山东大学耳鼻喉眼学报 ›› 2024, Vol. 38 ›› Issue (4): 43-54.doi: 10.6040/j.issn.1673-3770.0.2024.093

• 论著 • 上一篇    

抗IL-4Rα单克隆抗体与鼻内镜手术治疗嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的疗效分析

陈兴雪,张广玲,武天义,王卫卫,孙占伟,李世超,王广科   

  1. 郑州大学人民医院/河南省人民医院 耳鼻咽喉头颈外科, 河南 郑州 450003
  • 发布日期:2024-07-09
  • 通讯作者: 王广科. E-mail:13598895398@163.com

Analysis of anti-IL-4Rα monoclonal antibody and endoscopic sinus surgery in the treatment of eosinophilic chronic rhinosinusitis with nasal polyps

CHEN Xingxue, ZHANG Guangling, WU Tianyi, WANG Weiwei, SUN Zhanwei, LI Shichao, WANG Guangke   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou 450003, Henan, China
  • Published:2024-07-09

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摘要： 目的 比较分析抗IL-4Rα单克隆抗体、鼻内镜手术(endoscopic sinus surgery, ESS)治疗嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉(eosinophilic chronic rhinosinusitis with nasal polyps, ECRSwNP)的短期疗效。 方法 21例双侧ECRSwNP患者分别接受ESS治疗(手术组)、单克隆抗体治疗(单抗组)及鼻用糖皮质激素(对照组)治疗。观察各组在治疗后1、3、6个月各项主观及客观评分基线的差异,评价两种治疗方式的治疗效果。 结果 单抗组和手术组治疗后6个月鼻内镜评分(nasal polyps score,NPS)、鼻腔鼻窦结局测试22条(sino-nasal outcome test-22, SNOT-22)评分、SNOT-22鼻塞评分、嗅觉评分、Lund-Mackay评分与基线对比,差异均具有统计学意义(P均<0.05)。治疗后6个月单抗组和手术组间NPS评分(P=0.02)差异具有统计学意义,SNOT-22评分(P=0.57)、鼻塞评分(P=0.94)、嗅觉评分(P=0.11)及Lund-Mackay评分(P=0.08)差异无统计学意义。单抗组和手术组哮喘患者FEV1%(P=0.04)、FEV1/FVC(P=0.01)治疗前后差异有统计学意义,两组间差异无统计学意义(P=0.25,P=0.74)。三组患者嗜酸性粒细胞计数(F=1.73, P=0.21)及嗜酸性粒细胞百分比(F=0.03,P=0.87)治疗前后变化差异无统计学意义,三组间差异无统计学意义(P=0.18,P=0.07)。 结论 抗IL-4Rα单克隆抗体和鼻内镜手术均可显著改善ECRSwNP患者鼻部症状、嗅觉水平以及肺功能,缩小鼻窦炎病变范围,提高患者生活质量。抗IL-4Rα单克隆抗体患者的嗅觉改善更明显,ESS患者的息肉负担减少、鼻部症状改善更显著。

关键词: 抗IL-4Rα单克隆抗体, 鼻内镜手术, 嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉, 糖皮质激素

Abstract: Objective To observe and analyse the short-term efficacy of anti-IL-4Rα monoclonal antibody and endoscopic sinus surgery(ESS)in the treatment of eosinophilic chronic rhinosinusitis with nasal polyps(ECRSwNP). Methods Twenty-one patients diagnosed with bilateral ECRSwNP were treated with endoscopic sinus surgery(surgery group), anti-IL-4Rα monoclonal antibody(monoclonal antibody group)and intranasal corticosteroids(control group)respectively. To observe the difference in subjective and objective scores after treatment at 1 month, 3 months and 6 months compared with baseline, to evaluate the therapeutic effect of the two interventions, and then the efficacy of each group was compared to analyse whether there were differences. Results Nasal polyp scores(NPS), sino-nasal outcome test-22(SNOT-22)score, SNOT-22 nasal obstruction score and olfactory score, and Lund-Mackay score at 6 months post-treatment in monoclonal antibody group and surgery group were compared with the baseline data before treatment. The differences were statistically significant(P<0.05). There was a statistically significant difference in NPS(P=0.02), and no significant difference in SNOT-22(P=0.57), nasal obstruction score(P=0.94), olfactory score(P=0.11)and Lund-Mackay score(P=0.08)between monoclonal antibody group and surgery group. There were statistically significant differences in FEV1%(P=0.04)and FEV1/FVC%(P=0.01)in monoclonal antibody group and surgery group before and after treatment in patients with comorbid asthma, but there was no significant difference between the two groups(P=0.25, P=0.74).There was no statistically significant difference in changes in eosinophil count(F=1.73, P=0.21)and eosinophil percentage(F=0.03, P=0.87)before and after treatment among the three groups. The differences between the three were not significant(P=0.18, P=0.07). Conclusion Both anti-IL-4Rα monoclonal antibodies and endoscopic sinus surgery can not only significantly improve nasal symptoms, olfactory levels, and lung function in patients with ECRSwNP, but also reduce the extent of sinusitis lesions and improve patients' quality of life. Olfactory improvement in anti-IL-4Rα monoclonal antibody patients was more significant than in ESS patients, while polyp burden and nasal symptoms were significantly improved in ESS patients.

Key words: Anti-IL-4Rα monoclonal antibody, Endoscopic sinus surgery, Eosinophilic chronic rhinosinusitis with nasal polyps, Glucocorticoid

中图分类号: 

  • R765.9
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