
ddp fl'ng d i l u tri sau 4 tudn cho thay, ddp u'ng d i l u tn giO'a 2 nhflm la tuang duong nhau Tuy nhidn, sau 8 t u i n d i l u tn s l lupng vd kich t h y d c san phfl cung nhy mfl'c dfl ngda cua bdnh nhdn d 2 nhdm d i u giam, rfl rgt nhat la bgnh nhdn d nhdm I tdc la nhflm p h l i hap giu'a Singuiaire va Xyzal, Sy khde bidt
TCNCYH 94 (2) - 2015
TAP CHi NGHIEN CO'U Y HQC
trong eai thidn tridu chfl'ng eua hai nhflm cfl y nghia t h i n g kd vdi p < 0,001,
Leukotnen mflt hfla chat trung gian cfl tac dyng sinh hpc manh gap 100 lan so vdi hista- mine dd d y p c chfl'ng mmh gdy s i n phfl, ngfl'a rfl r§t d bdnh nhdn mdy day. T h u l c khdng leukotriene du-ac coi Id t h u l c khdng vidm the hd mdi da cho n h i l u bdng chijng trong vide quan ly thdnh cong bdnh mdy day man tinh (3] T h u l c d y p c d y a vdo phdc d l d i l u tn mdy day man tinh tfl' nhung ndm 2008 [7] K i t qua nghidn cfl'u cua chung tfli cung phfl hpp vdi nhilu nghien cdu khi chfl'ng minh tac dyng cua t h u l c khang leukotnene trong d i l u tri mdy day man tinh.
Mdy day man tinh la bdnh cd tinh c h i t dai ddng hay tdi phdt, anh hudng rat Idn d i n chat lyang cupc s i n g bdnh nhdn. Trong nghidn cfl'u cfla chflng tfli, sau 4 tuan dieu tri, d nhom 1 khong cfln bdnh nhdn ndo xudt hidn mdy day hdng ngdy, con d nhflm 2 v l n cfln 1 bdnh nhdn n i l mdy day ngdy mdt lan. Khi t i l p tuc d i l u tn them 4 t u i n nu'a, ti Id bdnh nhdn khong xuat hidn may day d nhdm 1 Id nhflm d i l u trj phoi hpp giu'a Singuiaire va Xyzal la 87,1% eao han nhdm 2 "chi d i l u tn Xyzal dan thuan Id 25,8%, Sy khdc bigt nay co y nghia thong kd vdi p < 0,001,
Nhy vgy, so vdi nhflm bdnh nhan ehi dieu tri mflt minh thuoc khdng histamine H1 (levocentizin) thl nhflm bdnh nhdn du'ae d i l u tri p h l i hpp thuoc khdng histamine H I (levoceritizin) vd khdng leukotriene (montelukast) kiem sodt t i n s u i t xuat hidn t i n thu-ang mdi trong benh may day man tinh tflt han Theo Pacor ML vd cflng sy, khi so sdnh tac dung eua montelukast vd cetirizme d 51 benh nhdn bi mdy day man tinh khdng dung ngp vdi phu gia thuc pham hodc aeid acetylsalicylic cho thay nhdm bgnh nhdn d u p c dieu tri' bdng montelukast va cetinzine tdng ddng ke so ngdy khdng bi ngda vd san phfl [10]
K i t qua d i l u trj cua 2 nhdm: theo b i l u do 1 chflng tfll thiy* sau 4 tuan d i l u tn, ty Id bdnh nhdn a nhflm p h l i hpp giOa Singuiaire va Xyzal khflng co trigu chdng Id 6,5% nhyng sau 8 t u i n dieu trj ty Id ndy tdng rat cao la 90,3%. Cfln benh nhdn d nhflm si> dyng Xyzal dan t h u i n cd ti le h i t tneu chfl'ng tfl' 6,5% sau 4 tuan d i l u tri ldn 41,9% sau 8 tudn d i l u tri S y khde bidt v l hidu qua d i l u tri d hai nhdm bdnh nhdn sau 8 t u i n cd y nghTa t h i n g kd vdi p < 0,001.
