聚焦超声配合鼻喷激素治疗变应性鼻炎的疗效观察

doi:10.6040/j.issn.1673-3770.0.2016.257

摘要/Abstract

摘要： 目的观察聚焦超声配合鼻喷激素治疗变应性鼻炎的疗效。方法将药物治疗效果不理想的持续性中-重度变应性鼻炎患者进行聚焦超声治疗后完全随机分为A、B两组,A组在术后继续使用小剂量鼻喷激素治疗3个月:B组作为对照组在术后不加用鼻喷激素。分别于治疗前和治疗后3个月、1年和2年对患者进行症状VAS评分,比较两组的评分和有效率并观察不良反应情况。结果与治疗前相比,两组术后3个月、1年和2年时的VAS评分均显著下降(P均<0.05),但随着时间延长呈递增趋势,B组每个阶段随访评分的增加均有统计学差异(P<0.05);A组1年内随访评分无明显差异,2年时差异有统计学意义。A、B两组之间术后1年和2年时的评分比较也有差异(P<0.05),A组评分更低,且A组随访2年时的总有效率为71.4%,高于B组的53.1%。结论对药物治疗难以控制的持续性中-重度变应性鼻炎聚焦超声治疗的疗效显著,但是随着时间的延长其疗效有下降趋势。如果术后配合使用小剂量鼻喷激素,则对于该治疗的中远期疗效有明显的提高。

关键词: 聚焦超声, 外科治疗, 变应性鼻炎

Abstract: Objective To observe the therapeutic effect of focused ultrasound and nasal spray hormone in treating allergic rhinitis under nasal endoscopy. Methods After focused ultrasound treatment, the patients with allergic rhinitis were randomly divided into A and B two groups. Group A continued to use small dose of nasal spray hormone for 3 months, while group B as the control group without using nasal spray hormone. We interviewed the patients respectively before and at the 3 months, 1 year and 2 years after surgery. The visual analogue scale(VAS)was recorded. Results Compared with baseline, the VAS scores of the two groups were both significantly decreased(P<0.05)at postoperative 3 months, 1 year and 2 years. but with the time extension, the scores of group B were statistically significantly increased(P<0.05); No obvious difference was found at group A within 1 years follow-up, the difference was statistically significant at 2 year follow-up. Between group A and B there were statistically significant difference scores at postoperative 1 year and 2 years follow-up, the score of group A was lower. Conclusion For allergic rhinitis, the efficacy of focused ultrasound is significant, but it is decreased over time. If with postoperative small dose of nasal spray hormone, the long-term treatment effect is significantly improved.

Key words: Allergic rhinitis, Focused ultrasound, Surgical treatment, operative

中图分类号:

R765.21

臧健,刘茜,姜学钧. 聚焦超声配合鼻喷激素治疗变应性鼻炎的疗效观察[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 56-59.

ZANG Jian, LIU Qian, JIANG Xuejun. Clinical effect of focused ultrasound in combination with nasal spray hormone in treating allergic rhinitis.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(4): 56-59.

