慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性

doi:10.6040/j.issn.1673-3770.0.2024.357

摘要/Abstract

摘要： 目的比较分析嗜酸性粒细胞慢性鼻-鼻窦炎伴鼻息肉(eosinophilic chronic rhinosinusitis with nasal polyps, eCRSwNP)合并哮喘术后短程局部使用糖皮质激素(布地奈德,鼻滴或喷雾)辅助糠酸莫米松治疗的安全性与有效性。方法将87例eCRSwNP合并哮喘术后患者随机分为3组,分别采用布地奈德鼻滴剂(A组,29例)和布地奈德鼻冲洗(B组,29例)联合糠酸莫米松鼻喷雾剂,与单独使用糠酸莫米松鼻喷雾剂(C组,29例)治疗。比较3组治疗1周后的症状减轻率、生活质量改善率及糖皮质激素治疗敏感率。于治疗第1 d(D1)、治疗第7 d(D7)、治疗1个月、3个月采用鼻部症状总分表(total nasal symptom scale, TNSS)、内镜鼻息肉评分(nasal polyp, NP)和中文版鼻腔鼻窦结局测试22(sinonasal outcome test-22, SNOT-22)评分评价患者的症状及生活质量改善情况。观察并比较3组不良反应发生情况。结果 A组和B组治疗后1周的症状减轻率、生活质量改善率及糖皮质激素治疗敏感率均高于C组(P<0.05),但A组与B组差异无统计学意义(P>0.05)。治疗1周后,3组的TNSS、内镜NP和SNOT-22评分均显著降低,治疗后1个月、3个月均有降低趋势(P<0.05),A组和B组的评分显著低于C组(P<0.05),A组和B组差异无统计学意义(P>0.05)。3组均未发生严重不良反应。结论短程局部用糖皮质激素可用于治疗eCRSwNP合并哮喘,安全性较好。与单用糠酸莫米松鼻喷雾剂相比,布地奈德滴鼻剂联用糠酸莫米松鼻喷雾剂能够更好地改善临床症状,提高患者的生活质量。布地奈德滴鼻或鼻腔冲洗两种给药方式在治疗eCRSwNP合并哮喘患者的效果有可比性。

关键词: 嗜酸性粒细胞慢性鼻-鼻窦炎伴鼻息肉, 哮喘, 糖皮质激素, 布地奈德, 糠酸莫米松

Abstract: Objective To compare and analyze the safety and efficacy of short-course postoperative topical glucocorticoid(budesonide, nasal drops or spray)adjunctive mometasone furoate therapy for eosinophilic chronic rhinosinusitis with nasal polyps(eCRSwNP)combined with asthma. Methods 87 postoperative patients with eCRSwNP combined with asthma were randomly divided into 3 groups and treated with budesonide nasal drops(group A, n=29)and budesonide nasal rinse(group B, n=29)in combination with mometasone furoate nasal spray, versus mometasone furoate nasal spray alone(group C, n=29). The rates of symptom reduction, quality of life improvement, and glucocorticoid treatment sensitivity rate were compared among the 3 groups 1 w after treatment. The total nasal symptom scale(TNSS), endoscopic nasal polyp(NP)score, and Chinese version of sinonasal outcome test-22(SNOT-22)were used on the 1st of treatment(D1), the 7th d of treatment(D7), 1 and 3 months after treatment to evaluated the symptoms and quality of life of patients. The occurrence of adverse reactions in the three groups was observed and compared. Results The symptom reduction rate, quality of life improvement rate and glucocorticoid treatment sensitivity rate in group A and group B were higher than that in group C at 1 w after treatment(P<0.05), but the difference between group A and group B was not statistically significant(P>0.05). After 1 w of treatment, the TNSS, endoscopic NP and SNOT-22 scores were significantly reduced in all 3 groups, and there was a decreasing trend at 1 and 3 months after treatment(P<0.05). The scores of group A and group B were significantly lower than those in group C(P<0.05), but the difference between group A and group B was not statistically significant(P>0.05). There were no serious adverse reactions in any of the 3 groups. Conclusion Short-course topical glucocorticoid can be used to treat eCRSwNP combined with asthma with a favorable safety profile. Budesonide nasal drops in combination with mometasone nasal spray improved clinical symptoms and the quality of life of patients better than mometasone furoate nasal spray alone.The efficacy of two modes of administration, budesonide nasal drops or nasal rinse in the treatment of patients with eCRSwNP combind with asthma was comparable.

Key words: Eosinophils, Chronic rhinosinusitis with nasal polyps, Asthma, Glucocorticoids, Budesonide, Mometasone furoate

中图分类号:

R765.4+1

曹正勇,李小波. 慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 43-50.

CAO Zhengyong, LI Xiaobo. Comparison of the safety and efficacy of short-course postoperative topical glucocorticoid adjuvant therapy for eCRSwNP combined with asthma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 43-50.

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