Nhy vdy, so vdi bdnh nhdn d nhflm d i l u tn levoceritizin dan t h u i n thl bdnh nhan trong nhflm d i l u tn p h l i hpp giO'a levoeetirizin va montelukast ddp fl'ng t i t han vdi ty Id khoi b f n h cao han sau 8 tuan didu tn, d i l u ndy tuang dflng vdi nghidn cdu cfla Lorenzo vd cdc cOng s y khi flng thay rdng bdnh nhdn may day man tinh co t h l dfli hot thdi gian dieu tn Idu hon vdi montelukast [3], Trong nghidn eflu cfla Ellis MH vd Wan KS, nhu'ng bdnh nhdn mdy day man tinh khflng dap ung vdi khang histamine se d u p c d i l u tri bo xung them mon- telukast cho thdy khi d i l u tn bo xung them montelukast giam dang k l tneu chdng d mflt so bgnh nhdn, dac biet vdi nhflm benh nhan ndng (5/22 bdnh nhdn) [8; 9] Nghien cdu eua Pacor ML va cdng s u cho b i l t khi k i t hap khdng leukotriene vd khdng histamine cho bdnh nhdn may day man, k i t qua la tdt ea bdnh nhdn d i u dap u'ng tot vdi t h u l c [10].
Tdc dy'ng khdng mong muon cua thulc:
trong nghidn c u u cfla chflng tfli, nhom t)gnh nhdn d i l u tri b i n g thuoc levoceritizin dan t h u i n khdng cfl bdnh nhdn ndo bi anh hudng bdi tdc dyng phu cua thuoc.Trong nhflm bdnh nhdn d i l u tri p h l i hap giu'a t h u l c levoeetirizin vd thuoc montelukast cd 1/32 (3,1%) bdnh nhdn d u d n g nhy bj anh hudng bdi tdc dung phy cfla t h u l c . Cy t h l Id bdnh nhdn nay cfl dau dau chdng mdt, dau byng, roi loan tidu
• TAP CHl N G H i e i f cO'U Y H(?C hfla. Tuy nhidn, khi khai thde Igi thi cdc tdc
dyng phy ndy trflng hpp vdi mdt dpt cam cflm (d bdnh nhdn dau d i u , chdng mgt vd mpt dpt ngfl dflc t h y c p h i m (b$nh nhdn dau byng, r l i logn tidu hfla). Sau dd bdnh nhdn v l n d y p c t i l p tyc s y dyng t h u l c vd khdng thay bat ky tndu chyng ndo khdc xay ra. N h u v$y, ed t h l k i t ludn cdc tri$u chfl'ng tren khdng phai Id tdc dyng phu cua thuoc.
Trong nghidn cfl'u ndy, tat ca cdc bdnh nhan d i u d u p c khdm vd xdt nghi$m chfl'c ndng gan trudc vd sau d i l u tri nhung khdng efl bdnh nhdn ndo cd men gan ldng. Nhu v$y, montelukast cfl hidu qua va an todn trong d i l u trj bdnh nhdn mdy day man tinh khi k i t hpp vdi khdng histamine H I K i t qua cfla chflng tfli cung tuang t y n h y cdc nghidn cfl'u khdc [3;
8; 10].
V. K^T LUAN
Nhflm bgnh nhdn d u p e d i l u tri phfli hpp giO'a Singuiaire (montelukast) vd Xyzal (cetinzine) kiem sodt trieu chiJng bgnh (so lupng. kich t h y d c san phu vd mfl'c dd ngya cung nhy. tan s u i t xuat hi$n may day) h i $ u , qua han so vdi nhdm bdnh nhdn d i l u tri Xyzal (Cetirizlne) dan thuan, S y khdc bidt cfl y nghla thong kd sau 8 tudn d i l u tri.
Ty 1$ khdi bdnh (khdng tridu chfl'ng) sau 8 tuan d i l u trj cfla nhdm bgnh nhdn dieu tn phoi hpp giO'a Xyzal (Levoceritizin) vd Singuiaire (Montelukast) Id 90.3% cao hpn ed ]? nghTa so vdi nhdm bdnh nhdn dieu tn Xyzal (Levoceritizine) dan t h u i n Id 41,9%.