参考文献

[1] 中华耳鼻咽喉头颈外科杂志编委会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南(2009年,武夷山)[J].中华耳鼻咽喉头颈外科杂志,2009,44:977-978.
[2] Wu A W, Ting J Y. Indications for surgery in refractory rhinitis[J]. Curr Allergy Asthma Rep, 2014, 14(2):414.
[3] Seidman M D, Gurgel R K, Lin S Y, et al. Clinical practice guideline: allergic rhinitis executive summary[J]. Otolaryngol Head Neck Surg, 2015, 152(2):197-206.
[4] Wei H, Zhang Y, Shi L, et al. Higher dosage of HIFU treatment may lead to higher and longer efficacy for moderate to severe perennial allergic rhinitis[J]. Inter J Med Sci, 2013, 10(13):1914-1920.
[5] Wei H, Shi L, Zhang J, et al. High-intensity focused ultrasound leads to histopathologic changes of the inferior turbinate mucosa with allergic inflammation[J]. Ultrasound Med Biol, 2014, 40(10):2425-2430.
[6] Feng G F, Han Z L, Wang F, et al. Comparison of high-intensity focused ultrasound therapy under nasal endoscopy guidance versus first-line drug treatment in patients with persistent allergic rhinitis[J]. Gene Molecular Res, 2015, 14(3):9865-9871.
[7] 张静茹,魏宏权,夏炎,等.聚焦超声治疗变应性鼻炎患者的2年随访分析[J].中国医科大学学报,2014,43(3):253-264. ZHANG Jingru, WEI Hongquan, XIA Yan, et al. Focused ultrasound treatment of patients with allergic rhinitis two-year follow-up analysis[J]. J China Med Univ, 2014, 43(3):253-264.
[8] 韩继波,孔勇刚,许昱,等.射频消融和高能聚焦超声术治疗持续性变应性鼻炎疗效对比[J].临床耳鼻咽喉头颈外科杂志,2011,25(8):349-351. HAN Jibo, KONG Yonggang, XU Yu, et al. Clinical observation and comparison on radiofrequency ablation and focused ultrasound in treatment of perennial allergic rhinitis[J]. J Clin Otorhinolaryngol Head Neck Surgery, 2011, 25(8):349-351.
[9] Brozek J L, Bousquet J, Baena-Cagnani C E, et al. Allergic rhinitis and its impact on asthma(ARIA)guidelines: 2010 revision[J]. J Allergy Clin Immunol, 2010, 126:466-476.
[10] Ciprandi G, Mora F, Cassano M, et al. Visual analog scale(Vas)and nasal obstruction in persistent allergic rhinitis[J]. Otolaryngol Head Neck Surgery, 2009, 141(4):527-529.
[11] 石崧,周水淼.鼻后下神经下鼻甲支的应用解剖学研究[J].中国耳鼻咽喉头颈外科,2006,13(7):491-492. SHI Song, ZHOU Shuimiao. The study of the inferior turbinate branch of the posterior inferior nasal nerve[J]. Chin Arch Otolaryngol Head Neck Surgery, 2006, 13(7):491-492.
[12] Bousquet P J, Combescure C, Neukirch F, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines[J]. Allergy, 2007, 62(4):367-372.
[13] Bousquet J, Vignola A M, Chanez P, et al. Airways remodelling in asthma: no doubt, no more?[J]. Inter Arch Allergy Immunol, 1995, 107(1-3):211-214.
[14] Bousquet J, Jacot W, Vignola A M, et al. Allergic rhinitis: a disease remodeling the upper airways?[J]. J Allergy Clin Immunol, 2004, 113(1):43-49.
[15] 佘文煜,董震.实验性变应性鼻炎鼻黏膜组织重塑的特点[J].中华耳鼻咽喉头颈外科杂志,2006,41(1):48-52.
[16] Nakaya M, Dohi M, Okunishi K, et al. Prolonged allergen challenge in murine nasal allergic rhinitis: nasal airway remodeling and adaptation of nasal airway responsiveness[J]. Laryngoscope, 2007, 117(8):881- 885.
[17] Constantino Gde T, Mello Jr J F. Remodeling of the lower and upper airways[J]. Braz J Otorhinolaryngol, 2009, 75(1):151-156.
[18] Hirshoren N, Kohan M, Assayag M, et al. Extra domain-A fibronectin is necessary for the development of nasal remodeling in chronic allergen-induced rhinitis[J]. Ann Allergy, Asthma Immunol, 2013, 110(5):322-327.
[19] Kim T H, Lee J Y, Lee H M, et al. Remodelling of nasal mucosa in mild and severe persistent allergic rhinitis with special reference to the distribution of collagen, proteoglycans, and lymphatic vessels[J]. Clin Expe Allergy, 2010, 40(12):1742-1754.
[20] Trifilieff A, EI-Hashim A, Bertrand C. Time course of inflammatory and remodeling events in a murine model of asthma: effect of steroid treatment[J]. Am J Physiol Lung Cell Mol Physiol, 2000, 279(6):L1120-1128.
[21] Vanacker N J, Palmans E, Kips J C, et al. Fluticasone inhibits but does not reverse allergen-induced structural airway changes[J]. Am J Respir Crit Care Med, 2001, 163:674-679.
[22] Chhabra N, Houser S M. The surgical management of allergic Rhinitis[J]. Otolaryngol Clin North Am, 2011, 44(3):779-795.
[23] 林欣然,张龙城.聚焦超声治疗变应性鼻炎研究进展[J].临床耳鼻咽喉头颈外科杂志,2012,26(14):670-672.
[24] She W, Takeuchi K, Suzuki S, et al. Remodeling of nasal mucosa by allergen exposure in guinea pigs is suppressed by steroid and pranlukast[J]. Rhinol, 2009, 47(2):199-206.
[25] Miller M, Cho J Y, McEIwain K, et al. Corticosteroids prevent myofibroblast accumulation and airway remodeling in mice[J]. Am J Physiol Lung Cell Mol Physiol, 2006, 290(1):L162-169.

相关文章 15

[1]	王坛,武珂,李连庆,宫丽丽. 皮下免疫治疗注射后出现全身不良反应的伴发因素及处理[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 71-74.
[2]	卢汉桂,林歆胜,姚丹勉,魏永新,李创伟. 变应性鼻炎大鼠IL-35的表达及对辅助性T细胞免疫调节的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 66-70.
[3]	浦洪波,杜晓东. 无锡地区2 000例变应性鼻炎变应原检测结果分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 105-107.
[4]	陈鸣,俞雪飞. 浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 18-22.
[5]	吴湘萍. 患者管理方式对变应性鼻炎舌下含服粉尘螨滴剂疗效的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 68-72.
[6]	李松,王宗贵,杨景朴,张竹萍. 鼻内镜下翼管神经切断术进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 72-76.
[7]	郅莉莉,宋道亮. 嗜酸性粒细胞及IL5在上颌窦后鼻孔息肉与鼻息肉中表达的差异[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 43-46.
[8]	万文锦,王文,程雷. 尘螨变应性鼻炎皮下免疫治疗与舌下免疫治疗的荟萃分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 103-108.
[9]	朱新华. 变应性鼻炎冲击免疫治疗的临床应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 13-17.
[10]	刘怀涛,马瑞霞,程雷. 难治性变应性鼻炎的外科治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 18-21.
[11]	关凯,李丽莎. 鼻腔冲洗在变应性鼻炎防治中的应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 22-27.
[12]	史丽,赵莉,张红萍. 变应性鼻炎的长期抗炎治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 9-12.
[13]	刘静. 基于整体观念变应性鼻炎的中医辨证论治[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 28-30.
[14]	程雷,钱俊俊,田慧琴. 变应性鼻炎研究的若干进展[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 1-3.
[15]	许昱,陶泽璋. 重视变应性鼻炎药物治疗的规范化和个体化[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 4-8.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed