孟鲁司特在儿童哮喘中的应用及抗炎作用——简单选择还是权衡之举？

文献信息

中文摘要

孟鲁司特是一种选择性半胱氨酰白三烯受体1拮抗剂，在哮喘和过敏性鼻炎的管理中具有已确立但仍有细微争议的作用。通过抑制白三烯介导的信号传导，孟鲁司特靶向一条参与支气管收缩、黏液分泌、血管通透性、嗜酸性粒细胞募集、细胞因子释放和气道重塑的通路。现有证据表明，孟鲁司特可能降低多种过敏性炎症标志物，包括呼出气一氧化氮分数、外周血和组织嗜酸性粒细胞增多、嗜酸性粒细胞衍生介质、黏附分子、部分细胞因子以及与气道重塑相关的标志物。这些效应在哮喘和过敏性鼻炎中最为一致地得到证实，而在慢性荨麻疹、特应性皮炎和其他炎症性疾病中的证据仍然有限或处于探索阶段。孟鲁司特每日一次口服给药以及按年龄调整的儿童剂型，使其成为特定儿童中的实用选择，尤其是当吸入治疗困难或依从性存在问题之时。然而，孟鲁司特不应被视为基于皮质类固醇的抗炎治疗的直接替代品。当前证据和指南定位支持其主要用于附加控制药物，或在更有效治疗存在禁忌时作为替代选择。有关神经精神不良事件的担忧，尤其是在儿童中，进一步影响了获益-风险平衡，尽管证据仍不一致。当前数据显示，严重且经诊断编码的神经精神事件风险并未增加，但较轻的睡眠相关和行为症状被一致报告，因此仍需谨慎和积极监测。总体而言，孟鲁司特仍是一种生物学上合理且临床上有用的治疗，但其价值取决于适当的患者选择和对其抗炎潜力的现实预期。

英文摘要

Montelukast is a selective cysteinyl leukotriene receptor 1 antagonist with an established, though nuanced, role in the management of asthma and allergic rhinitis. By inhibiting leukotriene-mediated signaling, montelukast targets a pathway involved in bronchoconstriction, mucus secretion, vascular permeability, eosinophil recruitment, cytokine release, and airway remodeling. Available evidence indicates that montelukast may reduce several markers of allergic inflammation, including fractional exhaled nitric oxide, peripheral and tissue eosinophilia, eosinophil-derived mediators, adhesion molecules, selected cytokines, and markers related to airway remodeling. These effects are most consistently demonstrated in asthma and allergic rhinitis, while evidence in chronic urticaria, atopic dermatitis, and other inflammatory conditions remains limited or exploratory. Montelukast's once-daily oral administration and age-adjusted pediatric formulations make it a practical option in selected children, particularly when inhaled therapy is difficult or adherence is problematic. However, montelukast should not be regarded as a direct substitute for corticosteroid-based anti-inflammatory therapy. Current evidence and guideline positioning support its use mainly as an add-on controller, or an alternative when more efficacious treatment is contraindicated. The benefit-risk balance is further shaped by concerns regarding neuropsychiatric adverse events, especially in children, although evidence remains heterogeneous. Current data show no increased risk of severe, diagnostically coded neuropsychiatric events, yet milder sleep-related and behavioral symptoms are consistently reported, so that caution and active monitoring remain warranted. Overall, montelukast remains a biologically plausible and clinically useful therapy, but its value depends on appropriate patient selection and realistic expectations of its anti-inflammatory potential.