鼻腔盥洗及联合鼻用糖皮质激素治疗变应性鼻炎及血管运动性鼻炎效果观察

doi:10.6040/j.issn.1673-3770.0.2018.620

摘要/Abstract

摘要： 目的

观察单用鼻腔盥洗及鼻腔盥洗联合鼻用糖皮质激素治疗变应性鼻炎（allergic rhinitis，AR）和血管运动性鼻炎（vasomotor rhinitis,VMR）的效果。

方法

招募93例AR患者，随机分为3组，记为A1、A2、A3组，每组31例。招募56例VMR患者，随机分为3组，记为V1、V2、V3组，其中V1组19例，V2组17例，V3组20例。A1及V1组单用鼻喷糖皮质激素治疗，布地奈德鼻喷雾剂64 μｇ/喷，每侧每次1喷，2次/d。A2及V2组单用鼻腔盥洗治疗，采用0.9%氯化钠溶液，每侧每次75 mL，2次/d。A3及V3组联用鼻腔盥洗和鼻用激素治疗，早晚行鼻腔盥洗30 min后再使用布地奈德鼻喷雾剂。连续治疗３个月。于干预前、干预后1、2、3个月分别用视觉模拟评分量表(VAS)评估患者鼻部症状，用鼻-结膜炎相关生活质量问卷（RQLQ）评价生活质量，采用呼出气一氧化氮（NO）测定系统测定下气道呼出气NO（FENO）值。

结果

所有患者在试验期间耐受性良好，未出现严重的不良反应，均完成试验。3个月末时，A3组VAS、RQLQ、FENO值较干预前均显著降低，与A1组、A2组VAS总分比较差异无统计学意义（F=1.465，P=0.174）；与A1组RQLQ总分比较差异有统计学意义（t=2.668，P=0.014），而与A2组RQLQ总分比较差异无统计学意义（t=1.545，P=0.136）；与A1组、A2组FENO值比较差异均有统计学意义（t分别为3.241、2.987，P分别为0.004、0.008）。3个月末时，V3组VAS、RQLQ、FENO值均较干预前显著降低，与V1组、V2组VAS总分比较差异均有统计学意义（t分别为2.352、2.083，P分别为0.027、0.043）；与V1组、V2组RQLQ总分比较差异均有统计学意义（t分别为2.581、2.339，P分别为0.013、0.031）；与V1组、V2组FENO值比较差异无统计学意义（F = 1.563，P=0.159）。

结论

鼻腔盥洗单用或联合糖皮质激素长期治疗AR和VMR效果较好。

关键词: 鼻炎，变应性, 鼻炎，血管运动性, 鼻腔盥洗, 治疗结局

Abstract: Objective

The aim of this study was to compare the efficacy of nasal lavage alone and nasal lavage in combination with nasal corticosteroids in allergic rhinitis (AR) and vasomotor rhinitis (VMR).

Methods

This study included 93 patients with AR and 56 patients with VMR, who were randomly divided into three groups each: A1, A2, and A3 (n = 31 in each group) and V1 (n = 19), V2 (n = 17), and V3 (n = 20), respectively. Patients in groups A1 and V1, A2 and V2, and A3 and V3 were treated with budesonide nasal spray, nasal flushing with 0.9% sodium chloride solution, and a combination of nasal lavage and budesonide nasal spray, respectively, for three months each. Nasal symptoms were assessed using the visual analog scale (VAS) before and after the intervention; the rhinoconjunctivitis quality of life questionnaire (RQLQ) was used to evaluate the quality of life, and the fractional exhaled nitric oxide (FENO) values were measured by the exhaled NO assay system..

Results

All patients completed the experiment with good tolerance, and no serious adverse reactions occurred. The VAS, RQLQ, and FENO values in the A3 group after three months were significantly lower than the values before intervention. There was no statistically significant difference in the total VAS scores among the A1, A2 and A3 groups (F = 1.465, P = 0.174). There were statistically significant differences in the total RQLQ scores between the A3 and A1 groups (t = 2.668, P = 0.014), but not between the A2 and A3 groups (t = 1.545, P = 0.136). There were statistically significant differences in the FENO values between the A3 and A1 groups (t= 3.241, P=0.004) and between the A3 and A2 groups (t= 2.987，P = 0.008). At the end of the third month of treatment, VAS, RQLQ, and FENO values in the V3 group were significantly lower than the values before intervention. The differences in total VAS scores were statistically significant between the V3 and V1 groups (t = 2.352, P = 0.027) and between the V3 and V2 groups (t = 2.083, P = 0.043). There were statistically significant differences in RQLQ scores between the V3 and V1 groups (t = 2.581, P=0.013) and between the V3 and V2 groups (t = 2.339, P = 0.031). There was no significant difference in the FENO values among the V1, V2 and V3 groups (F=1.563, P=0.159).

Conclusion

Nasal lavage alone or nasal lavage in combination with glucocorticoids was more efficient in the long-term treatment of AR and VMR.

Key words: Rhinitis, allergic, Rhinitis, vasomotor, Nasal irrigation, Treatment outcome

中图分类号:

R765.21

孙铭宏,高娴,赵婷,刘文君. 鼻腔盥洗及联合鼻用糖皮质激素治疗变应性鼻炎及血管运动性鼻炎效果观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 73-78.

Minghong SUN,Xian GAO,Ting ZHAO,Wenjun LIU. Comparison between the efficacy of nasal lavage and combination treatment in allergic rhinitis and vasomotor rhinitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 73-78.

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参考文献 13

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组别	VAS总分
组别	治疗前	1个月末	2个月末	3个月末
A1组	4.16±0.76	3.84±0.59	3.42±0.81	3.15±1.03
A2组	3.98±0.48	3.65±0.72	3.44±0.83	3.05±0.97
A3组	4.10±0.37	3.75±0.47	3.34±0.70	2.96±0.35
t₁		1.851 ^b	3.709 ^a	4.392 ^a
t₂		2.123 ^a	3.136 ^a	4.784 ^a
t₃		3.258 ^a	5.344 ^a	9.462 ^a

组别	RQLQ总分
组别	治疗前	1个月末	2个月末	3个月末
A1组	58.93±22.31	48.56±20.25	40.62±18.49	36.24±21.24
A2组	62.44±28.30	48.67±22.62	40.55±17.83	34.47±18.92
A3组	61.03±18.42	47.33±20.45	38.57±18.63	31.56±19.73
t₁		1.916 ^b	3.518 ^a	4.101 ^a
t₂		2.116 ^a	3.644 ^a	4.575 ^a
t₃		2.771 ^a	4.773 ^a	6.079 ^a

组别	FENO值
组别	治疗前	1个月末	2个月末	3个月末
A1组	60.8±19.2	50.5±19.7	43.5±14.9	37.6±17.8
A2组	57.5±13.7	51.9±15.4	44.2±15.8	38.3±17.3
A3组	57.0±17.6	47.6±16.9	39.8±16.7	30.2±14.8
t₁		2.085 ^a	3.963 ^a	4.934 ^a
t₂		1.513 ^b	3.541 ^a	4.844 ^a
t₃		2.145 ^a	3.947 ^a	6.489 ^a

组别	VAS总分
组别	治疗前	1个月末	2个月末	3个月末
V1组	4.39±1.13	3.01±0.94	3.63±0.88	4.05±0.68
V2组	4.24±1.34	3.91±1.14	3.66±0.95	3.32±1.22
V3组	4.36±2.01	2.47±0.94	3.13±1.26	2.85±1.34
t₁		3.789 ^a	2.312 ^a	1.124 ^b
t₂		0.770 ^b	2.201 ^a	2.093 ^a
t₃		3.809 ^a	2.318 ^a	2.795 ^a

组别	RQLQ总分
组别	治疗前	1个月末	2个月末	3个月末
V1组	59.14±21.49	42.56±20.14	45.32±17.63	47.05±19.87
V2组	57.65±17.68	48.26±16.83	40.75±18.37	38.65±16.79
V3组	56.31±27.74	40.27±18.67	36.36±19.83	29.25±15.20
t₁		2.454 ^a	2.167^a	1.801^b
t₂		1.586 ^b	2.733^a	3.213^a
t₃		2.145 ^a	2.617 ^a	3.826 ^a