D i l u tri phoi hpp giOa Xyzal (Levoceritizine) vd Singuiaire (Montelukast) cd dfl an todn cao.
Lo'i cam c n
Nhflm nghidn cfl'u cam a n khoa Khdm bdnh, bdnh vidn Da lieu Trung u a n g vd Trung
tdm Dj U'ng - M i l n djch Idm sdng, b$nh vidn Bgch Mai dd cho phdp chflng tfli t n i n khai nghidn cfl'u ndy.
TAI LIEU THAM KHAO
1. Nguydn Nang An (2003). Tinh hlnh di U'ng thuoc d n u d c ta, d l x u l t nh&ng bi0n phdp can thidp Di tAi dOe t$p cip nhd nudc, 50 - 52.
2. Schwartz L.B (1991). Mast cells and their role in urticarial. J Am Acad Dermatol. 25, 1 9 0 - 2 0 4
3. Lorenzo G.D., Pacor M.L., Mansueto P et al (2006). Is there a role for antileukotrienes in urticaria?. C//mca/, and Experimental Dermatology, 3 1 , 327 - 334,
4. Maxwell D.L., Atkinson B.A., Spur B.W., et al (1990). Skin responses to intrader- mal histamine and leukotnene C4. D4 and E4 in patients with chrome idiopathic urticaria as normal subjects J Allergy Cim Immunol 86(5), 759 - 765
5. Marcus M., Markus M., Martin M., et al (2013). Revisions to the international guidelines on the diagnosis and therapy of chronic urticarial.Jot/ma/ of the German Society of Dermatology, 19,971 - 9 7 8
6. Chow S.K.V (2012). Management of chronic urticaria in Asia' 2010 AADV consen- sus guideline, Asia Pae Allergy. 2,149 - 1 6 0
7. Zuberbier T., Asero ri., Bindslev- Jensen C et al (2009). EAAC I/GAL EN/EDF/
WAO guideline: management of urticana Allergy. 64, 1 4 2 7 - 1 4 4 3 .
8. Ellis M.H (1998). Successful treatment of chronic urticaria with leukotriene antago- nists J Allergy Clin Immunol, 102, 876 - 877,
9. Wan K.S (2009). Efficacy of leukotriene receptor antagonist with an anti - H I receptor antagonist for treatment of chronic idiopathic urticanal. J Dermato/og Treat, 20(4), 194 - 1 9 7
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10. Pacor M.L., Lorenzo G.D., Corrocher with montelukast and cetirizme in patients with R (2001). Efficacy of leukotriene receptor an- chronic urticaria with intolerance to food addi- tagonist in chronic urticana A double-blind, tive and/or acetylsalicylic acid. Clin Exp Al- placebo-controlled comparison of treatment /ergy, 3 1 , 1 6 0 7 - 1 6 1 4 .
Summary
EFFICACY OF LEUKOTRIENE RECEPTOR ANTAGONIST WITH AN ANTI - H1 RECEPTOR ANTAGONIST FOR TREATMENT OF
CHRONIC URTICARIA
The aim of the study was to explore the efficacy of Montelukast (leukotriene receptor antagonist) with Cetinzine (anti - H I receptor antagonist) for treatment of chronic urticaria A randomized clinical trial was conducted with 2 groups of chronic urticaria patients who visited Center of Allergy & Clinieal Immunology, Bachmai hospital and Department of Out patients, National Dermatology and Venerology hospital. Group 1 (31 patients) was prescribed 1 tablet Singuiaire 10 mg in the evening and 1 tablet Xyzal 5 mg in the morning. Group 2 (31 patients) was prescribed only 1 tablet Xyzal 5 mg in the morning. The results' Group 1 had a good control of symptoms (number and size of erythematosus, itching, sequence of urticaria symptoms) It was significantly different after 8 weeks of treatment, p < 0.001. The prevalence of good control situations in the group 1 (90,3%) was higher than group 2 (41 9%). High efficacy was observed when using leukotriene receptor antagonist with an anti - H I receptor antagonist for treatment of chronic urticarial
K e y w o r d s : c h r o n i c urticaria, montelukast, singuiaire, cetirizlne, xyzal
TCNCYH 94 (2)-2015
